For many years, Hasidic women in the Brooklyn neighborhood of Borough Park had a problem.

If they were stricken by illness or accident, or suddenly went into labor, their only ambulance option was the local branch of the Hatzolah, a volunteer emergency service set up to serve Orthodox Jews.

The Hatzolah are good; the crews have a response time of one to two minutes. But the Hatzolah are also all male – a very real issue in a religion and community that orders strict separation of genders.

It meant Hasidic women needing emergency medical attention would sometimes refrain from calling for an ambulance.

“Women were too embarrassed to call for help and then didn’t call for help,” said Paula Eiselt, the director of 93Queen, a new documentary which follows the efforts of Hasidic women in Borough Park to set up their own all female, ambulance service.

“I read a story of a woman who actually passed away because she was having a heart attack and her hair wasn’t covered and she hesitated and waited,” she said.

Eiselt spent four years tracking their journey in the Borough Park, which has one of the largest Orthodox Jewish communities in the US, for a film which offers a rare glimpse into a closely guarded area.

The film’s protagonist, lawyer Rachel “Ruchie” Freier, fights against sexist attitudes in the Hasidic community as she cajoles and encourages her group of women into training as paramedics. Freier is bombarded with abuse as she strives to set up the service, and local online community boards are flooded with angry messages.

“I sometimes wonder why God created me a woman. If I’d have been born a Hasidic man, I don’t think I would have half the problems I have,” Freier says at one point in the film. “So much of the things that I want to do are that much harder because I’m a woman.”

Part of the vitriol is aimed at Freier’s rising public profile as she sets up the all-woman service, called Ezras Nashim. She receives an email accusing her of lacking “values of modesty and tzniut” – the latter describing a set of Jewish laws insisting that people, especially women, behave in a way that does not attract attention. Eiselt said that concept typically makes it difficult for the media to gain access.

“It’s definitely a very challenging community to get access to. I think there’s kind of a contentious relationship with media,” Eiselt said.

As an Orthodox Jew herself, Eiselt said she was able to build relationships with Freier and the other women in the film, giving her access to homes and the training sessions as they build knowledge of how to perform CPR and deliver babies, among other skills.

Photograph: Julieta Cervantes

Freier and the others carry on in the face of the patriarchy, eventually earning recognition from the New York fire department, which assigns Ezras Nashim the radio call sign 93Q – 93Queen. But while the commitment and effort the Ezras Nashim women show is admirable, it’s hard not to feel uncomfortable at the subordinate role they are forced to play in their Hasidic community.

Some of the women talk about how they have had to sacrifice their careers because of the pressure to have children young and then raise them, with minimal input from male family members. Freier, after a hard night working on the Ezras Nashim project, comes home and begins to prepare food for her family at 3am.

Against that backdrop, it is jarring to hear one of Freier’s daughters discuss her dream of being a brain surgeon – “nine years of college and then residency”, she says – when she grows up.

“The problem is once you hit 22, it starts getting harder to date,” her sister, who can’t be older than 14, tells her.

In Eiselt’s opinion, however, things are moving in the right direction in this Borough Park enclave – if slowly.

“I think a big takeaway for me is you know feminism doesn’t look the same in every community. The way feminism looks in Borough Park is not the way feminism looks like in secular New York City,” she said.

“I think we need to embrace and support women like Ruchie [Freier) and say: ‘You’re doing great.’

“Just because her progress may not be at the point where we think it should be, this is the first step and if we’re going to say: ‘What you’re doing isn’t good enough,’ then what’s the point of them even doing anything?”