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Israeli forces gather at the border with Gaza, southern Israel - 25 Apr 2024

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Middle East conflict live updates: WHO says health services in south Gaza will run out of fuel in three days

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Loay Ayyoub

JERUSALEM — Walaa didn’t expect the birth of her fourth child to spark abject fear. But by the time her contractions started, the whole family was frantic.

There were no ambulances to be seen in the streets of Gaza’s Rafah City, she said, now so crammed with displaced families that there was barely any food left available for the 27-year-old.

When her uncle Wissam, a doctor, reached the tent where she had lived for weeks in the cold, he said, he could see they had run out of time. “I’m having the baby now,” she kept telling him. It was dark, and she was scared.

His cellphone flashlight was all they had to see by.

The humanitarian catastrophe caused by Israel’s three-month military campaign against <a href="https://www.washingtonpost.com/israel-hamas-war/" target="_blank" class="contextual_link">Hamas</a> in Gaza counts some 52,000 pregnant women among its greatest victims. As airstrikes push 1.9 million people into an ever-smaller corner of the besieged enclave, disease is spreading, famine is looming and levels of anemia are so high that the risk of postpartum hemorrhage has soared and breastfeeding is often impossible. <a href="https://www.care-international.org/news/gaza-100-days-urgent-focus-maternal-and-reproductive-health-needed-4" target=_blank>Forty percent of pregnancies are high-risk</a>, CARE international estimates.

Prenatal care is almost nonexistent — what remains of Gaza’s hospital network is on its knees, at 250 percent capacity and consumed with treating mass casualties from Israeli bombing. Far more women are giving birth outside of medical facilities — in displacement camps, even in the street — than inside them.

Damage to facilities and communications blackouts — the strip lost cellphone service for a week this month — have left Gaza’s health ministry unable to compile<b> </b>reliable data for infant or maternal mortality during the conflict. But doctors and aid groups say miscarriage and stillbirths have spiked.

“What we know about pregnancy-related complications is that it’s hard to prevent them in any setting, but the way that we save a woman and newborn’s life is we treat the complication quickly,” said Rondi Anderson, a midwifery specialist for the Project HOPE aid group.

“So women with access to emergency care are the ones that live,” she said. “Women that don’t, die.”

The only place that Wissam could find to deliver his terrified niece’s baby was a spot of cold earth between the tents. Aid workers hung bedsheets to give the woman a modicum of privacy. No one had been able to contact Walaa’s husband, and her mother was so scared that at times she had to look away. They cut the boy’s umbilical cord with an unsterilized scalpel and they filled tin cans with hot water to keep him warm. He weighed 7 pounds and Walaa named him Ramzy.

The family spoke on the condition that only their first names be used because they feared for their safety in the event that Israeli troops entered the town.

They fled their home in northern Gaza so abruptly that no one thought to grab clothes for the baby. This week, Ramzy was swaddled in a onesie outgrown by another child in the camp. He wailed as Walaa, still in pain from tearing during the birth, gingerly pulled herself upright.

The 16-year blockade imposed by Israel and Egypt after Hamas won control of Gaza had already made pregnancy and childbirth more difficult for expecting mothers. Before the current conflict, <a href="https://www.map.org.uk/news/archive/post/1504-watch-addressing-gaps-in-neonatal-physiotherapy-services-in-gaza" target="_blank">hospitals often lacked adequate equipment and training for neonatal staff</a>, according to Medical Aid for Palestinians, <a href="https://reliefweb.int/report/occupied-palestinian-territory/hidden-hunger-micronutrient-deficiencies-west-bank-and-gaza-enar" target="_blank">and more than half of pregnant women were anemic</a>.

Hamas fighters streamed out of the enclave on Oct. 7 to kill around 1,200 people in Israel and take another 240 hostage. Israel responded with a bombing campaign and ground war to eradicate Hamas, killing almost 25,000 Palestinians, most of them civilians, to date.

The South African legal team that <a href="https://www.washingtonpost.com/world/2024/01/11/south-africa-icj-hearing-israel-genocide/" target="_blank">accused Israel before the International Court of Justice this month of committing genocide</a> during the conflict argued that the obstruction of lifesaving treatment since Oct. 7 amounts to preventing births.

A lawyer for Israel called allegations that it is obstructing the delivery of food, water, fuel and other supplies critical for Gaza “tendentious and partial,” and said it was working “around-the-clock” to help scale up the volume of aid making it into the enclave.

Hanaa al-Shawa, 23, gave birth to her first child, Ayla, during the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> pandemic, and the little girl, she said, brought her family a “glimmer of hope.” Shawa and her husband Mustafa, 25, were ecstatic when they learned in July that another child was on the way. The war began in October, and the future they dreamed of fell apart. “I had felt overwhelming joy,” Shawa recalled. “I did not realize that this joy would turn into great suffering.”

The World Health Organization said Wednesday that the <a href="https://www.washingtonpost.com/world/2024/05/08/israel-hamas-war-news-gaza-palestine/" target=_blank>closure of the Rafah border crossing </a>meant health services in southern Gaza would run out of fuel in three days. Israel said that it has reopened a separate border crossing, Kerem Shalom, another key entry point for humanitarian aid for the Gaza Strip, that was closed over the weekend after a <a href="https://www.washingtonpost.com/world/2024/05/05/israel-hamas-war-news-gaza-palestine/?itid=lk_inline_manual_1" target=_blank>deadly Hamas rocket attack</a>.

<a href="https://news.un.org/en/story/2024/01/1145677" target=_blank>Nearly 20,000 babies</a> were born in Gaza during the first 105 days of the war, UNICEF reported Friday. Delays in the delivery of lifesaving supplies, the U.N. children’s agency said, have left some hospitals performing Caesarean sections without anesthetic. Spokeswoman Tess Ingram said she met a nurse at Gaza’s Emirati maternity hospital who had helped with postmortem Caesareans on six dead women.

“Seeing newborn babies suffer while some mothers bleed to death should keep us all awake at night,” Ingram told reporters Friday. “In the time it has taken to present this to you, another baby was likely born, but into what?”

“Becoming a mother should be a time of celebration,” she said. “But in Gaza it’s another child delivered into hell.”

For the five pregnant women interviewed by Washington Post reporters, fear that mother or baby might not survive suffused their waking thoughts — and made appearances in nightmares, too.

Shawa and Mustafa left their home in Gaza City’s Yarmouk Street in the second week of October. The Israel Defense Forces had ordered 1.1 million people in northern Gaza to move south for what it described as their own safety.

“I was afraid that I would miscarry because of the power of the rockets,” she said.

Many pregnant women made the 20-mile journey from north to south on foot, their legs swollen and joints heavy as they carried their luggage, three women who made the journey told The Post.

When Ayla was born, her family had a room full of toys ready for her. The room in which Shawa’s second child, a girl, will spend her first weeks, in a friend’s home in the Tel al-Sultan area, is tainted with asbestos, she said.

“We carried Ayla here in just the clothes she was wearing, and we don’t even have anything warm for her,” Shawa said. “If I’m unable to provide for her, what will I do for my next child?”

Rising food scarcity and malnutrition can cause potentially life-threatening complications during childbirth and lead to low birth weight, wasting, failure to thrive and developmental delays.

Shawa said she had only eaten tinned food, with no access to fruit or vegetables, since she left her home three months ago. Doctors have said her iron levels are low and her blood pressure is high. Mustafa searches daily but has found no suitable medication to control it.

Saja Al-Shaer, 19, started to feel like she was too young to become a mother. Her weight had dropped below 110 pounds, she was anemic, and her husband had not managed to get her medication, either. “He spent three days knocking on the doors of pharmacies,” she said. “I do not know if I will see this child or not.”

In late December, doctors at the al-Aqsa Hospital, 11 miles to the north, received a pregnant woman whose high blood pressure caused eclampsia and bleeding to her brain, according to Deborah Harrington, a British obstetrician who volunteered at the hospital with a Medical Aid for Palestinians team.

The baby was delivered by a C-section, Harrington said. The mother was still on life support when the physician left two weeks later.

“These women are presenting it in much more extreme condition,” Harrington said. “They’re just not getting hypertensive treatment. They’re not being screened for diabetes. If they’re diabetic, they’re not getting treatment for their diabetes.

“They know that actually accessing care, as it often is for women in conflict, is really difficult and fraught with danger. At night, there is often no light, so moving around is really difficult. You can’t call an ambulance because there’s no signal. The women I saw were really frightened.”

From the corner of the damp room where Walaa was tending to Ramzy on Friday, she worried about where they would find clean water or baby formula. Her family had looked everywhere for diapers, but come up empty. In Tel al-Sultan, Shawa was fixating on rumors that Israel’s army would direct them to evacuate again. The walking, the carrying, the sense that nothing around her was hygienic — it all frightened her.

But she had made one decision that no shortage or military orders could change. She would name her daughter after her sister-in-law, killed in an Israeli airstrike weeks earlier while trying to find shelter for her own children.

The girl, she said, would be called Heba. In Arabic, it means blessing from God.

<i>Mahfouz reported from Cairo and Harb reported from London. Loay Ayyoub in Rafah contributed to this report.</i>

IWMF Courage in Journalism Awards, 2023.

University of Cambridge, BA in Social and Political Sciences

Louisa Loveluck is a London-based correspondent, covering global crises. She was the paper's Baghdad bureau chief from 2019-2023, and before that, covered the war in Syria from Beirut.

Louisa Loveluck

Heba Farouk Mahfouz is a reporter/researcher in The Post’s Cairo bureau. She joined the paper in 2016 and has covered human rights, gender issues, the economy, religious minorities and the war in Gaza. Mahfouz previously reported for the Japanese News Agency in Cairo and Egypt's leading independent news website, Mada Masr.

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