Fragile Settings, Sustainability, Eastern Mediterranean

First Responders to the Climate Crisis: Caring for Fisherfolk on the Baba, Bhit, Shamspir and Salehabad Islands

12 December 2023

Neha Mankani is Midwifery Associations Capacity Assessment and Strengthening Project Lead at ICM, and graduate of the Young Midwifery Leaders Programme. Through her charity Mama Baby Fund, Neha and her team have provided life-saving birthing kits and midwifery care to more than 15,000 flood-affected families in Pakistan. This year, Neha was named one of BBC’s 100 Women in the category Climate Pioneer.  

This month, Neha brings us a blog describing her work as a first responder to the climate crisis.   

Rukaiya, who gave birth through our midwife-led clinic at Baba Island, shares a bowl of crab curry with me in the backyard of her home. Overlooking the Arabian Sea and debilitated mangroves, the backyard transforms with the tides. At high tide, the water threatens to take over her home, while at low tide, all I can see is sludge and plastic bags.  

I am here for a postnatal visit for Rukaiya’s sister-in-law, Sara, who gave birth to her first baby yesterday. The stifling heat and limited power, available for only half the day, make our conversation about how to keep herself and the baby cool even more crucial. We emphasize the importance of hydration for her during this time.  

As a midwife on a climate-affected coastal fishing island off Karachi, Pakistan, my role extends far beyond providing care to pregnant women and babies. Baba, Bhit, Shamspir and Salehabad islands, once a tranquil haven for fisherfolk, are now grappling with the harsh realities of climate change, impacting not only the environment but also the health and well-being of the island’s inhabitants. In this community, our team of two midwives, myself and Jahan plays a crucial role in health support amidst the challenges posed by a warming planet. From coordinating emergency plans during sea storms to addressing the mental health impacts of climate-induced stress we are midwives and first responders.  

Coastal fishing communities are grappling with rising sea levels, unpredictable weather patterns, and the threat of extreme events like cyclones. As these communities adapt to the evolving environmental conditions, we find ourselves at the intersection of healthcare and climate resilience. Rising temperatures, combined with environmental degradation has this community witnessing shifts in disease patterns and increased vulnerability to vector-borne illnesses, skin diseases, respiratory issues, a range of infectious diseases, and the direct and indirect impact of heat on maternal and newborn health outcomes.   

We have watched our tiny, one-room midwife run clinic become a safe space for women from across the fisherfolk community, catering to a population of more than 25,000. Amidst the chaos, there is a profound sense of community. The islanders, bound by their shared experiences and common struggles, rally together to support one another. As midwives who are with them in some of the most joyful and most difficult moments in their lives, we too have become trusted members of this tightly-knit community. Being part of this sisterhood and the messiness of human life is my favourite part of my work.   

The community has had a harmonious coexistence with nature and the sea for generations, and we have learned how this shapes cultural practices around birth and the postnatal period for families.  The environmental changes in coastal ecosystems have directly impacted this fisherfolk community’s livelihood, significantly impacting maternal and child health and nutrition and thereby pregnancy outcomes. We support community women in learning from each other about sustainable and locally sourced diets, and the importance of breastfeeding and climate resilient sources of nutrition for families. We share how we can all be collectively responsible for the environment.   

One of the most significant aspects of my work is adapting to the changing needs of expectant families. Providing care in this community has helped us learn about adaptability and innovation. Our boat ambulance, equipped to withstand adverse weather conditions, allows midwives to reach remote areas during rough weather and provides the entire community with free sea transport in emergencies and for medical referrals. Additionally, we consult with other healthcare specialties remotely, minimizing the need for unnecessary travel and reducing the carbon footprint associated with accessing healthcare services in the city. Our solar powered clinic is climate friendly and ensures we can provide care safely even when there is no electricity in the community.    

As I reflect on my role in this community, I think about the urgent need for holistic and sustainable approaches to maternal healthcare globally. The midwife-led model of care is an effective method of providing quality, culturally appropriate care while reducing the carbon footprint of maternal and reproductive health. By embracing eco-friendly initiatives, implementing evidence-based practices, and fostering community awareness, midwives can become powerful agents of change in the face of climate challenges, ensuring the principles of ecological sustainability.  

As I left the island that evening, I strolled past Rukaiya’s house. The tide was encroaching upon the shore, and Sara was cradling her newborn while keeping a watchful eye on Rukaiya’s son playing in the seawater outside their room. I reflected on the profound beauty that resides within this resilient coastal community and the gratitude I feel for being a part of their story.