As health officials in Gaza said Wednesday that the healthcare system in the blockaded enclave is now "completely out of service," human rights advocates including birth workers demanded a cease-fire to protect the estimated 50,000 pregnant people living under siege in the open-air prison, where Israel has been bombing civilian targets for nearly three weeks while claiming to be attacking Hamas.
The Palestinian Family Planning and Protection Association (PFPPA) warned days after the airstrikes began that 37,000 women would likely be forced to give birth without electricity or medical supplies, because Israel promptly cut off access to fuel and other essentials after Hamas launched a surprise attack on October 7.
That fear is already being realized in hospitals across the enclave, which is home to about 2 million people, half of whom are children.
Walid Abu Hatab, an obstetrics and gynecology medical consultant at the Nasser Medical Complex in Khan Younis, told Al Jazeera Wednesday that among other dangers, pregnant women face an increased risk of contracting illnesses as a growing number of people from northern Gaza are crowded into shelters in southern areas—a "health and environment disaster," Abu Hatab said.
"There are women who have been displaced from their places of residence to other areas, which means changing the health centers which had previously monitored their condition," he told Al Jazeera. "This makes access to them very difficult for them as they need primary care and follow-up sessions during the various periods of pregnancy."
"I received dozens of calls from pregnant women telling me that they were unable to reach health centers to provide them with treatment such as insulin and treatment for blood thinning for those with heart disease," Abu Hatab added. "The lack of access to healthcare and treatment puts their lives in danger and may lead to death, and this is what we are mainly concerned about."
"The bombs don't stop, and no human, tree, or stone has been spared. We don't know whose house will be destroyed or who will die. I just hope me and my child are safe."
Niveen al-Barbari, a pregnant woman who before October 7 was regularly seeing a specialist to monitor her high blood pressure and gestational diabetes, told the outlet she wonders daily where she will give birth and how she'll be able to do so safely as Israel's airstrikes show no sign of stopping and the country prepares for a likely ground invasion of Gaza.
"The bombs don't stop, and no human, tree, or stone has been spared," al-Barbari said. "We don't know whose house will be destroyed or who will die. I just hope me and my child are safe."
Al-Barbari is one victim of what Human Rights Watch called a "women's rights crisis" which is unfolding alongside the broader humanitarian catastrophe, with women and girls affected "in specific and devastating ways."
The group said the onslaught will "likely result in increased maternal and infant mortality and morbidity, undermining heath gains previously made in Palestine," as women are forced to go without prenatal treatment and in some cases, give birth without the help of medical professionals.
About 5,500 of the pregnant people in Gaza are expected to give birth in the next month, according to the United Nations Population Fund (UNFPA), which has resorted to deploying emergency delivery kits to at least half of those women due to Israel's refusal to allow humanitarian aid convoys into the enclave.
The kits include a bar of soap, a 40-square-inch plastic sheet, scissors to cut an umbilical cord, latex gloves, and an instruction pamphlet to guide women delivering on their own.
"Pregnancies do not stop during emergencies," said the UNFPA, warning that "devastating consequences" can arise when reproductive health is overlooked in violent conflicts.
Doctors in Gaza warned Wednesday that for women who do manage to give birth face harrowing prospects for their babies if they are born prematurely.
With fuel running out in the enclave's hospitals, premature babies in incubators "will die once the power goes," the BBC reported.
"The babies in these incubators are the same as my son who was in an incubator after birth," said Melanie Ward, CEO of Medical Aid for Palestinians (MAP). "But he was born in London and these babies are Palestinian. Every life is of equal value. Fuel must reach them."
MAP, which on Tuesday held a vigil in London for the 2,360 children who have been killed in Gaza so far, warned Wednesday that hospitals across Gaza have only hours to go until "total collapse."
Patients in critical condition will die without fuel, including 130 newborns in neonatal intensive care units. Cancer patients and people with kidney failure are also being placed at risk as they miss multiple rounds of chemotherapy and dialysis due to shortages of medical supplies.
"Harrowing scenes are unfolding in hospitals across Gaza," said Fikr Shalltoot, Gaza director for MAP. "Doctors have reported that patients who would otherwise live are dying. Hundreds of patients with horrific injuries from Israel's bombardment sit untreated and in agony in corridors. Surgeons operate without anesthetics and by torchlight."
"World leaders must act now to prevent the total collapse of Gaza's healthcare system," said Shalltoot. "The trickle of aid getting through is nowhere near enough to reverse this humanitarian catastrophe. People will die if fuel does not reach Gaza's hospitals today."
In the U.S. on Wednesday, birth workers called on the American College of Nurse-Midwives, the largest organization representing midwives in North America, to join international calls for a humanitarian cease-fire in Gaza in order to ensure the safety of pregnant people, unborn babies, newborns, and medical providers tasked with providing reproductive care.
"Hospitals have lost power and healthcare providers are having to decide whether to evacuate and abandon their patients or stay and perish in the onslaught of Israeli bombs, which have been indiscriminately aimed at homes, mosques, schools, and hospitals," wrote the birth workers. "We say the answer to grief is not more war and destruction. We say no to continued occupation, apartheid and genocide. We ask the American College of Nurse-Midwives to stand on the right side of history with Doctors Without Borders in calling for the bombing to stop."
The International Confederation of Midwives (ICM) called for "peace, understanding, and the resolution of conflicts through dialogue and diplomacy" a week into Israel's siege, warning that "violence and war bear a heavy toll on vulnerable civilians, especially women, babies, and families with young children."
"The absence of proper maternal health services further exacerbates an already dangerous situation, jeopardizing the lives of women and newborns," said the ICM. "During conflicts, sexual violence, war's oldest, most silenced, and least condemned crime, becomes widespread. Everyday situations, like ensuring cleanliness and dignity during a regular menstrual cycle, become difficult or impossible. This is all in addition to the stress, loss, and trauma that communities are subjected to."
Israel's blocking of humanitarian aid and its continued bombardment pose "additional risks to health and life for women and girls," said Human Rights Watch. "Their suffering is one more reason that Israel's allies, especially the United States, should press it restore the flow of electricity and water, allow fuel into Gaza, and open its crossings for humanitarian aid."
