TEL AVIV, Israel — In Rafah, baby Manal has just woken up from a nap. "Have you made a poo-poo?" asks her mother, Likaa Saleh, 24, as she opens a flimsy diaper that was hard to find and is several sizes too small.
The 5-month-old begins to cry. The skin on her tush and legs has rashes and is peeling where the tight material of the diaper rubs — a skin irritation that won't go away. "No, no, no," Saleh soothes her. "I'll put some cream on you now and all the pain will go away. You're a good girl."
It's hardly the life Saleh imagined for her second child when she learned she was pregnant last year. Baby Manal is one of an estimated 20,000 children who have been born in Gaza since Israel began its bombardment of the enclave in response to the Oct. 7 attack by Hamas. Amid a spiraling humanitarian crisis, women who are pregnant or have recently given birth are confronting impossible conditions as they grapple with how to care for their newborns. In place of celebrations and nursery rhymes, they face airstrikes and ground fighting. Instead of bottles and baby food, they're fighting disease and a growing lack of food and water.
"I can't teach her to eat or feed her because there's no food, no vegetables, and there's not enough milk for her," Saleh says. "I can't sleep at night because all I'm doing is thinking and I'm heartbroken."
Saleh and her family used to live in an affluent area of Gaza City, a home with all the supplies she'd need to welcome her baby, who was due in late October. Instead, Manal's arrival by C-section came under air attacks a month after the war in Gaza began.
The circumstances of the birth was one of "the worst moments of my life," Saleh says. And each day since then over the past five months has gotten harder and harder. Now, sheltering in Rafah, a city with more than a million displaced Palestinians, she has trouble finding milk, food, diapers and baby clothes that fit.
"Those who pay the highest price in war are mothers and kids," says Hiba Tibi, a country director for CARE, an aid organization that helps women and children in Gaza. "They are becoming less and less hopeful. They are giving up."
The United Nations estimates that in Rafah, where Saleh and baby Manal are living, a tenth of children under age 2 are suffering from the most severe malnutrition. But as you move farther north and farther away from the trickle of aid coming into Rafah, conditions worsen.
In northern Gaza, where Saleh is originally from, a third of children under 2 are experiencing a life-threatening lack of food, and an international committee of experts warns that famine is now "imminent." Gaza health officials say at least 23 children have died from malnutrition. CARE's partners in the north of Gaza report that women in shelters are burying their newborns who have died.
"They see in almost all the shelters, babies that are born and dying before even getting registered," says Tibi. "So they are not even counted in life."
She can't shake what one new mother told her recently. "She told me, 'I wish I never gave birth. I wish I didn't have this kid come to life.'"
"No electricity, no clean water"
In addition to women like Saleh who have given birth since the war, many more are still pregnant, suffering from malnutrition, infection and dehydration, and without access to medical care. According to the Gaza Ministry of Health, there are nearly 60,000 pregnant women in Gaza, with about 5,000 women expected to give birth in the next month.
Only about a third of the territory's hospitals are still partially functioning, since Israel launched its assault on Gaza in response to the Oct. 7 Hamas attack that killed 1,200 people in southern Israel. The Israeli military's offensive in Gaza has killed more than 32,400 Palestinians, according to the Gaza Ministry of Health.
The war has seen several hospitals come under attack. In recent days, the Israeli military has conducted raids at Al-Shifa hospital, the largest in Gaza, as part of an operation that it says is designed to "thwart terrorist activity" at Al-Shifa. Equipment and supplies have been damaged, healthcare workers arrested and most hospital functioning has stopped, according to health officials in Gaza.
These are the circumstances that have driven pregnant women all across the enclave to find treatment at a health clinic in Deir al Balah, in central Gaza. Run by the U.S.-based aid organization Project Hope, the clinic sees up to 60 pregnant women a day. Nearly a quarter are malnourished, according to staff at the clinic.
"It's really bad and it's becoming worse and worse every day," says Maram Badwan, the lead physician at the clinic, who is also displaced from her home. "Most of the children and women [we treat] stay in tents and with no electricity, no clean water." In addition to malnutrition and dehydration, she and her staff see many cases of hepatitis A, anemia, lice and scabies.
The clinic has a limited supply of medicine and prenatal vitamins that it offers its patients, and it also gives free ultrasounds. Women come from all over Gaza. For many, it's the first doctor's visit in their pregnancy.
The risk of disease surrounds new and expecting mothers
That's the case for Rhonda Abd Al-Razeq, a pregnant 26-year-old who is living at a shelter in Deir al Balah. She fled her home in the northernmost area of Gaza, where she and her husband farmed mulberries, onions and potatoes. Over the last several months, they've stayed at different shelters, leaving after each one came under fire from Israeli airstrikes, she says. At her current shelter, 60 people are sleeping in the same room.
Abd Al-Razeq isn't sure how far along she is. Asked what defines her life right now, she responds, "Struggle, struggle, struggle."
She caught hepatitis A, along with several members of her family, many of whom have fungal infections. "If there was cleanliness, would I have gotten hepatitis?" she asks, exasperated. "The water we drink is itself dirty. How would we not get a disease?"
In her visit with Badwan, Abd Al-Razeq learned she was also malnourished and hypertensive, and yet the ultrasound showed her baby's heartbeat was strong.
She also learned the baby's sex: a boy, a welcome joy at a time when she's constantly worried about where and how she'll give birth.
Giving birth in an overcrowded shelter
There aren't many safe places for Abd Al-Razeq and other pregnant women to give birth in Gaza. If they can't make it safely to the few remaining hospital beds, they're likely to have their deliveries in crowded shelters.
Arvind Das, who recently led a team of medics from the International Rescue Committee into Gaza, said that all across the enclave he witnessed women giving birth in overcrowded shelters, some with as many as 80,000 people crammed inside. .
"There is no privacy. There is no dignity," he said, holding back tears. "You have literally 1.5 meters of space, and that's where pregnant women are meant to deliver the children."
CARE is one of several aid organizations training women to be midwives to help other women in the shelters give birth.
Sherehan Abdel Hadi, who gave birth to her son Sanad at the end of December, says delivering is just the beginning of many more challenges.
"My son needs milk," she says. "I am not having any healthy food."
While pregnant, Abdel Hadi and her family fled on foot from Gaza City. They're now living at an uncle's house in Deir El Balah.
"There are continuous bombardment and airstrikes," she says. "We are afraid all the time."
The noise from Israeli planes and drones makes it hard for Sanad to sleep, she says. So does their crowded living situation: Abdel Hadi, the new baby and her three older children are staying with relatives, a large extended family crammed in together, sleeping three on a mattress.
"Sanad is crying all of the time, no stop," she says. "I struggle with the hot water to bathe him, and his diapers are too big and leak a lot, so he needs to change clothes, but I don't have enough clothes."
Without access to hot water, and with the crowding at home, she's worried that baby Sanad will get sick.
Back In Rafah, Likaa Saleh is trying to get young Manal to eat something. She's boiled potatoes because she doesn't have money to purchase anything else. With some coaxing, she gets her baby to stop crying and take a soft potato. She feels a moment of relief as Manal stops crying and eats — a momentary respite from her near-constant worry about her daughter's future and the world she's brought her into.
Abu Bakr Bashir contributed from London.
