10/25/23, 10:14 AM The Health Crisis Facing Women and Children in Gaza

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The Health Crisis Facing Women and Children in Gaza

By Danielle Cohen, a writer for the Cut who covers pop culture news and entertainment.

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10/25/23, 10:14 AM The Health Crisis Facing Women and Children in Gaza

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In the two weeks since Hamas’ horrific terror attacks, Israeli forces have carried out a brutal assault on Gaza, killing
thousands of civilians and displacing nearly a million Palestinians. Air strikes targeting at least 59 health facilities have
battered medical infrastructure that was already in shambles after 16 years of Israeli occupation. More than 60 percent of
primary health care centers now are shut down, according to the U.N.’s Office for the Coordination of Humanitarian Affairs,
and four hospitals in northern Gaza have been evacuated. Israeli authorities also have imposed a total siege on Gaza’s access
to food, water, electricity, and fuel, plunging the territory into what one United Nations division called an “unprecedented
catastrophe.” Among the civilians suffering: An estimated 84,000 pregnant women, some of whom have already delivered
babies in these conditions, and Gaza’s substantial child population, which accounts for almost half the strip’s inhabitants.

On Wednesday, Israel agreed to let a small number of workers waiting at the Egyptian border cross into Gaza with food,
water, and medicine. It’s unclear how much these resources will help; aid is not expected to reach northern Gaza, where
most of Israel’s attacks have landed and where many are stranded in hospitals and unable to safely evacuate. Dr. Yara M.
Asi, an assistant professor at the University of Central Florida’s School of Global Health Management who’s worked with
Amnesty International on policy reform and outreach, has spent years chronicling the medical crisis in occupied Palestinian
territory through focus groups and interviews on the ground. She shared with the Cut that she’s received harrowing updates
in recent days from colleagues and students in Gaza. “Every bad outcome that you can imagine is going to befall these
people,” she says. Here, she describes the dismal state of maternal and infant health in the strip right now.

Before the current humanitarian crisis, UNICEF estimated that one in four pregnant women in Palestine were
considered high-risk (worldwide, the rate for high-risk complications is only 6 to 8 percent), and the infant mortality
rate was 13 percent. What factors made maternal and infant health in occupied Palestinian territory so dismal
before Israel’s siege started?

Gaza has stubbornly high infant and maternal mortality rates. In the pre-existing siege, Israel created a “dual use” list of
items that they deemed potentially usable for military purposes, which severely limited goods entering the territory. That
includes lumber and concrete for building facilities, so every time the health system gets attacked, it is never fully rebuilt.
What’s left of the deteriorating health infrastructure is primary care services and some trauma-care services. Specialized
reproductive maternal services and children’s health services are much more limited.

If you have any complications in a pregnancy, or if your newborn has complications, you’re facing a health system that
doesn’t have the resources, the hospital beds, the medications, or even basic goods and supplies. People with really
traumatic injuries or chronic illnesses would apply for medical permits, which are Israeli-issued, to get care in Israel or the
West Bank. Those permits can be denied or delayed to the point where you’re missing your appointment. We frequently see
a child’s permit get approved, but the parent is denied. Pregnancy lasts nine months, and these permits can take up to six
months to get. The types of issues that a pregnant woman may have are often emergencies: She wakes up bleeding all of a
sudden, for example. She doesn’t have time to apply for a permit.

Based on what you’re hearing from colleagues, how has the current siege escalated all these preexisting concerns?

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10/25/23, 10:14 AM The Health Crisis Facing Women and Children in Gaza

The updates are harrowing. Hospitals are getting a thousand new patients per day, many with traumatic injuries. They’re
running out of basic dressing and gauze, using cloths and rags and blankets to tourniquet people’s wounds. I’ve heard from
physicians that they’re performing emergency surgeries without anesthetics because they don’t have any. They’re starting to
worry about potential infection rates because their sterilization machines don’t have power. The conditions are unsanitary
because people are splayed everywhere. Oftentimes health workers, who have family at home, are working 24-hour shifts
for four or five days in a row. They’re also scared for their lives.

A lot of doctors have told me they receive children who are the lone survivors of an attack on their families. We’ll have a lot
of orphans coming out of this. They’re triaging people who need immediate care, so we will undoubtedly see babies that
could have been born, that could have thrived under different conditions, die.

A WHO spokesperson has estimated that there are 84,000 pregnant women in Gaza, and the UNFPA says 5,500 are
expected to deliver in the next month. How are these conditions affecting them?

We’re going to see a significant increase in infant and maternal mortality, not just from airstrikes, but from inability to feed
an infant and to deliver in safe, hygienic circumstances. During the last few months of pregnancy, you need not just medical
care, but nutritional food, access to clean water, some feeling of mental safety. If the deprivation continues, pregnant
women are going to start dying of malnutrition and lack of water. There’s an estimated 1 million people displaced, so most
people are going from place to place — they sleep at a school one night, they sleep at an uncle’s house the next. The stress of
going through this is going to have unquantifiable impacts on pregnant women.

I read an interview with a woman who said she could feel her baby moving excessively while she was hearing the bombing,
as though the baby was also hearing and experiencing it. We don’t know how to quantify those kinds of effects on a growing
fetus. This situation is not only going to make miscarriage more difficult, it will undoubtedly increase miscarriage rates as
well. We’ll certainly see increased rates of postpartum depression.

What does delivering a baby in this environment look like?

Women who can get to a hospital to deliver are being discharged almost immediately because they need beds for trauma
cases. They don’t get time to rest, recover, do skin-to-skin, or figure out nursing. They’re not reporting births because the
health registry is completely non-functional right now. Many women are scared to leave their homes because there’s
intermittent bombings, and we know hospitals are not safe. So they’re giving birth at home.

Delivering babies at home isn’t impossible, but in these conditions, with zero access to healthcare and, as of right now, to
clean water, there will be infections and stunted growth. We’ve heard of women who had newborns, and they’re so stressed
that their bodies are unable to produce milk, or the child is so stressed by the sound of airstrikes that they’re unable to latch.
There’s no formula or diapers. Hospitals have no electricity and are running out of fuel for incubators, so newborns who
would otherwise need extra support to help them leave the hospital in relatively good shape — even that moderate level of
protection is gone.

What kind of medical care do women experiencing miscarriages need, and are they able to get any of that right now?

If a woman has a miscarriage at home, she may just need a checkup to make sure she’s not excessively bleeding. Physicians
are not in a position to do those kinds of checks right now. If they’re miscarrying at a more advanced stage of their
pregnancy, you may have women going into labor with stillborn babies. This is incredibly dangerous, especially if the baby is
breech or if there is any issue with the umbilical cord. Women who miscarry have no time to mourn. They’ll probably have
to go through the physical experience and then immediately reprioritize their own survival.

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10/25/23, 10:14 AM The Health Crisis Facing Women and Children in Gaza

What other maternal health concerns can we expect?

Women are typically impoverished in Gaza to begin with. Most women don’t work because the unemployment rate is so
high. If their partner dies — and we’re seeing a lot of men being targeted — then you have a woman who is not just alone,
potentially pregnant or with a newborn, but has zero form of income if and when things slow down. So there’s also some
economic aspects that are going to be a real challenge for women in the aftermath.

It seems like some humanitarian support might be trickling in — Israel has said it will allow some very limited
supplies in from Egypt. Do you see that helping with any of these concerns?

The priority right now is trauma care and restocking the basics. It doesn’t seem like they’re going to funnel that aid to the
north, where they have issued these evacuation orders. That’s where many of the Gaza Strip’s hospitals are, including the
largest hospital, Al-Shifa, and one of the primary cancer centers. If aid is kept in the south to encourage people to
congregate there, it’s not going to help those people at all. They’ve also mentioned that they’re going to ensure this aid is not
used by Hamas or taken by any of the other militant groups. What does that mean in practice? Does that mean that they’re
going to limit the kinds or types of aid that they’re going to let in?

Many hospitals, particularly in north Gaza, have received evacuation orders. How, realistically, can they do that?

You cannot just throw these people in a car and send them to a different hospital. For one, there’s no fuel, so cars aren’t
going anywhere. Two, ambulances are often retrieving trauma patients from previous explosions. They’re not sitting outside
the hospital able to transport patients. Three, when you leave the hospital, you’re also leaving that infrastructure. Other
hospitals are full, so if you take a patient out of their initial hospital, they’re just not going to get care. Unplugging some of
these patients and taking them out of the hospital environment will kill them, and many generators are running incubators
that keep babies alive. There’s no alternative for a newborn. It is a death sentence — that’s not hyperbole. That’s why we’re
seeing paramedics and physicians in Gaza saying, We are just going to stay.

We still don’t know definitively what was behind Tuesday’s explosion at al-Ahli hospital, though several other
hospitals and care centers have been damaged by Israeli airstrikes. How does this destruction affect the few
remaining health workers’ ability to help?

Regardless of what happened at al-Ahli, there are several dozen documented incidents of Israel bombing or damaging
hospitals. It kills and harms medical staff. There are already very few specialists in the territory, and many have fled to the
south or sheltered at home with their families. There’s already a low bed-to-patient count in the Gaza Strip, and even if the
airstrikes were to stop tomorrow, this infrastructure will take years to get back to the stage it was before October 7 — which
was already insufficient. Every specialized machine is not only thousands of dollars but was likely weeks or months of
paperwork and finagling just to get it imported. It also causes strain on other hospitals.

Half of Gaza’s population is under 18. What kind of help does that age group need most right now?

At this moment the biggest detriment to children is lack of access to food, water, and shelter. And secondary to that would
be trauma care after airstrikes. At this point, children with chronic illnesses or who need dialysis are probably not getting
any services at all.

Basically every child in Gaza has mental-health issues. There’s been some debate about whether it’s even appropriate to call
it PTSD because it’s not post-traumatic. It’s chronic trauma. They’re not fearing something irrational that happened in the
past; they’re fearing active circumstances and for good reason. Mental health is deprioritized everywhere in the world, even
in the richest countries. When you layer onto that a really poor population with a bad health system, mental health is
priority Z.

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10/25/23, 10:14 AM The Health Crisis Facing Women and Children in Gaza

Is there any kind of mental-health care that can help children or postpartum or pregnant women at the moment?

Right now, the priority is physical survival. A lot of people lean on their faith as a form of mental self-care. I’ve heard
recordings from mothers who say, “I’m trying to be strong and rely on God so that I can smile for my kids.” Mothers are
doing what mothers always do, which is shoving their own needs aside and trying to deal with the needs of their children. I
don’t even think they would have a conception of their own mental health because they’re worried about keeping
themselves and their child alive. We have seen efforts, especially in the U.N. schools, where teachers are trying to play with
the kids and give them mental-health support in the form of drawing classes or singing. Even amongst all this, they’re
trying to give the children some semblance of normalcy.

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