As more families depend on human milk banks to meet the vital health and nutritional needs of babies, these facilities should implement emergency response plans, similar to those in blood and tissue banks and other critical medical services. Human milk is a lifesaving resource for preterm, low-birth-weight, and critically ill infants, with the World Health Organization recommending pasteurized donor milk for babies who are unable to receive their own mothers’ milk. Milk banks need to ensure they can continue to function during natural disasters, armed conflict, and other emergencies, both as separate emergency services and, at the same time, continue playing their vital role in breastfeeding support. In addition, milk banks should consider the potentially larger role they can play in disaster response, when an increased number of babies could benefit from their services.
I established the human milk bank in Israel as a part of Magen David Adom (MDA, the country’s emergency medical response organization) and in collaboration with the Ministry of Health in 2018, and I have been its CEO ever since. The facility itself is housed in the same secure facility as the main national blood bank. This has allowed us to function without interruption during the last three years as the country has been embroiled in war and targeted by hundreds of missile attacks. While our facility and situation are unique in many ways, our experience offers lessons that milk banks around the world, often located in hospitals or within communities, can implement in order to prepare to function during disasters and emergencies.
Among the first steps that milk banks should consider are safe and secure storage facilities, automated processes in case there are workforce shortages, and contingency plans for collection and distribution. Most milk banks use facilities that meet health and safety standards, keeping the milk at regulated temperatures and safe from contamination. However, they should also consider measures to protect their operations against natural disasters like floods, wildfires, and earthquakes. Those in volatile geopolitical environments should think about how the facility and their employees could be protected against missiles, drones, or other military threats. Since the building our milk bank is located in has multiple underground floors and designated bomb shelters, staff can continue working normally during incoming missile attacks. Additionally, there is a deep underground shelter that we can quickly move the milk to, where there are also several layers of backup power to continue to keep it cold. The facilities were built to withstand not just missile attacks, but also biological and chemical attacks as well as earthquakes.
Automation is another feature that can help facilities cope during emergencies or unexpected events. For example, at the MDA milk bank, there is a robotic arm system that helps bottle the milk, which allowed the facility to function with far fewer staff during the recent conflict with Iran, when missile fire made it difficult for employees to reach their place of work. Such features are also useful during health emergencies like the recent COVID-19 pandemic, which could also limit the number of people working in a facility.
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Milk banks should also consider that during an emergency, they may experience an increase in demand or potential use for their milk. Mass numbers of injury or death, including of nursing mothers, could leave many more babies in need of human milk. Situations where mothers may need to be separated from their nursing infants, due to reporting for national service or emergency volunteer or work duties, could also create greater demand. As my colleagues and I outlined in a recent article in the Oxford University Press journal Military Medicine, our milk bank has seen these spikes in demand, including in the immediate aftermath of the attacks of Oct. 7, 2023, which killed 1,200 people in Israel. In response, regulations about who was eligible for donor milk were expanded to include these cases, with 80 percent of the affected families reporting that access to donor milk helped them better handle the outbreak of war and contribute to their child’s health. Our milk bank provided about two tons of milk to these families in the months following Oct. 7.
At the same time, donors could also be affected and unable to provide the volume of milk they usually do. While initially more women rushed to donate milk, as the emergency situation has continued in Israel, we have also seen dips in donations as lactating mothers are busy caring for children amid closed schools and partners in military reserve duty, or cannot reach the facility in periods of heavy missile attacks. Building up an emergency reserve of milk is one obvious step. But in addition to that, milk banks should be integrated into emergency response planning, with other parts of the health system helping more families access donor milk, and assisting in the logistics for safe storage and distribution. Due to our integration into the national health system, we were able to start offering home deliveries of milk in conjunction with the recipients’ health care providers.
Another promising avenue for increasing the potential contribution of donor milk to emergency response is the ongoing innovation to make human milk shelf-stable. Human milk that is treated to become shelf-stable at room temperature would be a potential game-changer in emergencies. Mainly, it could ensure a supply that requires less-specialized logistics to deliver to those in need, making it available to more babies, including those who usually rely on formula. While professional relief groups and governments often provide powdered baby formula in the wake of natural disasters like earthquakes or hurricanes, the formula can only be prepared and used if there is clean and safe drinking water, a resource that is often jeopardized in emergencies. In such cases, shelf-stable donated human milk could be a better alternative for any infant or toddler who relies on formula. In addition to not requiring water, human milk contains nutrients that offer increased immune protection against diarrhea and respiratory infections, which can be more common following disasters.
Even as shelf-stable human milk remains in its early stages, milk banks can contribute significantly during emergencies and natural disasters, offering critical resources for the most vulnerable of babies and their families. In order to harness this potential, milk banks need to actively engage in emergency planning and preparedness. While we all hope for calm and quiet, the reality is that we need to be prepared like any other part of the health system.
Sharron Bransburg-Zabary is a health care executive.
