Karam and Adam, twin Palestinian babies born after their mother underwent IFV treatment using sperm smuggled out of the Israeli prison where their father has been held for the last 11 years. Credit: Silvia Boarini/IPS

By Silvia Boarini
GAZA CITY, Jul 31 2015 (IPS)

Thirteen-year-old Hula Khadoura sits on a large sofa in her grandfather’s home in the neighbourhood of Tuffah, Gaza City, her one-year-old twin brothers Karam and Adam on her lap. “I am so happy they arrived,” she beams, holding the babies’ feeding bottles in her hands.

There is an aura of mystery and something of the miraculous around the  twins’ births – their father, Saleh Khadoura, has spent the past 11 years in an Israeli prison and has had no physical contact with Hula’s mother, Bushra, since then.

Hula hears people refer to her brothers as ‘special babies’ but does not fully grasp what the fuss is about. She is completely unaware of the unusual obstacles her father’s sperm had to overcome to reach her mother’s eggs.“After the suffering I am put through with each visit [to her husband in an Israeli prison], with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken” – Bushra Abu Saafi

Freedom ambassadors

Bushra Abu Saafi, is one of around 30 Palestinian women who have conceived babies since 2013 with sperm smuggled out of the Israeli prisons in which their husbands are being held. She was only the second woman in Gaza to do this. Before her, two had tried but only one succeeded.

According to the Palestinian Prisoners’ NGO Addameer, there are currently some 5,750 Palestinian political prisoners being held in Israel. Of these, roughly 5,550 are adult males.

Women whose husbands are serving decades-long sentences do not want to see their dream of starting a family, or increasing its size, taken away by the very same authorities that took away their husbands.

Until recently, the Israeli Prison Service (IPS) was highly sceptical that sperm smuggling could be happening at all. Spokesperson Sivan Weizman told the press that tight security made it very unlikely. Recently, though, they have acknowledged that it may be an issue.

The Palestinian National Authority and Hamas, on the other hand, have never shown any doubt and have financially supported women wishing to try this very unconventional method of conceiving.

In May in Gaza, the Palestinian Ministry of Prisoners even organised a collective birthday party for the little ‘ambassadors of freedom’, as babies born this way are often called.

Families apart

“It was my husband who suggested we try ‘in vitro fertilisation’ (IVF) treatment with his smuggled sperm,” Bushra Abu Saafi told IPS from her father’s apartment, where she lives with her five children.

The majority of Palestinian households have at least one relative in an Israeli prison. For a people under occupation, political prisoners become part of the collective identity, they are adopted by Palestinians as long lost brothers, sisters, mothers or fathers and are celebrated at Prisoners’ Day marches and recurring demonstrations.

In the private sphere, the prisoners continue to be individuals and occupy prominent places in the home. Their handicrafts are displayed with pride, their photos adorn each room and the vacuum they have left is still palpable.

A flowery picture frame with a photo of her smiling husband Saleh in his twenties sits on a side table in Bushra’s living room. He was arrested at the age of 23, accused of being part of the Islamic Jihad. They had been married for five years and only two of their children have had the privilege of spending some time with him as a family.

When Saleh was imprisoned, Bushra was pregnant with Ahmed. “It hasn’t been easy these past 11 years,” she told IPS.  “We miss him terribly, my son Ahmad especially. He doesn’t know the meaning of the word ‘father’. He tells me ‘when I grow up I want to be like grandad’.”

Smuggling new life out of jail

Entering a fourth pregnancy was something Bushra did not take lightly and her father worried about the extra pressure. “When Saleh proposed this to me from prison, I was sceptical,” she confessed. “My family and I worried about what people would say. Imagine, pregnant with a husband in jail!”

She need not have worried. The advice she was given, like other women undergoing IVF in this way, was to tell everyone in her family and village that her husband’s sperm had been brought out and would be used for insemination. Since then, local media stations have helped spread the story and both Palestinian society and local religious authorities have been highly supportive.

“In the end, my father saw that it was my desire to try for another baby and eventually supported my choice,” Bushra said. It took two months and many tests before she could be ready for the operation.

Although the women do not wish to discuss how the sperm is smuggled past Israeli security and out of prison, it is acknowledged that it may be slipped into the clothes of  unaware children.

While wives talk to imprisoned husbands through glass and over a phone, children are the only ones allowed physical contact at the end of a visit. The clinics performing the operation,  both in Gaza and in the West Bank, report that sperm has arrived in a variety of improvised containers, from sweet wrappers to eye drop bottles.

“The preparation, the waiting, it was all very tough,” said Bushra. “But when the news came that I was pregnant, the pressure was off and we finally celebrated.” The double surprise came later, when she was told that twins were expected.

She describes the steps leading to this pregnancy as being about resistance and overcoming challenges. “After the suffering I am put through with each visit, with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken.”

Fertility and non-violent resistance

According to Liv Hansson, a Danish public health specialist who has researched fertility in Palestine, the practice of sperm smuggling only makes associations between fertility and resistance easier to draw.

“In a context such as Palestine, where women are well educated and child mortality is low, a lower fertility rate would be expected according to classic demography,” Hansson told IPS. The fertility rate of 4.1 registered in Palestine between 2011 and 2013, then, must be seen in the light of Israel’s ongoing occupation.

Indeed, fertility has long been considered by Palestinians as part of resistance efforts against Israel’s military occupation. For its part, Israel views high fertility rates in the West Bank and Gaza, and in majority Palestinian areas inside Israel, as a very real threat. Talk of the ‘demographic time-bomb’ – the time when Palestinians will outnumber Jewish Israelis – is very common.

“Former Palestinian president Yasser Arafat famously stated that ‘the wombs of Palestinian women are the greatest weapon of Palestine’,” Hansson told IPS. “Fertility is seen as something of interest not only to the family but to the community, society at large and to politicians too.”

The wait

Bushra and her five children will have to wait three more years to be reunited as a family with Saleh. Since 2012, following the release of kidnapped Israeli soldier Shalit, Israel’s Prison Service has been slowly reinstating visiting rights for family and prisoners from Gaza.

Ahmed saw his father two years ago for the first time, Hula six months ago and for the twins, the only meeting so far has been through the photograph on the side table, portraying Saleh as a young man eager to live life.

Edited by Phil Harris    

A MDR-TB patient at a Médecins Sans Frontières clinic in Manipur in north-eastern India. Credit: Bijoyeta Das/IPS.

By Bijoyeta Das
NEW DELHI, Mar 5 2014 (IPS)

For years Joba Hemron, 50, prayed that her cough would go away. She was diagnosed with Tuberculosis (TB) in 2011. She was put on a Directly Observed Treatment Short-course (DOTS), provided free at a public health clinic in Bongaigaon district in Assam.

But soon she began missing too many doses. “My sons work in the fields, I was too weak to go on my own to get the pills,” she says. She went to a private clinic, hoping to collect all the medicines at once. That was expensive, which meant she could again not complete the course."Each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance."

Three years and five doctors later, she kept losing weight. “I took medicines whenever convenient but I was only getting worse.” Her family sold a goat and with the money traveled to the state’s capital, Guwahati.

She was diagnosed with multi-drug resistant TB (MDR-TB). “I don’t know what this means, no one explains anything. Will I get well?” she asks. Her frail body shakes as cough rakes her lungs.

For many like Hemron, lack of proper diagnosis and interrupted dosages are increasing their resistance to available drugs. Drug resistance is human-made – an iatrogenic disease resulting from mismanagement of TB, experts say.

Drug resistant TB can occur as a primary infection or develop during a patient’s treatment. India accounted for the greatest increase in MDR-TB in 2012 with an estimated 64,000 new cases.

India provides free TB treatment through the Revised National Tuberculosis Control Programme (RNTCP), which reaches 1.5 million patients. TB remains the deadliest infectious disease in the country with two deaths every three minutes. India has more than a quarter of TB cases globally.

Ramanan Laxminarayan, vice-president of the Public Health Foundation of India says the national TB programme is “stuck in the 1990s.” It is yet to rope in all available tools and involve the private sector.

“Every case of MDR-TB can be 20 times more expensive to treat than a sensitive strain and cause much greater inconvenience, pain and suffering for the patient,” he adds.

Despite regular adherence to medicines, some patients are becoming resistant to frontline drugs. In Mumbai, doctors at Hinduja Hospital said they had identified patients who are “totally drug resistant,”and did not respond to any available drugs. The Indian government rejected the claim.

According to the World Health Organisation (WHO), about 450,000 people contracted DR-TB in 2012. About half of them are in India, China and Russia. An estimated four-fifths of DR-TB cases are still undetected. There were 170,000 MDR-TB deaths globally in 2012.

Madhukar Pai, associate director at McGill International TB Centre, a research organisation situated at the McGill University Health Centre in Montreal, Canada, explains that neither public nor private healthcare providers offer quality TB care. He says there are many instances of wrong drug regimens, low quality drugs, scarce monitoring of treatment adherence, patient movement between providers, adding single new drugs to already failing regimens, and inadequate use of drug-susceptibility testing. All this results in MDR and extensively drug resistant (XDR) TB.

MDR-TB treatment is expensive, the treatment often lasts up to two years, with increased risks. Access to the two new MDR-TB drugs— bedaquiline and delamanid, remains limited. They are available in India only through compassionate use mechanisms.

Most patients in India go the private sector but some abandon treatment because of high costs. By the time patients end up in public hospitals they infect many, and also develop severe forms of drug resistance, Pai says.

“In the private sector, irrational TB prescriptions are so common – doctors make up their own drug combinations. This is disastrous. And each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance,” he says.

About 10 percent of drugs in India are estimated by some doctors to be fake, which can muddle up treatment. Testing for drug-resistance is limited in the public sector. “Empiric treatment is used,” Pai says, not treatment that is tailored to a patient’s drug susceptibility profile. This results in selection of drug resistant strains.

The solution isn’t “merely technological”, says Mike Frick of the Treatment Action Group, a research and policy think thank based in the U.S.

New diagnostic machines like GeneXpert may uncover more cases of drug resistance but “it cannot solve the health system’s failure to link patients to the highest level of care that is their right,” says Frick. India fails to provide psycho-social and economic support for patients.

Globally, funding for research into TB has fallen. Governments have slashed budgets; Pfizer and AstraZeneca have abandoned anti-invectives research – increasing the wait for better drugs, diagnostics and vaccines. “It decreases our chances of replacing toxic drugs in the current MDR-TB regimen with newer, safer drugs that are easier for patients to tolerate,” Frick tells IPS.

In 2013, there were numerous reports of drug stock-outs in India, which the government denied. Many patients had to stop treatment; others were turned away from clinics. When treatment is incomplete, it creates an opportunity for drug-resistance to develop.

“The cruel irony is that even as Indian generic manufacturers continued to produce many of the TB drugs that people in other countries depend on, the Indian government couldn’t guarantee TB drug availability to its own people,” Frick adds.

TB is an opportunistic disease and HIV positive patients are more susceptible. Daniel, who asked only his first name be used, is a HIV positive patient. Six months ago he was diagnosed with MDR-TB. “The medicines are so hard, drain me of all strength,” he says.

He is forced to go to public hospital because of the exorbitant costs of medicines. “But there are long waits and everyone comes to know about you. It only adds to the existing stigma.”