Human Milk Bank in a War Zone: A Report of the 2023-2025 War in the Middle East

This article describes how the National Human Milk Bank (NHBM) of Israel handled challenges caused by the invasion of Southern Israel by Hamas on October 7, 2023, leading to the massacre of more than 1,200 Israeli civilians and the taking of more than 250 hostages into the Gaza Strip, including women and children. This created a need for donor human milk (DHM) for infants, not based on infants' medical conditions (routine usage), but rather because of maternal death, disability, or emergency deployment. We studied satisfaction levels among the families involved with the donated milk. We hypothesized that caretakers would experience initial anxiety related to providing infants DHM before its administration, but high levels of satisfaction following it.

At the onset of the war, it was decided that the criteria for receiving DHM would be widened to include infants of mothers who were victims of the attack, infants injured in the attack, and infants of mothers emergently called up for military combat. Later on, criteria were expanded to include breastfeeding women psychologically impacted by the attack or its resultant displacement. Satisfaction was determined from questionnaires that were sent to families 6 months to 1 year after the events took place.

Forty-six infants of 44 mothers (2 sets of twins) received DHM between October 2023 and January 2025. The most frequent reasons for eligibility were maternal deployment to active duty (n = 20), maternal secondary exposure to events (n = 18), and maternal death or severe injury (n = 7). Twenty families returned the questionnaires, showing that at enrollment, approximately 50% of families expressed a high or moderate degree of anxiety. In contrast, after the infant received DHM, less than 25% still expressed anxiety. More than 80% attested that DHM donation helped them in handling the consequences of the war and contributed to their child's health, while more than 90% felt that the DHM donation contributed to their own well-being.

In settings of maternal loss or incapacity during war, donor human milk can be effectively provided by human milk banks and lead to a high level of satisfaction. We suggest that human milk banks should be considered a component of emergency preparedness planning.