Health Care Workers Say Conditions for Pregnant People in Gaza Are Getting Worse

In July, a woman in Khan Yunis in Gaza went into labor in the middle of the night, which is when the shelling and attacks from Israeli forces become more intense. While trying to reach the hospital, the ambulance she was riding in was attacked by Israeli forces. The woman and her fetus both died.

This is one of a handful of horrific stories four care workers with the Palestinian Family Planning and Protection Association on the ground in Gaza told Jezebel about the worsening conditions pregnant people face in Gaza, nearly a year since Israel's genocidal campaign began. One PFPPA staff member, NS, told Jezebel that a patient told her "the shellings and clashes nearby caused a close female relative of hers to panic at birth and caused her to bleed and lose the baby.” (The PFPPA staff members shared written statements, and asked to be identified by their initials to protect their identities.)

Another PFPPA staff member, WH, said they were once working in a refugee camp when they received a sudden evacuation order and were soon under attack: "Everyone began to run, when a 26-year-old woman began to have contractions and was clearly going into premature birth and she just dropped on the ground from the fear.” With the help of WH and other PFPPA workers, the woman lived and was able to give birth in a tent, but due to continued Israeli attacks, WH says they weren't able to call an ambulance to get the woman to a hospital. Still, she's considered fortunate compared to other pregnant people PFPPA has tried to care for.

Tarneem Hammad, a spokesperson for Medical Aid for Palestinians (MAP) who's currently based in Gaza, told Jezebel in written statements that the maternal mortality rate in Gaza has increased "over 20% since October," along with a 15% increase in infant mortality in the last six months. In January, Care International told Jezebel that their own field doctors reported a 300% increase in miscarriages since October.

“The miscarriage rate is really high because pregnant women are exposed to severe fatigue when fleeing during the continuous bombing and displacement from one place to another,” WH said. “Also, the hard work required of the pregnant woman, such as transporting water from one place to another, malnutrition and exposure to the suffocating smell of gunpowder.” It doesn’t help that miscarriages “are often happening in unsafe settings,” where “complications such as severe bleeding" are more likely.

This reproductive violence is unfolding amid a broader backdrop of mass, indiscriminate casualties in Gaza. This week, Gaza’s Health Ministry reported over 40,000 Palestinians have been killed by Israeli forces since October, though the actual number is likely much higher; the United Nations estimated in May that 63 women including 37 mothers have been killed by Israeli forces every day, and Gaza’s Health Ministry reported in January that 70% of the dead were women and children. The PFPPA care workers who spoke to Jezebel say that over the last 11 months, their patients in Gaza have contended with steadily worsening starvation, displacement, constant bombardment, and shelling, as well as the complete collapse of the health system.

In a July Instagram post, PFPPA shared the story of one of their own care workers, Wafa Abu Hasheish, who miscarried while fleeing a bombing. "I was able to find a doctor only after reaching Rafah, who confirmed I was miscarrying. I didn't even realize I was pregnant," the mother of three said. In the same post, Ammal Awadallah, executive director of PFPPA wrote, "A woman who conceived at the start of these hostilities will now be giving birth ... This will be a lost generation in Gaza, a generation born in genocide."

Earlier in the war, reports of people in Gaza suffering through c-sections without anesthetic drew international attention. Months later, this has become even more commonplace as Israel continues to prohibit basic medical supplies from entering Gaza. “We have heard of cases of pregnant women who were bombed and were about to die [having] urgent c-sections performed to save the baby,” NS said, adding that c-sections without anesthetic have only "multiplied" thanks to the increasing scarcity of basic medical supplies. WH added that especially in the north, there are "many women" having c-sections without anesthetic, or a "half anesthetic" in order to ration supplies. After c-sections, women are "supposed to stay under observation for at least two days" but are now being discharged immediately, WH said. Hammad says MAP has documented similar cases of c-sections without anesthetic, "leading to excruciating pain," and that these women have also "had to leave the hospital after delivery due to lack of beds or nearby bombardment."

Horror stories of c-sections without anesthetic are gut-wrenching, but the day-to-day reality for pregnant women is bleak, too, WH says, pointing to how “many [pregnant] women” lack any painkillers whatsoever for everyday pregnancy-related pains, let alone any nutrition or “good food” requisite for healthy pregnancies. On top of this, postpartum infections and diseases affecting mothers and their newborn children are rampant—and without medical supplies or access to hospitals, treatable conditions can be a death sentence, the PFPPA staff members said.

WH told Jezebel they've seen widespread neonatal conditions including premature births and respiratory issues among newborns. Lack of prenatal care in particular has “led to a rise in chronic diseases and preeclampsia among women.” Another PFPPA care worker, FW, told Jezebel that "infant deaths due to the high rate of infectious diseases, intestinal complications, lack of hygiene and the spread of epidemics.” Hammad says MAP doctors are constantly treating newborns "suffering from severe conditions, including low birth weight, respiratory distress, and hypothermia."

In April, one doctor at Emirate hospital told UNICEF spokesperson Tess Ingram that before the war, the hospital saw much larger newborns at around five kilograms or 11 pounds. “They just don’t see babies that size anymore. They’re much, much smaller, and many of them have congenital disorders and infections,” Ingram told Jezebel at the time. In particular, Ingram said a doctor at Emirate told her he’s never seen “such an acute spread of Hepatitis A as this,” as there are no sanitary products, privacy, or any medical supplies to protect from infection.

Before October, Ingram said Emirate had gone from delivering 18 babies per day to 75; the hospital has just 40 beds but went from admitting 40 patients per day to 400 per day, often pairing pregnant women two to a bed and releasing them within three hours of giving birth. PFPPA care workers told Jezebel that remaining hospitals, especially centrally located hospitals like Al-Aqsa and the Awda Center, are similarly at capacity and struggling to serve pregnant patients. In the South, only one hospital, Mubarak Hospital, remains, WH said, “but the number of cases is significantly higher and greater than the number of beds.”

If women and their newborns survive these conditions, their struggles continue long after delivery. “You find [new] mothers all the time suffering from imbalance, dizziness, and inability to breastfeed as a result of malnutrition, [that's] also reflected on the newborns,” PFPPA care worker EG said. Starvation and universal malnutrition make it almost impossible for mothers to feed and care for themselves let alone their babies. NS says they “met a woman who was only able to give her four-month-old baby tea, as nothing else was available.” When formula is available, the demand is so high from postpartum mothers being unable to breastfeed that the "price is doubled and most do not have the ability to buy it."

According to Hammad, only two out of 10 "partially functioning" hospitals still provide maternity services, compared to 36 hospitals before October. "We had reports in April that one gynecologist and obstetrician working in a tent in Rafah was receiving up to 70 women [delivering] a day," she said.

That report was before Israel launched its invasion of Rafah in May. The entirely manmade crisis still has no end in sight.