Saving and improving the lives of seriously ill pregnant women, babies, and children in low-resource settings since 1995
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16th June 2025
Subject: Urgent Appeal to the UN Security Council on Maternal, Newborn, and Child Health in Conflict Zones
To:
H.E. Ambassador Carolyn Rodrigues‑Birkett
Permanent Mission of Guyana to the United Nations
801 Second Avenue, 5th Floor
New York, NY 10017
USA
Email: guyana@un.int
CC: Permanent Missions of China, France, Russian Federation, United Kingdom, and United States
Dear Ambassador Rodrigues-Birkett,
On behalf of Maternal and Child health Advocacy International (MCAI), I am pleased to submit the attached advocacy brief titled:
“Giving Birth and Living in Danger: An Urgent Appeal to the UN Security Council to Protect Mothers, Newborn Infants, and Children in War Zones.”
This brief is submitted in support of Guyana’s June 2025 presidency of the Security Council and outlines six urgent recommendations to address the devastating impact of armed conflict on maternal, newborn, and child health in Gaza, Sudan, Ethiopia, Ukraine, and Myanmar.
We respectfully request that the brief be shared with Council members and considered in relevant deliberations under the protection of civilian’s agenda.
Please find attached:
The corrected full advocacy brief (PDF)
Thank you for your leadership and continued commitment to humanitarian protection.
Warm regards,
Professor David Southall
Honorary Medical Director and Trustee MCAI
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Urgent medical evacuation proposal to care for high risk pregnant women, children, ill and injured patients in Gaza who cannot be properly cared for because of the destroyed healthcare system
12th June 2025
MCAI’s response to the latest tragedies occurring in Gaza and requesting medical evacuation for the more than 12,000 pregnant women, newborn babies, children, and adults who need urgent treatment in hospitals if they are to survive.
To the Secretaries of State for Foreign Affairs
Dear,
Please find attached a PDF of our proposal concerning a scheme for medical evacuations from Gaza prepared on behalf of our international medical charity.
This letter reflects the views of MCAI relating to over 1 year of unsuccessful work in trying to push for a permanent end to the killing and injuring of a population of civilians in Gaza. This lack of a cease-fire perpetrated by the unethical current government of Israel and the persistence of Hamas in retaining hostages is also prohibited by a recent veto by the USA of a UN Security Council Resolution.
Our approach has been to push for a permanent ceasefire and long-term end to this conflict and, because of the deliberate massive damage undertaken on health facilities and targeting of health workers (national and international), the provision of major medical evacuation assistance for the very large numbers of injured and ill pregnant women, babies, children and adult civilians trying to exist and survive in the worsening situation in Gaza.
Please see the links in the following document which are pushing us to identify the need for an effective “Movement” that can stop the killing and injuring in Gaza and enable those 12,000 pregnant women, newborn babies, children and civilian adults who according to WHO need urgent medical care and be evacuated urgently to international countries willing to donate hospital care and also support for each patient’s close family.
If you feel that you might be able to help in any way with the actions we are trying to achieve, please contact us on the address below or by phone or WhatsApp.
With kindest regards
David
Professor David Southall OBE, MD, FRCPCH
Consultant Obstetrician Liberia and Professor of Paediatrics UK
Honorary Medical Director Maternal and Childhealth Advocacy International (MCAI), 1 Columba Court, Laide IV22 2NL, UK
Mobile and WhatsApp numbers +44 (0) 7710 674003 and +44 (0)7944 632011
Director, MCAI Liberia, Field Office, House 13, Phebe Hospital, Liberia Enterprise Number 051730402
Dr Brigid Hayden FRCOG Consultant Obstetrician and Chief Executive and Chair of Trustees of
MCAI
Catherine Ferrari (Stowell) BA, MSc
Trustee MCAI
UN News published item on 14th April 2025 Thousands of Gaza patients waiting for urgent medical evacuation. Representative Rik Peeperkorn of the World Health Organisation (WHO) states as follows: Far too few patients have been able to leave Gaza for the urgent care they so desperately need. We estimate that up to 12,000 patients need medical evacuation but, since the blockade we have only been able to evacuate 121 people, including 73 children. "We call for the immediate resumption of medical evacuation through all possible routes. That should happen now.”
Latest MCAI letter to Foreign Ministries providing details of the medical evacuation proposal 12th June 2025
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 now, including the latest two handbooks on advanced hospital care for children.
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Handbook 1: Emergency Illnesses and Major Injuries Affecting Infants and Children; Including Adolescent Girls Who Are Pregnant. August 2021
Download (PDF, 15.0 MB)
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Handbook 2: Serious Illnesses in Infants and Children; Including Adolescent Girls Who Are Pregnant. August 2021
Download (PDF, 14.9 MB)
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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)
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Handbook of Obstetrics
Download (PDF, 14.8 MB)
Supplement to the Handbook of Obstetrics March 2023
Download (PDF, 0.7MB)
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 peer-reviewed publication published 1st February 2025 that summarises our latest work in Ukraine. Please click here for the main paper, here for Supplement 1 and here for Supplement 2
Abstract A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine.
Background Russian’s invasion of Ukraine has seriously disrupted perinatal care. In a humanitarian initiative, emergency obstetric and neonatal equipment and drugs were provided by Maternal and Childhealth Advocacy International and distributed by Ukrainian partners to a selected 61 maternity hospitals throughout Ukraine. The programme included engaging mothers in labour to undertake fetal heart rate monitoring using a battery operated, portable, doppler ultrasound probe. This paper describes some characteristics of participants and analyses differences in fetal distress management and maternal / neonatal outcomes following different approaches to fetal health surveillance.
Methods Data from 28,808 births were collected in specially developed database which contained information on maternal characteristics, course of pregnancy and childbirth, maternal and neonatal outcomes and donated drugs and equipment used. After informed consent, mothers (n = 13735) who agreed to use in labour fetal self-monitoring in addition to standard intrapartum fetal health surveillance, monitored and recorded fetal heart rate changes on a “contraction-by-contraction” basis into a special form. Data on maternal experience with self-monitoring were collected. Cases where fetal heart rate changes were identified (n = 1434) were extracted and analysed for differences in case management and maternal and neonatal outcomes in different approaches: joint monitoring (mother plus staff, n = 901) vs. staff only monitoring (n = 533) and different actors in case of joint monitoring (mothers, n = 512, vs. staff, n = 389).
Results Vacuum assisted delivery was utilised in only < 2% cases. Caesarean section rate was 27%. Mothers reported their experience with self-monitoring as great or good in 79%. Preterm deliveries were less frequent where fetal monitoring was provided by both staff and mothers jointly. In the staff plus mother group, more often lateral tilt, intravenous fluid, spontaneous vaginal and vacuum assisted delivery and less often caesarean sections were undertaken even when fetal distress alone was an indication for operative delivery at term pregnancy.
Conclusion Involvement of women may help to make delivery safer for mothers as complications may be recognized earlier and appropriately treated. Overall, the data shows that despite the full-scale war in Ukraine, it remained possible for high quality perinatal health care to continue.
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.
ABSTRACT
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's 2020 safeguarding policy including UNICEF's Preventing Sexual Exploitation and Abuse (PSEA) programme
Please click here to read this