Kangaroo Care: A Mother's Embrace Aids Premature Babies' Growth in Gaza Amidst Health System Crisis

In the Nasser Medical Complex in Khan Younis, southern Gaza, Rania Fadel holds her premature son, Ilyas, during a vital kangaroo care session. For 11 days following the birth of her twins on September 25, Rania was separated from Ilyas, who was admitted to the neonatal intensive care unit due to being born prematurely at just 1.4 kilogrammes. His twin, Yahya, was born healthy. Ilyas required specialized care in an incubator for issues affecting his blood and lungs. Rania, recovering from a Caesarean section, described the overwhelming emotion upon finally being able to hold her son: “When they called me to hold him, I rushed over. I was in a hurry to get to him. It was such a feeling.”

As Ilyas’s condition improved, he was moved to the hospital’s neonatal care unit, allowing Rania to participate in kangaroo mother care, a program newly launched at the hospital. This practice involves prolonged skin-to-skin contact between a caregiver, ideally the mother, and the baby, coupled with exclusive breastfeeding. “I was so happy. It was such a beautiful feeling,” Rania shared. During a session, a nurse assisted Rania in positioning Ilyas against her bare chest for approximately 90 minutes. “He started breastfeeding from me, and he stayed a little longer,” she said. “I felt he was improving.” The physical closeness provided immense comfort to Rania after their separation, reinforcing her son’s sense of security: “The baby feels that his mother is there. He feels safe. Honestly, it makes me very happy.”

Kangaroo mother care, which involves placing a baby against a parent’s bare chest for skin-to-skin contact, alongside breastfeeding and medical care, is proven to have significant health benefits for premature and low-birthweight infants. According to World Health Organization (WHO) guidance, it can reduce neonatal mortality by 32 percent and mortality by six months of age by 25 percent compared to conventional care. Khawla al-Madhoun, director of nursing at the hospital’s maternity and neonatal departments, highlighted its integrated approach: “When we place a baby on the mother’s chest, it helps the baby grow. We have seen babies who were unwell or underweight begin to grow faster with kangaroo care. This can help them leave the hospital sooner.”

The Nasser Medical Complex is introducing kangaroo care through a pilot program supported by the WHO, the United Nations Children’s Fund (UNICEF), and the UN Population Fund (UNFPA). While the agencies announced the initiative in September, its implementation is gradual, focusing initially on babies who are medically stable and do not require oxygen support. The team aims for longer periods of skin-to-skin contact, with WHO recommending at least eight hours daily, though their immediate target is two hours, adapted to family circumstances. Al-Madhoun emphasized that kangaroo care complements, but does not replace, intensive medical interventions like incubators or respiratory support when critically needed.

The push for specialized newborn care occurs against the backdrop of a severely strained health system in Gaza. Pre-October 2023, Gaza had 178 incubators across eight neonatal intensive care units. By November 2024, the destruction of three units by Israel had reduced the number of available incubators to approximately 54, a 70 percent decrease. This critical shortage, exacerbated by fuel and electricity limitations due to Israeli restrictions, places premature newborns at grave risk. Despite a supposed ceasefire and the delivery of some new equipment, the scarcity persists. In May, UNICEF reported supplying incubators and ventilators, yet neonatal units continue to manage fragile infants with insufficient resources.

The ongoing conflict in Gaza has worsened conditions for pregnant women, leading to economic hardship, food shortages, poor nutrition, and displacement-related challenges. “These conditions have contributed to the rise in premature births and babies born with low birth weight who need specialised neonatal care,” al-Madhoun stated. Repeated displacement and overcrowding further strain hospitals like Nasser Medical Complex, already grappling with limited space and essential equipment shortages.

Linda Abu Nasira, a 23-year-old mother, is also utilizing kangaroo care for her three-day-old daughter, who experienced a fever that has since subsided. Linda practices brief, approximately 30-minute, skin-to-skin sessions with her daughter every two hours, guided by the medical team. “She is a little better than yesterday,” Linda reported. Residing in a tent in al-Mawasi, Khan Younis, Linda faces difficult living conditions, struggling with food and water security while caring for her newborn and two older children. “We try to manage. But it is not like before, or like the conditions you would expect when giving birth.” She finds solace in the kangaroo care sessions: “As a mother, it means a lot to me to feel that I am helping my daughter recover. I hope she will recover and be discharged as soon as possible.”