By Hala Allabadi and Salwa Najjab
As escalating violence in Gaza continues for a fourth month, Gaza has descended into one of the world’s most severe humanitarian and health crises. Since October 7, 2023, more than 25,490 Palestinians have been killed, 63,354 have been wounded, and over 10,000 are still buried under the rubble in the Gaza Strip as of January 23, 2024.i Women and girls bear the brunt of the ongoing war on Gaza, accounting for a staggering 70 percent of all casualties reported so far, with two mothers killed every hour since atrocities erupted more than 100 days ago. More than 1.9 million people, 85 percent of the total population of Gaza have been displaced,ii including approximately one million women and girls. As a result, women and girls are seeking refuge in overcrowded shelters that lack essential provisions, such as food, water, healthcare, safety, and privacy, heightening protection risks.iii Furthermore, women are having to make impossible decisions regarding whether to evacuate, how and when they will do so, and where to go, all while grappling with fears of encountering attacks and harassment while on the move. It has been reported that women have also been exposed to violence and harassment by Israeli soldiers while they have been continuously on the move throughout the war.iv
According to UN Women, estimates show that at least 3,000 women may have become widows and heads of households, and at least 10,000 children may now be fatherless.v Women increasingly fear that, in light of food shortages, school closures, and loss of educational opportunities, families will resort to desperate coping mechanisms, including early marriage, especially given the high number of young girls who have lost one or both parents.vi Currently, women and girls are seeking refuge in overcrowded shelters that lack essential provisions, such as food, water, and privacy, heightening protection risks.vii The significant largely displaced population of women and girls, and new female-headed households, have unique and urgent needs and vulnerabilities that must be recognized and addressed.
An escalating mental health crisis in the enclave is vastly overshadowed by the scale of death and destruction caused by more than three months of bombardment. Experts believe that the psychological damage may prove one of the war’s most lasting legacies. Mothers living in Gaza under these indescribable conditions are currently experiencing multiple losses and deteriorating living conditions, including increasing poverty, displacement (in most cases several times), terror, harassment, high stress in managing everyday life with insufficient resources, and a sense of hopelessness. The ongoing exposure to the horrors of this war have exacerbated the mental health needs of women as they navigate anxiety, severe depression, and other forms of mental illness.viii For pregnant women, the situation is doubled, as war trauma is also associated with increased obstetric complications in pregnancy, including miscarriage.ix
For the first time in Gaza’s history, people are facing the looming threat of starvation and famine every day due to unceasing hostilities combined with restricted humanitarian access.x With food insecurity reaching unprecedented levels, women and girls are anticipated to bear the brunt of the situation, given that they frequently prioritize others over themselves when access to food is limited. Similarly, women who head households face security and protection risks while attempting to access food distribution points, making their families particularly vulnerable to severe food insecurity.xi Pregnant and lactating women are particularly at risk of undernutrition or malnutrition, heightening the risk of birth defects or death.xii
Increased risk of infections
According to UNRWA, over 4,600 displaced pregnant women and 400 newborns living in shelters require medical assistance. These shelters, now hosting thousands of displaced people beyond their capacities, are reporting hazardous living situations due to the lack of water and sewage systems and accumulation of waste.xiii With a lack of clean water, the rate of infections will increase among pregnant women, given their increased risk of acquiring infections. Pregnant women are prone to urinary tract infections and vaginitis, both easily treatable with appropriate medication.xiv However, with the lack of access to basic and lifesaving medications, these women will die of preventable diseases, which will ultimately significantly increase maternal mortality. Women in these shelters also face a heightened risk of contracting waterborne diseases due to contaminated water, and with temperatures dropping, the overcrowded living spaces have also raised concerns about the potential spread of respiratory diseases.xv With an overwhelmed hospital system that is quickly running out of medical supplies, women with either their newborns or unborn children are becoming the overlooked victims of this war.
Lack of hygiene supplies
Overall, in Gaza, there are over 690,000 adolescent girls and women of reproductive age who require menstrual hygiene products and access to clean water, toilets, and privacy.xvi Due to inadequate access to water, sanitation, hygiene facilities, and women’s health kits, women and girls find themselves in an untenable situation, lacking the means to effectively address menstrual hygiene.xvii With no access to sanitary pads, women and girls in Gaza have been pushed to use unsafe alternatives, such as newspapers, worn fabrics, or cardboard, all of which can expose them to serious health problems, including reproductive and urinary tract infections, which in turn may affect the uterus, especially in unmarried women.xviii This becomes a bigger issue, as there is currently a lack of medications in Gaza to treat women if they develop any infections or other health conditions as a result of unsafe alternatives to sanitary pads. In addition, some women are resorting to contraceptive pills as a means to interrupt their menstrual cycle, which may lead to psychological and physical impacts on women in the future. Women in shelters have reported that they face significant embarrassment within their family and the displaced community, as they are having to use makeshift alternatives to sanitary pads.xix Furthermore, the situation in shelters is so catastrophic for women that reports from the ground in the shelters state that women are refusing to eat and drink not only because there is not enough to go around, but also to limit the time spent having to use the unsanitary restroom facilities.xx
Destruction of healthcare systems
Across Gaza, 50,000 women are pregnant and over 180 babies are delivered every day, according to the World Health Organization.xxi Most of the healthcare facilities have been destroyed, and the remaining facilities are overwhelmed with treating severe injuries and trauma patients, forcing many pregnant women to give birth in shelters or in their homes with no health professional present. As a result of being displaced several times, many pregnant women have lost contact with their prenatal care clinics and their doctors. Without access to a trained health worker or midwife, childbirth can threaten the lives of both the mother and child and increase the risk of perinatal and maternal mortality and morbidity. Amid the raging war, women are reportedly giving birth on rubble-filled floors with some women bleeding to death while giving birth or others having their wombs removed after birth due to heavy bleeding, a situation that could have been avoided if proper health care was available.xxii
In addition, hospitals have now also run out of anesthetics, and pregnant women are being forced to undergo emergency C-sections without anesthesia,xxiii further raising the risks of maternal and neonatal death. Furthermore, the blockade imposed on the Gaza Strip has limited the entrance of critical supplies, with fuel shortages leading to power outages and the inability to operate lifesaving medical equipment such as ventilators and incubators.xxiv Medical doctors on the ground in Gaza report that “premature and underweight babies have little to no chance of survival” because of these limitations. Healthcare facilities and pharmacies are running out of medications, including painkillers, and there are no lifesaving medications such as surfactants to treat newborns or premature babies.xxv It is not only pregnant women whose care is disrupted, but also those who need other reproductive services. For example, women who are receiving hormone therapy or scheduled to have fibroids treated have seen their care disrupted and, in many cases, cut off. Similarly, women with preeclampsia and other complications do not even get admitted these days, as there is no capacity at any of the healthcare facilities.xxvi In short, no medical services are available for women with high-risk pregnancies, and few are offered to pregnant women in general.
Catastrophic impact on women with disabilities and women suffering from chronic diseases
Women with disabilities in Gaza are facing a double burden during this aggression while they face physical restrictions in mobility. Access to health services, including rehabilitation, is especially challenging for persons with disabilities due to stigma, discrimination, and significant physical, economic, and information barriers. Now that demand for aid is skyrocketing in Gaza, and new casualties occur as hostilities escalate, difficulties for people with disabilities to access these services are intensifying. Women with disabilities are also facing challenges in waiting in long queues to access water and food, as well as other challenges in protecting themselves from violence. Many cannot evacuate, particularly those with reduced mobility. Others are separated from their families whom they rely on for care and basic daily living. For those who do manage to flee, their assistive devices are often destroyed or left behind in the chaos. Most shelters are not adequately equipped to meet the needs of people with disabilities.xxvii Emergency shelters lack the necessary mattresses and medical beds, leading to ulcers and other health problems that cannot be treated in unsterile conditions. Furthermore, the food distributed does not meet the needs of persons with swallowing difficulties. In addition, displaced women grappling with chronic disease have been left stranded without access to treatment and their medications. In particular, cancer patients are living under catastrophic health conditions as a result of the mass displacement and lack of access to the specialized and crucial treatments that they need, such as chemotherapy and the combination of several medications.xxviii These deficiencies pose a significant threat to the well-being and quality of life of elderly women with chronic diseases and disabilities.
As the war continues, Gazans are witnessing a near-total breakdown of both personal and collective coping strategies. Overcrowding and lack of privacy in temporary shelters, coupled with scarce resources, can lead to disputes and violence, including gender-based violence (GBV). According to UN Women, there is deep concern over the increasing accounts of unconscionable sexual violence and other forms of GBV. UN Women has documented that Gaza’s only two women’s shelters available for women exposed to violence, both located in Gaza City, are now closed, and telecommunications and electricity blackouts are severely restricting remote GBV service provision.
In addition to mothers, pregnant women, and women caregivers, professional women, including doctors, nurses, journalists, and teachers, have sacrificed their lives in caring for others in Gaza. The implications of this war on women, the backbone of the society, will likely be transmitted to the community as a whole, not only temporarily during the war but for many years to come and to future generations.
i ReliefWeb, “Flash Update #100: Hostilities in the Gaza Strip and Israel,” OCHA, January 23, 2024.
ii “As Israel’s Aerial Bombardments Intensify, ‘There Is No Safe Place in Gaza,’ Humanitarian Affairs Chief Warns Security Council,” United Nations, January 12, 2024.
iii UN Women, “Gender Alert: The Gendered Impact of the Crisis in Gaza,” UN Women Regional Office for the Arab States, January 19, 2024.
iv “Press release: Two Mothers Are Killed in Gaza Every Hour as Fighting Exceeds 100 Days,” UN Women, January 19, 2024.
vi UN Women, “‘Scared, Exhausted, and Expecting the Worst’ – Women in Gaza Describe Humanitarian Crisis, UN Women – Feature Article,” UN Women Arab States, January 19, 2024
vii UN Women, “Press release: UN Women Report Reveals Devastating Impact of the Crisis in Gaza on Women and Girls,” October 20, 2023.
viii ReliefWeb, “Gaza: ‘Profoundly Alarming’ Mental Health and Medical Needs,” OCHA, January 5, 2024.
ix Raija-Leena Punamäki et al, “Maternal Pre- and Postnatal Mental Health and Infant Development in War Conditions: The Gaza Infant Study,” Psychological Trauma, 10(2), 2018.
x “Over One Hundred Days into the War, Israel Destroying Gaza’s Food System and Weaponizing Food, Say UN Human Rights Experts,” UN Office of the High Commissioner for Human Rights, January 16, 2024.
xi ReliefWeb, “Flash Update #105: Hostilities in the Gaza Strip and Israel,” OCHA, January 29, 2024.
xii Zoe Magee and Ruwaida Amer, “The Perils of Giving Birth in War-Torn Gaza,” ABC News, January 26, 2024.
xiii “Joint Statement by UNICEF, WHO, UNFPA and UNRWA on Women and Newborns Bearing the Brunt of the Conflict in Gaza,” UNICEF, November 3, 2023.
xiv ReliefWeb, “30 Days Too Many for Women and Girls in Gaza,” OCHA, November 7, 2023.
xv “Women and Newborns Bearing the Brunt of the Conflict in Gaza, UN Agencies Warn,” WHO, November 3, 2023.
xvi ReliefWeb, “UNICEF, State of Palestine Humanitarian Report No. 16 (Escalation): 18–24 January 2024,” January 27, 2024
xvii Aya Batrawy and Abu Bakr, Bashir, “Another Layer of Misery: Women in Gaza Struggle to Find Menstrual Pads, Running Water,” NPR, January 11, 2024.
xviii Linah Alsaafin and Ruwaida Amer, “No Privacy, No Water: Gaza Women Use Period-Delaying Pills amid Israel War,” Al Jazeera, December 2023
ixx Rachel Dixon, “‘We Feel Paralysed’: Women in Gaza Use Strips of Tents as Period Products Due to Israel Blockade,” ITVNews, January 20, 2024
xx “Bombardment, Displacement, and Collapsed Healthcare: A Crisis for Women and Girls in Gaza,” UNRWA, January 23, 2024.
xxi “Women and Newborns Bearing the Brunt of the Conflict in Gaza, UN Agencies Warn,” WHO, November 3, 2023.
xxii Zena Chamas, “Pregnant Mothers in Gaza Reportedly Facing Caesareans without Anaesthetic, Emergency Hysterectomies and Death,” ABC Australia News, December 28, 2023.
xxiii “Gaza: Collapsing Medical Conditions Exacerbate Risks of Maternal and Newborn Mortality,” Care International, October 31, 2023.
xxiv “Over 100 Incubator Babies at Risk Due to Israel’s Fuel Cuts to Gaza: UN,” Al Jazeera, October 22, 2023.
xxv Dr. Nabil AlBarqouni, Maternal and Neonate expert in Gaza, in an interview, December 2023.
xxvi ReliefWeb, “Babies Dying from Preventable Causes in Besieged Gaza – Oxfam,” OCHA, November 23, 2023.
xxvii Mallory Moench, “People With Disabilities in Gaza Face Additional Barriers in the Israel-Hamas War,” Time, November 5, 2023.
xxviii Linah Alsaafin and Ruwaida Amer, “Out of Medicines, Care: Gaza’s Cancer Patients Face Death amid Israel War,” Al Jazeera, November 14, 2023.