Credit: UNHCR

By Lori Silberman Brauner
TEANECK, New Jersey, Apr 26 2022 (IPS)

It was a long, harrowing road for Freshta and Shabaneh, two mothers (their names are pseudonyms) who fled Kabul, Afghanistan, late last summer before eventually settling in the southern New Jersey township of Hamilton.

Shabaneh, 30, the mother of three boys who was then between four and five months pregnant, recalls her flight out of Kabul’s Hamid Karzai International Airport on a U.S. army plane under less-than-optimal conditions.

Whatever seats had been in place had been removed from the plane to accommodate all the passengers, and she had no choice but to sit with her kids on plastic bags on the floor. “They were crying and I was nauseous,” she said through a translator. “I was feeling terrible.”

Freshta, 27, a medical student who fled the country with her husband and three kids, was then between two and three months pregnant. Before leaving, she had to pass through checkpoints manned by the Taliban, who questioned her paperwork, hassling her before she bravely told them: “Put your guns away, there are children here.”

The two families were among the more than 84,600 Afghan nationals, American citizens, and Lawful Permanent Residents who (as of Feb. 19) have arrived in the United States as part of Operation Allies Welcome, the coordinated federal government effort to support and resettle Afghan refugees — including those who worked on behalf of the United States — with more than 76,000 Afghan nationals having been resettled across the country, according to the Department of Homeland Security.

Both women’s husbands worked for American organizations, which enabled them to come to the United States on Special Immigrant Visas (SIVs): Shabaneh’s at a U.S. NGO, and Freshta’s at an American security company. Both women have parents and extended family left behind in Afghanistan, and requested pseudonyms to protect their well-being.

Through a translator, Sara Abasi, a volunteer ESL teacher who has been tutoring her, Shabaneh said that due to the Taliban takeover “our life was in danger,” so they decided to come to the United States.

The scariest moment before her departure was the morning, Aug. 15, when the Taliban took over Kabul; her husband was at work. “We couldn’t contact my husband,” as the Taliban had shut down the phone system. “I didn’t know if he was dead or alive.” He eventually returned home at 9 p.m. after walking for hours from his office.

Freshta’s family, it turns out, could have come to the U.S. in 2018 through the SIV program, but changed their minds because, as Abasi said, “they had a good life over there.”

But after last summer’s Taliban takeover, because of their connection to the U.S. government (her brother-in-law was also working for them), “their data was in the Taliban’s hands, so their lives were in danger.” Freshta, who had been training as a medical student in Kabul, then had two girls and a boy.

After Shabaneh’s family’s six-hour flight, they wound up at the Al Udeid Air Base in Doha, Qatar, where they spent 13 days before coming to the U.S. While “the food was great,” the living conditions were terrible, with no real beds or privacy, Shabaneh said. “We couldn’t sleep.”

It may have been even worse before her arrival — an Aug. 24 report in Axios detailed an email sent by supervisory special agent Colin Sullivan, an official at U.S. Central Command, to his colleagues titled “Dire conditions at Doha,” stating that the base, which had no air conditioning, was awash in loose feces and urine and infested with rats.

Following the revelation, the Pentagon told Axios it had taken concrete steps to improve conditions on the ground, including installing more than 100 toilets and offering 7,000 traditional Afghan meals three times a day.

The next stop for Shabaneh’s family was in the United States, at the Fort Bliss military installation outside of El Paso, Texas. There she had four or five prenatal check-ups and they had pillows and beds to sleep in, but conditions were still far from pleasant. The location had “very big bugs” — cockroaches — according to Lindsey Stephenson, another translator for the women. They grabbed the first resettlement opportunity they were offered, in New Jersey.

Freshta spent eight days in Qatar before coming to the U.S., and three months at the Fort Pickett military base in Virginia. As she tells it, “we didn’t have enough doctors,” only for emergencies, and it was difficult to eat the food while pregnant and nauseous — although she did have two ultrasounds to check on the baby’s health.

By the time conditions had improved, her family had left the base to be resettled in Hamilton, a large Trenton, NJ, suburb.

While the women were finally able to live in real housing, challenges remained for them in terms of accessing health care. Stephenson explained the women’s situation while having their initial post-base check-ups in New Jersey.

Noting that their resettlement agency had a contract with Eric B. Chandler Health Center, a community health center in New Brunswick affiliated with Robert Wood Johnson (RWJ) Medical School, she said that it was a good 45 minutes away. While pregnant women receive priority, it is still a hassle; and on top of that, “they don’t drive. They have to be driven… and guess what, their kids weren’t in school either.”

Shabaneh, who discretely nursed her two-month-old son while speaking in her apartment — as her kids, Freshta’s kids, and Stephenson’s kids noisily played around them — eventually gave birth at RWJ University Hospital. “They were really kind to me,” she said. From the beginning she chose to breastfeed, although she was offered formula as a feeding option.

Freshta also praised the care she received as a pregnant woman, noting that when she experienced a change in the baby’s movements, she instantly was told to come to the hospital — Capital Health in Hopewell, NJ — where she remained for 25 hours for evaluation.

Yet despite the quality care she received, she still prefers the Afghan medical system. “Our doctors in Afghanistan were more knowledgeable,” said Freshta, who spent considerable time working in a hospital setting as a medical student and could only look on while U.S. medical staff struggled to insert a needle in her arm for routine blood work. As Stephenson noted, “because of the lack of technology, then people actually have to be more skillful with their hands.”

Virtua Health Systems, which has five hospitals in southern NJ, and whose Mt. Holly location is just down the street from Joint Base McGuire-Dix-Lakehurst — the military base where many of the Afghan refugees were housed after coming to the United States — saw some 123 births from this population and over 1,000 encounters “in triage,” said Pamela Gallus, RN, assistant vice president of patient care services, Virtua Mt. Holly Hospital. “And we really early on saw them for a lot of other things other than deliveries. We did a lot of their prenatal care when they first arrived.”

What kind of medical care had these women previously had in Afghanistan? “It was somewhat variable,” said Dr. Michelle Salvatore, medical director, OB/GYN Hospitalists at Virtua Mt. Holly. “Some of the patients had what we would consider regular physician prenatal care prior to coming.

I would say that was not the majority of patients. Many of the patients lived in remote places in Afghanistan and villages and…and hadn’t really had a lot of interface with health care…. So, this was a little bit of a different scenario as we were trying to provide more of a preventative care-type model for them.”

Asked about their physical conditions when they landed in the hospitals, Dr. Nicole Lamborne, Virtua’s vice president of clinical operations-women’s health, said that despite the “incredible amount of stress they were under… physically, I don’t think we saw too many issues of really malnourished [patients], just different nourished.”

While in general, they were thinner patients, “it actually reduces some of our obstetrical complications — they were much more used to walking places. So, I think physically, in a lot of ways, they’re healthier than some of the patients that we have in the United States.”

Afghan women demonstrated interesting cultural patterns for breastfeeding after giving birth. “Every one of them was seen by a lactation consultant,” said Gallus. While only about 40 out of some 120 patients breastfed exclusively, “there were only two or three who [exclusively] formula fed,” Gallus said.

“The rest of them all ‘combo fed,’ where they gave a little bit of formula and primarily breastfed, because that is their culture. But they often felt that until their milk was established…they wanted to be able to give the baby some form of nutrient.”

Does it really matter if a newborn gets just a few bottles of formula? While the milk of women who exclusively formula feed will eventually come in — “it’s just a better supply” if one exclusively breastfeeds, said Virtua Mt. Holly Lactation Consultant Shirley Donato, RN, acknowledging that “it’s helping the baby to learn how to breastfeed and things like that.”

The new moms “came in knowing about formula…I don’t know if they educated them on the base about their choices and to make sure they had formula if they were formula feeding, but they came in knowing that formula was an option,” Lamborne said. “They had formula on the base,” Gallus concurred.

There are recommended practices for the introduction of infant formula into humanitarian settings, said Hannah Tappis, DrPH, MPH, a senior technical adviser at Jhpiego, an affiliate of John Hopkins University, whose expertise focuses on maternal health in crisis situations.

“The best thing you can do for a lot of places is give cash — not to send your old things or to, you know, go to Costco and stock up on formula,” Tappis said. “The best thing to do is to donate to organizations that if that’s what they need they’ll purchase [it].”

But donating formula “in a more global context” is not recommended, she said. “And you know, that doesn’t mean small charities or church charities aren’t doing it. But certainly the big organizations wouldn’t accept it, and it would be generally discouraged.”

At least before the women left the army base, Virtua medical personnel tried to create an atmosphere most conducive to breastfeeding. “One of the things that we always do here is we do ‘skin to skin’ as soon as the baby is born, so we put the baby actually on the chest and the breast,” Gallus said. Virtua also facilitates full-time rooming in with the babies to facilitate bonding; there is no nursery per se where the babies are lined up by bassinets.

In the meantime, Freshta, who was nearing the end of her pregnancy during a reporter’s visit, gave birth to a healthy baby boy on April 6. Although she had had a C-section, according to Stephenson, she was ready to return home after just two nights in the hospital. She chose to breastfeed him.

Lori Silberman Brauner is an award-winning journalist, editor and freelance writer who most recently served as deputy managing editor at the New Jersey Jewish News. She received a B.A. in political science from Muhlenberg College; an M.A. in international affairs from Drew University; and an M.S. from the Columbia University Graduate School of Journalism. She is a fellow in the International Center for Journalists’ Global Nutrition and Food Security program.

IPS UN Bureau

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Oceans contribute substantially to US wealth, but it’s unclear how much the government will participate in the UN’s first oceans conference. Lucena, Philippines, above. JOE PENNEY

By Lori Silberman Brauner
UNITED NATIONS, May 18 2017 (IPS)

In just a few weeks, the United Nations is convening a world gathering to discuss the health of the world’s oceans and seas, with member states, government and nongovernmental organizations, corporations and members of the scientific community and academia signed up to take part.

Yet while representatives from America’s private sector and academic community — even the state of California — will be participating, so far it is not clear what role, if any, the United States government, the UN’s most important member, will take in the conference.

To be held June 5 to 9 at UN headquarters in New York City, the main objective of the conference is to support the implementation of sustainable development goal No. 14, which calls to “conserve and sustainably use the oceans, seas and marine resources for sustainable development.”

The predecessor to the SDGs, as they are called, did not reference the ocean or seas in a single goal. The conference agenda is wide ranging, with panel discussions on financing the “blue economy” for small island developing nations to “women and girls in science for ocean.”

“If the cycle of decline that accumulated human activity has brought upon the ocean is not reversed, the implications for us all cannot be good,” said UN General Assembly President Peter Thomson in a newsletter from the conference’s co-chairs, Sweden and Fiji. (Thomson is Fijian.) “Anyone who cares about the health of the ocean can and should get involved.”

While the US has agreed to participate in the conference — showing up, at a minimum — a State Department press officer said that planning for the meeting, which is the first to focus on a single development goal, was “ongoing.” The office added that it had nothing else to offer at this time.

Another State Department official, who also asked not to be named, told PassBlue that the US was finalizing its delegation, including who would serve as the delegation’s head, and that “we intend to be actively engaged in the June Conference.”

Press officers at the US mission to the UN, which is still in a period of transition since Trump took office, did not respond to emails for comment.

Low-ranking US mission employees have been attending negotiations on the conference’s summary statement, or “call for action.” Moreover, the State Department maintains a Bureau of Oceans and International Environmental and Scientific Affairs; its acting assistant secretary is Judith Garber.

While the conference will attract governments and other major representatives from across the world — as every nation has a connection to the ocean — a UN organizer said that the hope was that a powerful country or individual would initiate actions to get the world to pay closer attention to SDG 14 and the state of the oceans, which cover 75 percent of the planet.

That could mean the US, the person said. After all, Trump owns many resorts located on oceanfront property, deriving profit from such views, access and cooling effects. Mar-a-Lago, his private home and private golf club in Palm Beach, Fla., is minutes from the Atlantic.

“Oceans contributed more than 3 million jobs and $300 billion to the U.S. GDP,” Jacqueline Savitz, a senior vice president for U.S. Oceans and Global Fishing Watch at Oceana, an advocacy group, noted. “Much of that depends on ocean health, which in turn depends on international action. That’s why the U.S. simply can’t afford not to lead on ocean protection, so we hope to see a continuation of U.S. leadership at the UN Oceans Conference.”

The conference comes on the heels of the Arctic Council ministerial-level meeting held earlier this month in Fairbanks, Alaska, offering a window as to how the US may approach the UN event. The Council, comprised of eight Arctic nations that include the US, completed its two-year chairmanship at the gathering.

The ministers issued a final statement, the Fairbanks Declaration 2017, reaffirming the Council’s commitment to maintaining peace, stability and constructive cooperation, among other crucial aspects to the future of the Arctic Circle.

Climate change was on the Fairbanks agenda. “Noting with concern that the Arctic is warming at more than twice the rate of the global average,” the declaration also recognized “the entry into force of the Paris Agreement on climate change and its implementation, and reiterating the need for global action to reduce both long-lived greenhouse gases and short-lived climate pollutants.”

US Secretary of State Rex Tillerson attended the conference as chairman of the Council and signed the declaration, despite the Trump administration’s wavering over whether to remain a party to the Paris Agreement. (Garber of the Oceans bureau in the State Department also attended.)

US Secretary of State Rex Tillerson attended the meeting of the Arctic Council as chairman, May 11, 2017.

The Council meeting also follows an executive order issued by Trump directing a review of offshore oil and gas exploration in the Arctic, reversing Obama’s Arctic leasing ban. (A question by this reporter to Garber’s office about the order was directed to the White House.)

Negotiators on the Oceans Conference call for action are also wrestling with references to the Paris Agreement. The latest version of the document said it recognized “the particular importance of the Paris Agreement,” but discussions continue from May 22 to 25 at the UN, so that language could be dropped or changed.

Many environmental challenges hurt the ocean, as a background note for the conference said: “Marine pollution and litter, 80 percent of which come from land-based sources, compromise ocean health.”

A quarter of all carbon dioxide released through human activity is absorbed by the oceans and raises the seawaters’ acidity, and nearly one-third of all fish stocks are below sustainable levels, up from 10 percent in 1974. The note also stated that the deterioration of coastal and marine ecosystems and habitats has a more severe and immediate impact on vulnerable groups, such as small island developing states like Fiji.

The conference will feature plenary meetings, partnership “dialogues” in which less-developed nations will chair events with richer countries, and a commemoration of World Oceans Day on June 8.

In February, when negotiations began on the call for action and the partnership-dialogue themes, the US participated in both segments.

“The United States views the Conference as an opportunity to focus on tangible areas for cooperation, without developing a new or amended UN ocean agenda,” its official meeting statement read.

It added, more critically, “While we remain flexible on the content of the Call for Action at this time, we would not want to see inclusion in the document of the creation of new bodies or high-level positions, language that would pre-judge the outcomes of any ongoing negotiations, nor do we believe the Call for Action should call for additional, follow-on conferences for SDG 14 considering the overlap and synergies among the various SDGs.”

A key focus of the conference is the presenting of voluntary commitments by governments, companies and others pledging action on conservation. With 189 commitments so far, these pledges represent governments that include France, Spain, Nigeria, Indonesia, Belgium, Grenada, Fiji, Palau and Sweden.

California, with its long Pacific Ocean border, has seven commitments registered, such as a plan to preserve its coastal ecosystems and prepare for rising sea levels.

University involvements include Arizona State’s Biogeography, Conservation and Modeling Laboratory, which researches fishery policies; and Northeastern University, which has created a Coastal Sustainability Institute to respond to environmental threats facing marine habitats.

In the private sector, Envision Plastics, from North Carolina, has announced a goal of removing up to 10 million pounds of plastic that could pollute the oceans over the next two years. Dell has committed to processing plastics collected from beaches, waterways and coasts to incorporate in new packaging of its computers.

The following countries will be paired for the partnership dialogues, emphasizing the rich state-developed state theme: Australia-Kenya, Iceland-Peru, Canada-Senegal, Estonia-Grenada, Italy-Palau, Monaco-Mozambique and Norway-Indonesia.

The US, notably, is not among them.

An annual Our Oceans global conference — not focused on SDG 14 — has been held for the last three years at different locations; this year, it is to be hosted in Malta in October.

Our Oceans is meant to enlist specific steps by nations to protect and mitigate climate effects on the world’s vast waters. Last year, the forum convened in Washington, led by Secretary of State John Kerry, an ocean lover cultivated through a family-owned island off Massachusetts, called Naushon, and a house on Nantucket (recently sold for a move by Kerry and his wife, Teresa Heinz, to Martha’s Vineyard).

“We have to keep the momentum going so that we can come together and protect our ocean,” Kerry said at the conference. “Why? Because our ocean is absolutely essential for life itself — not just the food, but the oxygen and weather cycles of the planet all depend on the ocean.”

(Brought to IPS readers courtesy of PassBlue, online independent coverage of the UN, a project of the Ralph Bunche Institute, City University of New York (CUNY) Graduate Center)