Lake Tanganyika, Off Kigoma, Tanzania — When midwife Mariam Abrahman, 32, rescued a heavily pregnant woman from a flimsy boat carrying Burundian refugees in Lake Tanganyika, she knew she'd arrived just in time.
"For the past few days the water had been choppy, but that afternoon the lake had calmed and I knew there'd be a rescue before too long," she says.
Kigoma is a lake port on the north-eastern shores of Lake Tanganyika, in north-western Tanzania. Ms Abrahman was on board MV Tanganyika, a privately owned vessel that was hired for rescue missions during the influx of Burundian asylum seekers.
As they sailed closer to the craft, which seemed barely seaworthy, she saw that the people on board were clearly distressed.
Counting the pregnant women on board and at risk
"There were well over 130 of them on a boat designed to hold just 30 people. The men were straddling the inflatable sides, and the women and children were squashed in the middle, with leaking fuel and seawater sloshing about their feet," she said.
"This isn't unusual - the people-smugglers who promise them safe passage will often chase them onto the boats, sometimes firing guns in the air to crush as many people aboard as possible."
The rescue crew were cautious in bringing the refugees on board MV Tanganyika.
"You have to be slow and steady - any sudden movements and you risk capsizing the rubber craft, the consequences of which don't bear thinking about," Ms. Abrahman says.
"The first thing we do is hand out lifejackets, before making trips on a smaller rescue boat to bring people on board. Fortunately, things went smoothly," she says.
Many of the men stretched out on the decks to sleep, a stress response borne from sheer exhaustion. But it was the women who drew Ms. Abrahman's concern.
"I counted nine swollen bellies among the women, but I spotted a woman called Justina Habirimana, whose bump was by far the biggest. She told me she'd spent hours at sea battling contractions, cramped up in a corner of the rubber boat with her husband Hakizimana, and two young sons, Manzi, seven, and Irakunda, five," she says.
"Anyone who's been on a journey with young kids will know how difficult it is. That Justina and Hakizimana attempted this crossing with their sons speaks volumes about the desperate situation they're fleeing from in their native Burundi," says Ms. Abrahman.
Tanzania is host to almost 300,000 refugees, the majority of whom - more than 213,000 - hail from Burundi. Most of them are housed in Nyarugusu, Nduta and Mtendeli camps in the Kigoma region.
Midwife ensures safe birth of a little miracle
Ms. Habirimana had felt the baby move downwards and was in a panic she would give birth on the boat.
"It's unimaginable what would have happened if she had. There was no space for her to move her legs, and no food or water, let alone medical supplies," says Ms. Abrahman.
Ms. Habirimana's contractions stopped when she was rescued and she fell into a deep sleep.
"The next morning I was woken early - the baby was coming. I rushed to the medical room and, thankfully, the labour went quickly and smoothly.
"When healthy little Irakoze was born, Justina and Hakizimana were over the moon. As I watched the proud parents fuss over their baby boy, it struck me how privileged I was to have delivered him. Of all the 500 or so babies I've delivered in my time, this one will stay with me."
In accordance with Burundian culture, Ms. Habirimana wanted to introduce her newborn boy to the other women on board.
"A huge cheer went up when she walked in with her head held high and her son swaddled to her chest. The atmosphere was wonderful. It was a special moment, and I was glad to be part of it - but it does little to detract from the vast human tragedy we see unfolding every day.
"It was lucky we got to Justina in time, and fortunate she had her family with her. We see a lot of women and girls travelling alone, as well as many children as young as 10 with no one to care for them.
"Once we reach Nyarugusu we alert the authorities about unaccompanied minors, but it's tough not knowing what becomes of them. Often, the people we rescue are surprised it takes six hours to reach the camp, because the smugglers tell them they'll be there in a few hours. People board these deathtrap boats with nothing to their name, then the smugglers leave them to the mercy of the lake."
Strengthening midwifery workforce in Tanzania
About two thirds of all maternal and newborn deaths can be averted with the help of well-trained midwives, according to the most recent State of the World's Midwifery report.
UNFPA works with partners, governments and policymakers to build a competent, well-trained and well-supported midwifery workforce in low-resource settings. UNFPA focuses on four key areas - strengthening competency-based midwifery training, developing strong regulatory mechanisms to ensure quality services, raising the voices of midwives by establishing and strengthening midwifery associations, and advocating for increased investments in midwifery services.
Pregnant women are particularly vulnerable in times of humanitarian crisis. To ensure they deliver safely, UNFPA supports midwifery services in the refugee camps.
Ms. Abrahman is one of the midwives supporting refugee women in Kigoma's camps.
When her father heard about Irakoze's birth, he sent her a message. "It said, 'Not all superheroes wear capes. Well done, Mum!'," she says, and smiles.
"Sometimes it can be hard to forget the terrible things you see. All in all, I thank God for the skills I have as a proud midwife, through UNFPA support."