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​Saving and improving the lives of seriously ill pregnant women, babies, and children in low-resource settings since 1995

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Urgent proposal to care for high risk pregnant women in Gaza

2nd April 2024

Please find here a link to our Press release concerning MCAI's Proposal to help thirty percent of pregnant women with high-risk medical conditions and their unborn babies who could die in Gaza because of a lack of hospital-based emergency obstetric and neonatal healthcare.

Please click here for a PDF of our press release.

Foreign, Commonwealth and Development Office @FCDOGovUK report that 

Women and girls are bearing the brunt of the desperate humanitarian situation in Gaza. The UK is working with @UNFPA to get vital lifesaving resources directly to women and girls in desperate need. However, analysis of an additional  tweet/X reports that it does not address high risk and life-threatening pregnancies, concentrates on normal deliveries, but does indicate that 180 babies a day are delivering in Gaza. 

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9th April 2024  Summary

The uninhabitable state of Gaza and the urgent need for medical evacuations of the most vulnerable

According to The Economist on 3rd April 2024, "The World Bank has estimated that at least $18.5bn-worth of infrastructure in Gaza has been destroyed in the war with Israel. That is equal to 97% of the combined GDP of the Palestinian territories in 2022. Damage to housing accounted for about three-quarters of the cost. As of January Gaza’s water and sanitation system were delivering less than 5% of pre-war output, said the Bank".

A report by The International Rescue Committee (IRC) on 2nd April 2024 outlines the tragic consequences for pregnant women in Gaza. Pregnant women and mothers in Gaza are fighting to keep themselves and their babies alive amidst healthcare collapse, the IRC warns.  Please click here for link

Please click here and see a report describing the excellent work being undertaken by Project Hope in Gaza:  Elissa Nadworthy. NPR March 28th 2024.  'Struggle, struggle, struggle.' What new and expecting mothers are facing in Gaza 


Suggested ways forward:

  1. Both Israel and Hamas have a responsibility to protect civilians under their care. 

  2. As a direct result of the continuing conflict, the damage to hospitals, to homes, and the killing of health workers, Gaza is now, for its 2 million survivors, uninhabitable, particular for civilians at high medical risk. 

  3. Women with high-risk pregnancies, newborn and unborn children, children with severe malnutrition, civilians with life-threatening illnesses, and vulnerable older adults are most in need of medical evacuation to be temporally placed in a safe environment where they can be properly treated, medically managed, and clinically cared for. 

  4. For evacuation to occur, an immediate ceasefire is essential, and the hostages held by Hamas must be returned to Israel.

  5. We suggest that UN organisations, especially WHO, UNICEF, UNFPA and UNHCR, should organise and facilitate the medical evacuations noting that mothers must never be separated from their children.

  6. MCAI is willing to help identify in Gaza those pregnant women and children who are at most risk. 

  7. Other countries, preferably in the region, must offer places for hospital care and treatment, provide transport, and funding, until Gaza becomes once again a suitable place for Palestinian civilians to live in.  

The MCAI Ukraine program

Since February 2022, MCAI has been  supporting mothers, babies and their families in Ukraine, following the continued attempts by Russia to destroy their country.  

 Here is a PowerPoint presentation that summarises progress to date in a program undertaken in partnership with the Ministry of Health of Ukraine, The Association of Obstetricians and Gynaecologists and The Association of Neonatologists of Ukraine. 

Please click here for a PDF of this presentation

Abuse of Women and Children in Armed Conflict and Domestically: More Effective Safeguarding Systems Urgently Needed to Prevent these Crimes and Ensure Protection

Please click here to read a PDF of this report from MCAI published (end February 2024) in the Medical Archives of the European Society of Medicine.  The Abstract follows below.


Emergency medicine health workers have major roles in managing the clinical effects of armed conflict and domestic abuse on women and children. To safeguard vulnerable people from such criminal abuse, there is an urgent need for international and domestic action.

International and national legal systems need to work more rapidly and efficiently with immediate power to protect against, and prevent, such abuse.

Internationally, the current weakness of the United Nations Security Council to provide civilian protection, such as through UN troops on the ground and no-fly zones over conflict areas, and thereby minimise the effects of armed conflict on civilians, can, and has, largely resulted from self-serving, dangerous vetoes of the 5 permanent members with major conflicts of interest, in part related to their role in the manufacturing and global distribution of weapons.

The International Court of Justice and the International Criminal Court have little immediate power to protect civilians affected by war crimes, including abuse, which breach the Geneva and other International Conventions. To date, the number of war criminals convicted by the International Criminal Court is incredibly small, and the long delay in the Courts’ decisions mean that the consequences of the war crimes sometimes continue for years.

We describe new systems to better protect women and children from abuse in the home. We propose a new definition that separates ill treatment from criminal abuse that is undertaken for gain by perpetrators (who are often carers or intimate partners with antisocial personality disorders). Ill treatment undertaken within families experiencing adversity such as homelessness, poverty, displacement, and addiction requires compassion and socio-economic support. In contrast the crimes of abuse committed for gain require stronger forensic approaches investigated and addressed by special, inter-agency, forensic taskforce units led by senior experienced detectives in partnership with social, healthcare, and legal professionals.


We also discuss additional issues linked to abuse, such as the links between animal/pet abuse and human abuse, the need for better systems to prevent and protect children living in institutions, better regulation of social media to protect children from scenes of violence and sexual abuse, and gun control needed to protect children, especially in the USA.

MCAI Books

Since April 2020, MCAI has developed four handbooks on hospital care in low resource settings. Handbooks 1 and 2 involve the care of children with serious illnesses and injuries, including adolescent girls who are pregnant. These two handbooks form part of a curriculum for a new task sharing program to train the first ever 6 paediatric clinicians in Liberia in partnership with UNICEF, WHO and The Ministry of Health. They have been edited and authored by experienced volunteer doctors and nurses working in hospitals and emergency care centres in low resource settings and areas of armed conflict and displacement throughout the world.

Handbook 3 addresses advanced hospital care for newborn infants and handbook 4 addresses advanced hospital care for pregnant women and adolescent girls.

In addition to the PDFs available here for download, printed versions of these latest 4 handbooks are being prepared and, subject to funding, will be provided free of charge to nurses, midwives and doctors in as many low resource and emergency settings as soon as possible.

All books are available to download nowincluding the latest two handbooks on advanced hospital care for children.

  • Handbook 1: Emergency Illnesses and Major Injuries Affecting Infants and Children; Including Adolescent Girls Who Are Pregnant. August 2021

Download (PDF, 15.0 MB)​

  • Handbook 2: Serious Illnesses in Infants and Children; Including Adolescent Girls Who Are Pregnant. August 2021

Download (PDF, 14.9 MB)

  • Handbook of Hospital Care for Newborn Infants. May 2022

Download (PDF, 6.9 MB)

Updated chapter on neonatal resuscitation June 2022

Download (PDF 1.1MB)

  • Handbook of Obstetrics

Download (PDF, 14.8 MB)


Supplement to the Handbook of Obstetrics March 2023

Download (PDF, 0.7MB)

10 year report of

our joint task-sharing program in Liberia

19th March 2024

Latest update on the implementation of the Liberian program on Task-Sharing which began in 2013 in a partnership  between MCAI and The Ministry of Health of Liberia, WHO, UNICEF, Irish Aid, UNFPA, DAK Foundation and the University of Edinburgh.

Please click here for our report.  This report is in the form of a PDF with interactive links to major contributions within the report.


25th September 2019. Video reporting on a major success by the maternal emergency care team in the management of a near-maternal-death at The Martha Tubman Memorial Government Hospital in Grand Gedeh County in Liberia. Watch the video.


MCAI's 2020 safeguarding policy including UNICEF's Preventing Sexual Exploitation and Abuse (PSEA) programme

Please click here to read this

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