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In Memory of Maryam

Midwife killed in attack at Kabul maternity ward refused to leave her patient

Massoma Jafari—former midwifery advisor for Jhpiego and ex-vice president of the Afghan Midwives Association—reflects on the May 12 attack on the hospital where she trained and its impact on the health and safety of women and babies.

Massoma Jafari
Massoma Jafari

Honestly, after nearly a week, it is still difficult to stop my tears when I think about the massive tragedy at a Médecins Sans Frontières (MSF) hospital in Kabul, Afghanistan. I am familiar with this hospital because it was in my neighborhood. Many of the MSF staff are my classmates, friends and neighbors. My nieces, my cousins and many of my relatives were born there. Often, I was there to accompany a patient or to donate blood for the victims of past terrorist attacks in the surrounding area.

As a student of the Ghazanfar Institute of Health and Science, I went to Dasht-e-Barchi hospital to complete my clinical practice. Back then, it was a small clinic, but by 2014, buildings were added to serve as maternity hospital run by MSF, also known as Doctors Without Borders. The hospital recruited midwives and other staff, offering them good salaries. Everything was of a high standard, with the best possible medical and non-medical equipment. Infection prevention procedures were exceptional, midwives were regularly trained and tested based on the latest competencies, and health education for patients was outstanding. Even the food was nutritious.

Dasht-e-Barchi is one of the most vulnerable and underserved areas of Kabul, an area mostly belonging to Hazara and Shi’a minorities. A center of mercy for many local residents, the hospital provided free, high-quality, and respectful services around the clock, 24/7, even during the current COVID-19 pandemic. It provided ambulance services that extended to the most remote area of Dasht-e-Barchi, and it created several hundred jobs and opportunities.

Since 2015, the Dasht-e-Barchi community has been targeted by ISIS and the Taliban. Hundreds have been killed in schools, mosques, news centers, educational centers, gyms—and even hospitals. But this is the first time that they targeted a maternity hospital in a most barbaric and unequal war. I do not know with whom they are fighting. A newborn? A mother who has just given birth? A midwife who is giving life to others?

Maryam served as a midwife during the COVID-19 pandemic. She was in the delivery room with a patient in the last stage of labor. As the alarms rang, her colleagues called for her to run away to safe rooms, but she replied that she had a patient. “I cannot leave her alone,” were among her final words.

Midwife Maryam died shortly thereafter. Her three children, including the youngest, who is the same age as my daughter, cannot see their mother anymore.

In losing her life, Maryam taught the rest of the world the true meaning of being a midwife. In Afghanistan, we midwives sing a song that says: You (mothers) are not alone, we (midwives) are with you.” Now, I feel its full and deep meaning. 

My friends who were there during the attack cannot sleep; they are tortured by flashbacks. Still, they are committed to continue their work under any circumstances. One of them said, “I am ready to sacrifice my life for others, to continue Maryam’s way.”

But their families have concerns for their safety, and find it difficult to let their daughters and wives go out and continue providing services. Many people are asking if health facilities are safe for women giving birth. They are caught between their fears of death from childbirth complications and terrorist attacks.

For decades, the Afghanistan government has been working to reduce maternal mortality by training midwives and expanding services to ensure that women in childbirth don’t die from preventable complications—work that has been supported by Jhpiego for more than a decade. On the day they struck Dasht-e-Barchi hospital, the terrorists attacked not only helpless women and children, but also these decades of efforts.

And yet, the world, the international community, Jhpiego, and MSF should not give up. They need to continue working with the Afghanistan government to recreate and reinforce the idea that hospitals and maternity clinics are safe for women and newborns.

Maryam’s bravery, sacrifice and selflessness need to be acknowledged.

She deserves to be remembered for her work as a midwife.

Ms. Jafari lives in Toronto. She was one of the 12 International Confederation of Midwives’ Young Leaders from 2017–2018. 

Jhpiego believes that when women are healthy, families and communities are strong. We won’t rest until all women and their families—no matter where they live—can access the health care they need to pursue happy and productive lives.

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