Intended for healthcare professionals

Opinion BMJ Annual Appeal 2023-24

Pregnant women in Gaza face perilous conditions as maternity services and infrastructure crumble

BMJ 2023; 383 doi: (Published 07 December 2023) Cite this as: BMJ 2023;383:p2895
  1. Soraida Hussein-Sabbah, gender and advocacy specialist at ActionAid Spain

A ceasefire is urgently needed for the survival and safety of women and their babies, writes Soraida Hussein-Sabbah

For the estimated 50 000 pregnant women trapped in Gaza, the right to give birth in a safe place with appropriate healthcare has become a distant dream.1 Only a permanent ceasefire will ensure they can seek and receive the medical care they need in safety.

Gaza has many doctors, nurses, and midwives, as well as public and private maternity hospitals. But after weeks of relentless bombardment, only nine of the occupied territory’s 36 hospitals are still operational, and only at limited capacity. Travelling to seek help is extremely dangerous and largely impossible since roads and vehicles have been destroyed by airstrikes and there is no fuel.

Any woman who finds herself near a hospital that is still operating is considered extremely lucky. In the north of Gaza, the only hospital that has been able to provide maternity services is ActionAid’s partner, Al-Awda hospital. The facility has been bombed and ran out of fuel completely in mid-November and yet has continued—against all the odds—to keep treating patients and delivering 20 babies a day on average.

Doctors at the hospital have been sending us regular updates on the unbearable conditions they are having to work under. With no fuel, staff are having to rely on batteries to power medical equipment, but they cannot run incubators or artificial respirators. Medical supplies are running desperately low and there is very little blood available for transfusions. There is a severe shortage of anaesthesia and pain killers, as well as medicine needed for treating potentially life-threatening pregnancy complications, such as magnesium sulphate for pre-eclampsia.

As one of the last functioning hospitals in the north, Al-Awda has been receiving increasing numbers of injured people, hugely adding to workloads. Hospital staff have been working around the clock without a break since the crisis started on 7 October 2023, continuing to treat patients with heroic bravery despite living with fear, uncertainty, and in many cases, while coping with bereavement.

Staff are working under the constant threat of danger, against a backdrop of near-continuous bombardment around the hospital. In early November eight staff members were injured when shrapnel flew inside the hospital, and ambulances and vehicles were damaged.

Tragically, on Tuesday 21 November, three doctors were killed when Al-Awda was hit by bombing. Just hours before the pause in fighting came into effect on the morning of Friday 24 November, facilities at the hospital were hit again, causing serious damage to a pharmaceuticals warehouse, an accommodation building, solar panels, and ambulances. Despite this, the hospital is continuing to provide services. The bombing is yet another potential breach of international humanitarian law in a crisis where the rights of patients—including pregnant women, new mothers, and their babies—to access lifesaving care are being violated daily. Healthcare workers, ambulances, and hospitals are never a legitimate target—they must be respected and protected under international law.

For pregnant women in Gaza, the main challenge right now is getting enough food and water. Around 70% of the population is having to drink brackish or contaminated water.2 Most bakeries and shops are no longer functioning because of damage from airstrikes or lack of fuel and are running out of essentials such as wheat flour, dairy products, water, and eggs—many have closed altogether. The amount of aid that has entered Gaza so far is nowhere near enough to meet the demand. For pregnant and lactating women, the lack of food and water can have serious health consequences: one mother told ActionAid that her child had slowly begun to develop a yellow appearance because of a lack of breast milk.

The risk of illness and infection is high because of unclean conditions, with much of the population either living in severely overcrowded shelters or sleeping in makeshift tents in the street. United Nations shelters have on average just one shower per 700 people and one toilet per 150 people, and cases of skin diseases and diarrhoea have increased dramatically.3 Those living outside in tents, meanwhile, are now vulnerable to the cold. Many families left their homes with only the summer clothes they were wearing. Without blankets, clothes, or even food, they are freezing and their health is at risk.

After weeks of constant shelling, the humanitarian pause that was agreed as part of the hostage deal—which ended on 30 November—was welcomed. But it was nowhere near long enough to get the amount of aid required into Gaza and to deliver it to those who need it most. Without a permanent and immediate ceasefire, the pause has been nothing more than a brief moment of respite from the bombing.

The BMJ’s 2023 annual appeal supports ActionAid’s work with women and girls in more than 45 countries to help achieve social justice and gender equality and to eradicate poverty. Shifting the power and working directly with women and girls, including in humanitarian emergencies, means that women’s specific health needs are less likely to be overlooked, putting them in a better position to build the future they deserve.

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  • Competing interests: Soraida Hussein-Sabbah declares that she has no competing interests.

  • Provenance and peer review: commissioned, not externally peer reviewed.