By Zani Prinsloo
I've always known Beirut as the glitzy capital city of Lebanon, where I vacationed many times over the years while working abroad. But the Lebanon I knew was not the one I discovered during eight months working there as a midwife for Doctors Without Borders (MSF) in 2016. Just 10 minutes away from picturesque, glamorous Beirut life lies a different world – a paradox, a place where the average Lebanese person would say to me: "You work there? But it's so dangerous!"
'There' is Shatila and Burj el-Barajneh in southern Beirut – cramped refugee camps that are expanding upwards (there literally is nearly no more space to expand, so people build higher and higher) as new refugees arrive in the city after fleeing war in Syria. There are at least a dozen refugee camps in Lebanon, I worked in these two in Beirut where MSF offers primary healthcare and runs women's healthcare centres for meet maternal health and paediatric patient needs. Altogether, I managed a team of 46 midwives – because through it all, even war and displacement, life goes on. Babies are born and midwives are needed. In Lebanon, a country of around 4 million people, more than 30 percent of the babies being born there today are Syrian.
Today, there are three different nationalities seeking refuge in Shatila camp: vulnerable Lebanese nationals; on top of that, Palestinian refugees who have lived there since they were displaced from neighbouring Palestine starting in 1948; and now Syrians, after the war in their country forced them across the border and into these same camps.
Burj el-Barajneh is a square kilometre in size and houses some 45,000 people, while another 30,000 live in the smaller Shatila camp. But those are just the official figures; in my time there it seemed like much more than that. Space is a very big issue. Instead of the big structures and tented hospitals MSF puts up in other projects, in Shatila we worked out of an apartment. (It's amazing what you can do in a very small space when you need to, how you can maximise every centimetre and every block of space to make sure you have place for every woman.)
Space is a luxury in general in the camps. The streets are extremely narrow, and the buildings on either side are just as narrow. Electricity lines run like spaghetti strands dangling everywhere. As more refugees arrive, people continue to build and build and build – upwards. It's an architect's nightmare. Many of the buildings are completely skew, and I would stand on the balcony in the morning thinking it's good nothing collapsed overnight! But it was also beautiful to look down onto the streets below and get to know the entire neighbourhood – from the man selling manaeesh (which is similar to pizza), to the one selling falafel, and another selling Coca-Cola and bubble-gum.
Along these very narrow streets is a very engaging community. They immediately know when someone new has arrived and immediately welcome you.
Across countries and cultures, my profession is one that has been passed from one generation to the next. The word 'midwife' can itself be translated as "being with women" and midwives are involved in all facets of the sexual and reproductive health lifecycle of a woman. Over the centuries, not much has changed in that most women still prefer to be accompanied by another woman during this period. This is especially true for many secluded and conservative societies where I have worked with MSF, including in Afghanistan, Syria and Lebanon.
But women living in war-torn countries like Syria, or those in Lebanon who had fled as a result of war, have a unique set of health challenges. Today, hospitals are being targeted in areas of conflict and patients feel less safe in buildings that were once a "safe space". Being pregnant becomes more risky – not just the physical challenges, but the psychological consequences of hospitals coming under attack can be devastating for the health of the mother and the unborn baby.
Personally, the main point of concern for me is early marriages. Because of circumstances beyond their control, women in some societies where we work are uneducated, and many have little say over their own reproductive health issues. As a result, child marriages, some as early as 12 years of age, occur and become the norm. By the age of 18, most of these women will have four to five children, and counting. And the higher the number of deliveries a woman experiences, the higher the risk of not surviving future childbirths. The cycle continues generation after generation.
But as a midwife, the upside for me is that my work is strengthened by my ability to educate women about the importance of birth spacing methods. One real benefit of living in a close-knit society such as the ones where we work, is that news spreads by word of mouth, and solidarity amongst women forms the cornerstone of the culture – women to women messages have a powerful impact and ultimately a desired result. Even if it does take loads of patience, commitment, and never giving up on getting there.
Being a midwife for MSF has allowed me to help women in their time of need – and to bear witness and speak out about violence against women and girls, the consequences of early child marriage and inaccessibility to care related to reproductive health. From Syria to Lebanon, I have been able to meet the women caught in conflict in their own country, and those who have fled across the border for safety, and I have tried to find ways to help them.
I know societies cannot be changed overnight, and most do not have the immediate ambition to do so. But I believe in planting seeds, watering them and waiting for them to bloom. For our patients, we cannot do anything about their pasts, we may not be able to do anything to assure they have a good future, but we will at least try to relieve the present. This is the motto I believe in.
Lebanon has a population of only 4.4 million people. But since the start of the Syrian war across the border, some 1 million refugees have fled into the country – most into camps near the border region. In Beirut, camps that have housed Palestinian refugees for decades now house the more recently displaced Syrians. South African midwife Zani Prinsloo recently worked in two of these camps, bringing maternal health care to vulnerable women living there.