When her uncle Wissam, a doctor, arrived at the tent where she had lived for weeks in the cold, he said, he saw that time had run out. She kept telling him: “I'm having a baby now.” It was dark, and she was afraid.
His cell phone flashlight was all they had to see.
The humanitarian catastrophe caused by Israel's three-month military campaign against Hamas in Gaza counts some 52,000 pregnant women among its biggest victims. As air strikes push 1.9 million people into an ever-smaller corner of the besieged enclave, disease is spreading, famine looms, anemia levels are so high that the risk of postpartum hemorrhage has skyrocketed, and breastfeeding is often impossible. Forty percent of pregnancies are high risk, according to estimates from CARE International.
Prenatal care is almost non-existent – and what remains of Gaza's hospital network is on its knees, at 250 percent of capacity, exhausted from treating large numbers of casualties due to Israeli bombing. The number of women giving birth outside medical facilities – in camps for displaced people, and even on the streets – is much greater than their number inside them.
Damage to facilities and communications outages – the Strip lost mobile phone service for a week this month – left Gaza’s Ministry of Health unable to collect data Reliable data on infant or maternal deaths during conflict. But doctors and aid groups say miscarriages and stillbirths have risen.
“What we know about pregnancy-related complications is that they are difficult to prevent anywhere, but the way we save the lives of the woman and the newborn is to treat complications quickly,” says Rondi Anderson, a midwifery specialist at Project Hope. Aid group.
“So the women who get emergency care are the ones who survive,” she said. “The woman who never dies.”
The only place Wissam could find to deliver his terrified niece's baby was a patch of cold ground between the tents. Aid workers hung up bedsheets to give the woman some privacy. No one could contact Walaa's husband, and her mother was so afraid that she sometimes had to look away. They cut the boy's umbilical cord with an unsterile scalpel and filled tin cans with hot water to keep him warm. He weighed 7 pounds and was named Symbolic Loyalty.
The family spoke on the condition that only their first names be used because they fear for their safety if Israeli forces enter the town.
They fled their home in northern Gaza so suddenly that no one thought to bring clothes for the child. This week, Ramzi was wrapped in underwear a size larger than another child at the camp. He sobbed as Walaa, still in pain from the tear during childbirth, gingerly pulled herself upright.
The blockade imposed by Israel and Egypt for 16 years after Hamas took control of Gaza has made pregnancy and childbirth more difficult for expectant mothers. Before the current conflict, hospitals often lacked proper equipment and training for neonatal workers, according to Medical Aid for Palestinians, and more than half of pregnant women suffered from anemia.
Hamas fighters left the Strip on October 7 to kill about 1,200 people in Israel and take 240 others hostage. Israel responded with a bombing campaign and ground war to eliminate Hamas, killing nearly 25,000 Palestinians, most of them civilians, so far.
South Africa's legal team, which accused Israel at the International Court of Justice this month of committing genocide during the conflict, said obstructing life-saving treatment since October 7 amounted to preventing births.
An Israeli lawyer described claims that it is obstructing the delivery of food, water, fuel and other vital supplies to Gaza as “one-sided and partial,” and said that Israel is working “around the clock” to help increase the amount of aid it pockets.
Hanaa Al Shawa (23 years old) gave birth to her first child, Ayla, during the Corona virus pandemic, and said that the little girl brought her family “a ray of hope.” Shawa and her husband, Mustafa, 25, were thrilled when they learned in July that another child was on the way. The war began in October, and the future they dreamed of collapsed. “I felt so happy,” Shawa recalls. “I did not realize that this joy would turn into so much suffering.”
The United Nations Children's Fund (UNICEF) reported on Friday that nearly 20,000 children were born in Gaza during the first 105 days of the war. The United Nations Children's Fund said that delays in delivering life-saving supplies had caused some hospitals to perform caesarean sections without anesthesia. Spokeswoman Tess Ingram said she met a nurse at the Emirates Maternity Hospital in Gaza who helped perform post-mortem caesarean sections on six deceased women.
“Seeing newborns suffer while some mothers bleed to death should keep us all up at night,” Ingram told reporters on Friday. “In the time it took to bring this to you, another child would have likely been born, but in what?”
“Becoming a mother should be a time to celebrate,” she said. “But in Gaza, there is another child consigned to hell.”
For the five pregnant women interviewed by Washington Post reporters, the fear that neither the mother nor the baby would survive dominated their waking thoughts — and appeared in nightmares, too.
Shawa and Mustafa left their home on Yarmouk Street in Gaza City in the second week of October. The Israeli army ordered 1.1 million people in northern Gaza to move south for what it described as their safety.
“I was afraid I would miscarry because of the force of the missiles,” she said.
Several pregnant women made the 20-mile trek from north to south on foot, their legs swollen and their joints heavy as they carried their luggage, three women who made the trip told The Washington Post.
When Ayla was born, her family had a room full of toys ready for her. She added that the room in which her second child, a girl, will spend her first weeks, at a friend’s house in the Tal Al-Sultan area, is contaminated with asbestos.
“We carried Ayla here with only the clothes she was wearing, and we don’t even have anything warm for her,” Shawa said. “If I can't provide for her, what will I do for my next child?”
Increasing food scarcity and malnutrition can lead to potentially life-threatening complications during birth and lead to low birth weight, wasting, failure to thrive and delayed growth.
Al-Shawa said that she has only eaten canned food, and has not been able to get fruits or vegetables, since she left her home three months ago. Doctors said her iron levels were low and her blood pressure was high. Mustafa searches daily but has not found a suitable medication to control it.
Saja Al-Shaer, 19, began to feel that she was too young to become a mother. Her weight dropped to less than 110 pounds, she was anemic, and her husband couldn't get her medications either. “He spent three days knocking on the doors of pharmacies,” she said. “I don't know if I'll ever see this baby or not.”
In late December, doctors at Al-Aqsa Hospital, 11 miles to the north, received a pregnant woman whose high blood pressure had led to preeclampsia and bleeding in her brain, according to Deborah Harrington, a British obstetrician who volunteered at the hospital as a medical specialist. Aid to the Palestinian team.
The baby was delivered by cesarean section, Harrington said. The mother was still on life support when the doctor left two weeks later.
“These women present it in a much more serious situation,” Harrington said. “They're not getting treatment for high blood pressure. They're not being screened for diabetes. If they're diabetic, they're not getting treatment for diabetes.”
“They know that actually getting care, as is often the case for women in conflict, is really difficult and risky. At night, there is often no light, so getting around is very difficult. You can't call an ambulance because there's no signal “The women I saw were really scared.”
From the corner of the dank room where Walaa was caring for Ramzi on Friday, she worried about where they would find clean water or formula for the babies. Her family searched everywhere for diapers, but came up empty. In Tal al-Sultan, Shawa was focusing on rumors that the Israeli army would order them to evacuate again. Walking, being pregnant, feeling like nothing around her was healthy—all of that terrified her.
But she made one decision that no shortage or military orders could be changed. She was going to name her daughter after her sister-in-law, who was killed in an Israeli air strike weeks ago while trying to find shelter for her children.
She said the girl would be called Heba. In Arabic, it means a blessing from God.
Mahfouz reported from Cairo and Harb from London. Louay Ayoub from Rafah contributed to this report.
