Yehia Hamuda was born two months prematurely in northern Gaza, but after Israeli raids on the hospital, he was spirited south to Rafah. There, staff at al-Emirati hospital are caring for him while parents Sondos and Zakaria are stuck in Jabalia, about 32 kilometres away on the other side of an Israeli checkpoint.Mohammed Salem/Reuters
Being a midwife, helping bring new life into the world, should be a joyous job. But for Hadeel Abo Seif, delivering babies in Gaza these days often comes with misery and sometimes tragedy.
Ms. Abo Seif, who works at the al-Awda Hospital in central Gaza, says she helps deliver 15 babies on an average day, and the United Nations Population Fund (UNFPA) says 180 children are born daily across the besieged territory.
That’s a pace that Gaza’s shattered health care system can’t handle, especially while it’s still dealing with hundreds of dead and wounded every day from the relentless Israeli assault, which is aimed at destroying the Hamas movement and rescuing the dozens of Israeli hostages Hamas has been holding since its Oct. 7 attack on Israel. The initial Hamas attack killed more than 1,100 Israelis and foreigners.
Smoke rises from an air strike in Rafah on May 7, when Israel launched a ground assault in parts of the city.Hatem Khaled/Reuters
Hopes for at least a temporary respite in the fighting took a serious blow Monday as Israel ordered the partial evacuation of the southern city of Rafah and commenced an offensive Tuesday that saw it take control of the main portal for humanitarian aid, the Rafah crossing between Gaza and Egypt. The move appeared to signal the start of a long-threatened invasion of the city of Rafah, where more than a million people are crowded, many living in tents, as well as the collapse of ceasefire talks.
On Wednesday, the UNFPA said that the main maternity hospital in Rafah had stopped admitting patients, telling Reuters that Al Helal Al Emirati Maternity Hospital had been handling some 85 births each day.
The fighting has already driven almost 80 per cent of Gaza’s prewar population of 2.3 million from their homes – with many taking refuge in Rafah – and has repeatedly seen even hospitals turned into battlefields.
“The focus is placed on treating the wounded – at the expense of mothers and babies. Women just deliver and they have to go home two hours later, and there’s no follow-up after they leave. Some mothers develop bleeding after they go home. Babies go home suffering of fever and diarrhea,” said the 29-year-old Ms. Abo Seif, who said she has worked as a midwife since 2020.
Ms. Abo Seif said the conditions are so perilous that she saw two infants die right in front of her earlier this year. She said the al-Awda Hospital – one of just five still functioning in Gaza, according to the Palestinian Ministry of Health, compared with 34 before the war – is lacking “incubators, gauze, medications, everything.”
“Most of the newborns suffer from malnutrition, because of the malnutrition of the mothers, and from poor respiration because of the dust created by the bombings,” she said.
“There is no postnatal care, no vaccinations for the newborns. Those living in tents have to go back home to tents.”
Sabreen was delivered by C-section in Rafah minutes before her mother, Sabreen al-Sakani, died of her injuries from an air strike. Doctors used a hand pump to resucitate the baby.AFP via Getty Images
Baby Sabreen's uncle crouches by her grave on April 26, after she died of what doctors said was respiratory distress.Mohammed Salem/Reuters
The plight facing women and children in Gaza was tragically highlighted late last month by the case of Sabreen al-Sakani, who was 30 weeks pregnant when she was killed in an April 21 Israeli air strike on Rafah. The air strike also killed her husband and their four-year-old daughter. Her second daughter, also named Sabreen, was rescued from her mother’s womb – using a hand pump to push air into the baby’s lungs – but she died five days later. Doctors at the badly overstretched Emirati Hospital in Rafah said Sabreen died of severe respiratory distress resulting from her premature birth.
Though the number of people killed in Israel’s war on Gaza is hotly disputed, the Palestinian Ministry of Health says 34,000 deaths have been recorded so far – and that more than two-thirds of those were women and children. UN Women, the United Nations agency charged with promoting gender equality, says 10,000 women, including 6,000 mothers, have been killed in the conflict.
Dominic Allen, the Palestine representative for the UN Population Fund (UNFPA), spent 10 days in Gaza last month. He said he encountered “indescribable levels of desperation and fear,” particularly among women and girls. “There’s 1.1 million women and girls who are terrified right now. This is a protection crisis as well as a food and water and medicine and medical aid and shelter crisis,” Mr. Allen said in an interview at his office in East Jerusalem.
A lack of any kind of safe space, combined with overcrowded UN Relief and Works Agency facilities – schools and warehouses that have been converted into makeshift refugee camps – have created special risks for women and girls, ranging from a lack of sanitation to a rise in gender-based violence. UNRWA spokeswoman Tamara al-Rifai said there was often only one toilet for every 880 people at some facilities.
Mr. Allen said he had heard stories of women using canvas from their tents as menstrual pads, while Ms. al-Rifai told The Globe that doctors were seeing a spike in urinary tract infections among women, who were cutting back on eating and drinking in order to avoid using the unsanitary camp toilets.
“The women I met asked for dignity. There is no dignity for them or their children,” Mr. Allen said. “There is no dignity in Gaza right now.”
A woman and babies reach the central Gaza Strip after fleeing Gaza City's al-Shifa hospital. Displacement has left Palestinians vulnerable to malnutrition and disease.AFP via Getty Images
Enabling the safe delivery of babies in the besieged territory is another challenge that aid agencies are grappling with, as malnutrition rises – the UN has warned of impending famine in the north of the strip – and the medical system is under staggering pressure.
“Doctors and medical directors and midwives are telling us that they’re seeing more complications. A doctor in the Emirati hospital said, ‘We don’t see normal-size babies any more. We don’t see big babies any more.’ And this is partly due to the huge amount of need for food and nutrition,” Mr. Allen said. “They see increased numbers of stillborn babies and neonatal deaths. Each one is a tragedy, but seeing more of those is horrific to hear.”
In an effort to help more mothers safely give birth, the UNFPA recently deployed a 40-foot shipping container as a mobile maternity clinic, complete with an operating theatre and delivery room, to a field hospital operated by the International Medical Corps in Rafah. Two more mobile clinics are stationed on the Egyptian side of the Rafah border crossing, where they’ve been waiting more than a week for Israeli authorities to approve their entry into Gaza.
Aid agencies also complain of entire convoys being turned back because items in kits to help midwives deliver babies outside of hospitals, such as rechargeable batteries for flashlights or small tubes of hand creams that contain glycerin, were deemed dual-use. Dual-use items are those that could conceivably have some military purpose.
Shimon Freedman, a spokesman for COGAT, the Israeli government agency that implements policies in Gaza and the West Bank, which is also under Israeli military occupation, acknowledged that dual-use items had caused delays, but said that almost all trucks of aid eventually passed inspection.
“If there is a dual-use item that hasn’t been approved, what will happen is the aid doesn’t go to waste. What happens is that that truck needs to be repacked without the items that haven’t been approved. And then that truck can be inspected again and make its way into the Gaza Strip,” Mr. Freedman said.
Children navigate the muddy streets of a tent camp in Rafah, whose crossing with Egypt has been the main point of entry for aid into Gaza.Mohammed Salem/Reuters
Everything will get far worse, Mr. Allen predicted, as the Israeli military continues to deliver on its threat to invade Rafah. Prime Minister Benjamin Netanyahu’s government says the city is the last Hamas stronghold in Gaza, and the likely location of the movement’s leadership and the more than 100 Israelis it is still holding hostage.
“Our hope is that all efforts will be made so that it doesn’t happen, because where will the people go? People have been displaced five, six times, and they’ve managed to cobble together some form of life in the shelters,” Mr. Allen said, speaking before the assault on Rafah began. “What if a ground incursion happens? Where will they go? The density of the population – how will how will they move? I mean, it’s unthinkable.”
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