Before the latest escalation in violence between Israel and Hamas, pregnant women in the Gaza Strip could have health check-ups, get advice on nutrition and prepare their homes for the arrival of their babies. Today, thousands are living in shelters where there is not enough food or clean water, and they dread the prospect of giving birth on the floor with no doctor or midwife to help.
Shorouq is seven months pregnant with her first child. She is living in a shelter in Khan Younis in the south of Gaza. "How can I possibly give birth here?" she asks. "There's no access to healthcare and hygiene. Giving birth in this shelter would be a catastrophe for me."
She is one of 50,000 pregnant women in the Gaza Strip, according to the United Nations Population Fund (UNFPA). More than 150 births take place every day.
Since Hamas massacred 1,400 Israeli and foreign civilians and took more than 240 people hostage on October 7, Israel has since been carrying out a sustained bombing campaign on the Gaza Strip and launched a ground invasion focused on the north. The UN estimates that over a million people, fleeing the bombs and fighting, have been displaced within Gaza.
Even before October 7, the healthcare system had been facing "significant challenges over the 16-year blockade", says Dominic Allen of the UNFPA. Israel has restricted the entry of goods and fuel into the enclave ever since Hamas took control of the Gaza Strip in 2007, after making gains in parliamentary elections a year earlier.
"Now the healthcare system is on the brink of collapse and, in some health facilities, already collapsing," says Allen. "Pregnant women are unable to access basic maternal health services. They're facing unthinkable challenges."
‘I am so scared for my unborn child’
Shorouq, an interpreter with a master’s degree in English-Arabic translation, hasn't seen a doctor since she was displaced from her home in the north of Gaza four weeks ago.
Israeli air strikes destroyed two buildings near her home, so she believes it has been at least partially destroyed. She can't go back to see if all the clothes and toys she picked out for her unborn daughter are intact. "I bought them one by one, and I was very selective in choosing her things," she says.
She took just one toy with her as she and her husband fled: a toy that she made herself. "It's a source of green life and full of good things, I made it for my princess," she explains.
Shorouq and her husband had planned to try their luck at seeing one of the few doctors or midwives at a health centre near their shelter. But as they were walking there, they saw a car being bombed.
"We were so close, we were terrified. We started running back to the shelter, abandoning our plans to go the health centre."
The bombing is traumatic for Shorouq. "If I wasn't pregnant maybe I could cope. But I am so scared for my unborn child," she says.
The shelter where they are staying in Khan Younis is not a bomb shelter and was not designed to accommodate the 50,000 displaced people who are staying there now. It's a training college run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Eighty-eight UNRWA schools have become temporary shelters.
"These shelters are a lifeline, but they're under significant duress," says Allen.
Sharing a toilet ‘with thousands of people’
In the shelter, Shorouq is at risk of contracting both waterborne and respiratory diseases.
"You have to wait in a long line to go to the toilet, and when you're waiting in this line you're just thinking that you're exposed to many diseases from the thousands of other people who you're sharing a toilet with. You can hardly ever find soap," she says.
"This is stressful for me, that I could be infected with one of these diseases and it could affect my baby. Since I've been here I've started to feel dizzy, I have a bad cough and backache from sleeping on the floor," she adds.
"A lot of people, especially children, are suffering from infections, including skin sores and waterborne diseases like diarrhoea," says Dr Bashar Murad, director of the Al Quds Hospital in Gaza City. "They are living in shelters where hygiene is bad and people are very close together, so disease spreads."
Diarrhoea can be deadly. The World Health Organization says it is the second-biggest cause of death in children under 5 years old around the world.
Two pieces of bread a day
Allen says the humanitarian standard of water consumption is three litres a day per person, minimum. “Pregnant women need at least one-third of a litre more, and breastfeeding women need at least two-thirds on top of that,” he explains.
"A woman who gave birth seven months ago told us that her milk supply has dried up because she can't drink enough water, and also because of the stress and strain of moving from one shelter to another," says Allen.
Hiba Tibi from CARE International says some women who are unable to breastfeed "are being forced to use contaminated water for baby formula as they have no access to clean water". While a limited number of aid trucks are now arriving into Gaza via the Rafah crossing, Israel is not permitting fuel to pass for fear Hamas will get hold of it. Fuel is needed for water desalination systems and pumps to operate.
Shorouq is thirsty and hungry all the time. "If I'm lucky, I get one small bottle of water a day and two pieces of bread, with processed cheese and sometimes dried thyme,” she says.
There are no sources of protein, fresh vegetables or fruit in the shelter. "Most of us are starting to suffer from malnutrition," says Shorouq.
‘There is nowhere safe in Gaza’
"There's the safety issue of where is she going to give birth, and how," says Allen. "There is nowhere safe in Gaza at the moment."
Shorouq does not know where she will give birth to her first child. Because of regular communications blackouts and overall patchy network coverage in Gaza, women in labour cannot count on being able to call an ambulance, doctor or midwife. "It's also dangerous to travel because of the bombing," says Dr Murad.
If they make it to hospital, mothers are likely to be discharged within just a few hours after the birth. "There is no regular post-delivery monitoring," says Tibi. "If the baby is in a very critical state, they may get one of the very rare spots in hospitals."
Even inside hospitals, women and newborns are at risk of catching infections. Overwhelmed by the sheer number of victims from air strikes and running out of medical equipment, "hospitals are now reusing disposable material that should only be used once", says Tibi. "There is a lack of water because of the lack of electricity and fuel needed to power pumps, and disinfectant," she adds.
Once discharged, mothers and their newborns won’t be going home but back to overcrowded and unsanitary shelters. "We pray every day we can go back to our homes and have a normal life," Shorouq says.
