Walaa, a displaced Palestinian woman, holds her newborn in a UNRWA warehouse on Monday in Rafah, southern Gaza. (Loay Ayyoub for The Washington Post)
8 min

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 Hamas 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. Forty percent of pregnancies are high-risk, 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 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, hospitals often lacked adequate equipment and training for neonatal staff, according to Medical Aid for Palestinians, and more than half of pregnant women were anemic.

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 accused Israel before the International Court of Justice this month of committing genocide 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 coronavirus 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.”