Pregnant women and newborns face trauma, infection, malnutrition in Gaza under Israeli assault

An injured child is brought to the Al-Aqsa Hospital after the Israeli attack. (Getty Images)
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Updated 20 November 2023

Pregnant women and newborns face trauma, infection, malnutrition in Gaza under Israeli assault

  • Even if they survive childbirth, mothers and babies are not out of danger as shortages threaten health and development
  • The siege of hospitals and blocking of aid deprive women in labor of pain relief and premature newborns of incubators

LONDON: What should have been a time of great joy and excitement has become a living nightmare for thousands of new and expectant mothers living under siege and constant Israeli bombardment in the Gaza Strip.

For Layla, 28, whose name has been changed for her safety, bringing a new life into the world at a time of so much death and destruction fills her with dread. “What worries me most is falling in love with life, amid all the death, once I hold my baby,” she told Arab News.

Like 5,500 other pregnant women in the Gaza Strip, Layla is due to give birth very soon amid a conflict between Israel and Palestinian militant group Hamas that has devastated healthcare infrastructure and deprived the population of access to nutritious food, clean water and public sanitation.

The closure of hospitals and clinics under the intense bombardment and chronic shortages of electricity, fuel and medicine are among the biggest challenges faced by the roughly 50,000 pregnant women in Gaza.

Prematurely born Palestinian babies in Shifa Hospital in Gaza City. (Dr. Marawan Abu Saada via AP)

As of Nov. 10, some 18 hospitals and 51 primary care centers across the embattled enclave are no longer operational, meaning fewer than 60 percent of hospitals and 30 percent of public health centers are operating to some degree.

Fikr Shalltoot, Gaza director for Medical Aid for Palestinians, or MAP, a British charity operating in the Palestinian enclave, said that pregnant women in Gaza “face a dire reality, with limited access to essential health services amid a near-total humanitarian disaster.”

“With over 180 births daily and a staggering 235 attacks on healthcare infrastructure since Oct. 7, the situation is critical,” Shalltoot told Arab News. This leaves women deprived of emergency obstetric services and forces many to give birth in unsafe conditions.

“Closed hospitals force births in shelters, homes and streets amid rubble, raising infection risks,” she said. “Maternity hospitals, like Al-Hilo, face attacks.”

Hospitals in Gaza have been on the frontline of the conflict, overwhelmed by wounded civilians since the start of Israel’s military campaign, which came in retaliation for the Hamas attacks of Oct. 7, which killed 1,200 and saw more than 200 people, both Israelis and foreigners, taken hostage.

Some 135 health facilities across Gaza have been damaged or destroyed. Although these facilities are protected under international humanitarian law, Israel claims Hamas has been using hospitals, particularly Gaza’s largest, Al-Shifa, to host underground command centers.

The aftermath of an explosion at the Ahli Arab hospital in central Gaza. (AFP)

Hamas and medical staff deny these facilities are being used to store weaponry, conceal hostages, or move fighters along a sophisticated network of tunnels. Israeli forces who took control of Al-Shifa on Wednesday are yet to provide evidence to support their claim.

There are at least 650 patients, including 22 in intensive care and 36 premature babies, at Al-Shifa, according to local media, in addition to some 400 medical staff. More than 2,000 Gazans have also taken refuge within the facility.

Amid the destruction and shortages, made worse by Israel’s restrictions on the entry of humanitarian aid into Gaza via the Rafah border crossing with Egypt, physicians have been forced to take extreme measures, such as performing cesareans without anesthetic or pain relief.

“Some women face complications while giving birth, and to stop the problem and because there are no (capabilities), tools, (or) time, (physicians) are faced with the extreme option to take out the uterus,” Soraida Hussein-Sabbah, gender and advocacy specialist at ActionAid Spain, told Arab News.

At Al-Awda Hospital, the only provider of maternity services in northern Gaza, doctors performed 16 cesarean C-sections last weekend under extremely challenging circumstances, according to local media.

Hussein-Sabbah said that although there are many trained and specialized obstetrics physicians and nurses in the Gaza Strip, as well as private and public maternity hospitals, “these cannot operate normally right now.”


• 50,000 Pregnant women in Gaza.

• 5,500 Women due to give birth soon.

• 180 Average number of births daily.

Despite this, “any specialized person found in a shelter, or any place … will continue serving as much as possible,” she added.

Elaborating on the dangers of conducting cesareans under such extreme circumstances, Zaher Sahloul, head of MedGlobal, a US-based medical NGO, said that while “doctors typically try to deliver as fast as possible,” performing such surgery requires them to “cut through multiple layers” and then “suture multiple layers.”

Performing such an operation without anesthetic, or even a partial dosage of pain relief, would be agonizing.

“It is, as you can imagine, an extremely traumatic experience, something that would be associated with PTSD,” Sahloul told Arab News. Medical professionals are also forced to discharge new mothers within three hours, which poses additional risks.

New mothers are typically monitored for a minimum of 24 hours because the postpartum period is associated with various complications, including hemorrhage. Even before the latest outbreak of violence in Gaza, “the two biggest causes of (maternal) deaths were bleeding and sepsis,” said Sahloul.

“The lack of water and sanitation puts them at an even higher risk of infection and sepsis. (Hospitals) do not (even) have any blood to transfuse these patients if they start to have complications.”

Even if they survive the ordeal of childbirth in these conditions, mother and baby are not out of danger. The lack of hygiene facilities, nutritious food, clean drinking water, safe sleeping spaces, and other basic comforts and necessities threaten health and development.

A Protester holds a placard at The Hague in support of Palestinian children. (Getty Images)

Fatty acid and vitamin deficiencies in lactating mothers can compromise newborns’ immune systems, putting them at risk of communicable diseases as well as cognitive development challenges, said Sahloul.

Fatema, another woman trapped inside Gaza, has resorted to using clean clothes to manage discharge as she lacks access to sanitary towels. Embarrassed, and with limited privacy, she has then buried those clothes, she told ActionAid.

More than 1.4 million Palestinians have been displaced since Oct. 7, according to the UN’s humanitarian office, OCHA. Many have set up makeshift tents outside hospitals, while others have squeezed into the corridors of schools or have slept out in the open.

MedGlobal’s Sahloul warned that with limited access to food and water, malnourished women face the risk of “preterm delivery,” which is also associated with fetal and neonatal morbidity and mortality.

Shalltoot of MAP, meanwhile, cautioned that as access to obstetrics services becomes increasingly difficult, “maternal deaths will rise, stress-induced complications soar, and malnutrition worsen, affecting childhood survival.” Moreover, “without fuel, premature babies relying on neonatal care face a life-threatening crisis.”

She added: “Maternity care at Al-Awda Hospital hangs in the balance. Doctors report a surge in premature births due to the bombing of homes, a heartbreaking crisis where premature deliveries are performed while mothers lay dying.”

Three premature babies at Al-Shifa died on Tuesday after the hospital’s neonatal intensive care unit was knocked out of operation. The lives of at least 36 others are in danger amid a lack of electricity and fuel for incubators, according to the facility’s director.

With women and children making up more than 70 percent of the casualties — one in four of them women of reproductive age — access to maternal health services is critical, said Shalltoot.

Palestinians queue as they wait to buy bread from a bakery, amid shortages of food supplies and fuel. (Reuters)

“Gaza is in urgent need of support to protect the lives of mothers and newborns,” she said, adding that “a ceasefire is imperative for pregnant women and infants.”

She said: “Without immediate access to fuel, aid, and medical experts, we face the looming threat of infectious diseases. Mass starvation, treatable deaths and a healthcare system in ruins are imminent unless swift action is taken.

“Opening multiple crossings is crucial to prevent a humanitarian freefall. Our plea is clear — act now to avert a catastrophic crisis.”

MAP has delivered a range of items, including medications and medical disposables that can be used to support delivery and the treatment of women and babies. “With our partner in Gaza, Ard El Insan, we have released all of our medications and food items for malnourished children and their families,” Shalltoot added.

Save the Children and ActionAid have also called for an immediate ceasefire and the opening of a humanitarian aid corridor.

“For this to happen, there is a need for a unified and coordinated call and pressure for the Rafah crossing to open, and the Israeli occupation forces to comply with international humanitarian law and allow for aid to come and civilians to be saved,” said ActionAid’s Hussein-Sabbah.

As of Nov. 14, at least 11,320 Palestinians have been killed in Gaza, of whom over 4,650 are children and more than 3,145 are women, according to the Hamas-run health ministry. A total of 198 medics have also died.

Earlier this month, Antonio Guterres, the UN secretary-general, described Gaza as “a graveyard for children” and “a crisis of humanity.”

A mother covers her child's face to protect from the smoke as Palestinians leave from the northern part of the Gaza. (Getty Images)

In a statement to Arab News, Save the Children said: “During this humanitarian catastrophe, civilians, especially children, continue to pay the heaviest price for the ongoing violence.

“Children are being killed at a devastating rate, whole families are being wiped from the registry, and a growing number of people, including children, are being left with no surviving family members.”

Attacks on schools and hospitals are considered “a grave violation against children by the UN and may amount to violations of international humanitarian law.”

Calling for an end to “the continued, systematic assaults,” the NGO said that “hospitals and schools cannot be battlegrounds, and children cannot be targets. Yet in Gaza, all three are attacked on a daily basis.

“Even during wartime, basic elements of humanity must prevail.”

Iran says it sent a capsule with animals into orbit as it prepares for human missions

Updated 22 sec ago

Iran says it sent a capsule with animals into orbit as it prepares for human missions

TEHRAN, Iran: Iran said Wednesday it sent a capsule into orbit carrying animals as it prepares for human missions in coming years.
A report by the official IRNA news agency quoted Telecommunications Minister Isa Zarepour as saying the capsule was launched 130 kilometers (80 miles) into orbit.
Zarepour said the launch of the 500-kilogram (1,000-pound) capsule is aimed at sending Iranian astronauts to space in coming years. He did not say what kind of animals were in the capsule.
State TV showed footage of a rocket named Salman carrying the capsule into space.
Iran occasionally announces successful launches of satellites and other space crafts. In September, Iran said it sent a data-collecting satellite into space. In 2013, Iran said it sent a monkey into space and returned it successfully.
It says its satellite program is for scientific research and other civilian applications. The US and other Western countries have long been suspicious of the program because the same technology can be used to develop long-range missiles.

Iran Revolutionary Guards seize two vessels smuggling 4.5 million liters of fuel — Tasnim

Updated 06 December 2023

Iran Revolutionary Guards seize two vessels smuggling 4.5 million liters of fuel — Tasnim

DUBAI: Iran’s Revolutionary Guards’ Navy have seized two vessels smuggling 4.5 million liters of fuel, the semi-official Tasnim news agency reported on Wednesday.
Tasnim said 34 foreign crew have been detained by the Guards in the operation.
Iran, which has some of the world’s cheapest fuel prices due to heavy subsidies and the plunge in the value of its national currency, has been fighting rampant fuel smuggling by land to neighboring countries and by sea to Gulf Arab states.

Israel reviewing strike that harmed Lebanese troops, army says

Updated 06 December 2023

Israel reviewing strike that harmed Lebanese troops, army says

  • Lebanese army say the soldier, a sergeant, was killed when an army position was shelled by Israel on Tuesday

JERUSALEM: The Israeli army said on Wednesday it was reviewing a strike that harmed Lebanese troops in south Lebanon, an apparent reference to Israeli shelling that killed a Lebanese soldier and wounded three others the previous day.
“The Lebanese Armed Forces were not the target of the strike. The IDF expresses regret over the incident. The incident is under review,” the Israeli military said in a statement.
Israel and the heavily armed Lebanese group Hezbollah have been exchanging fire across the Lebanese-Israeli border since the start of the war between the Palestinian group Hamas and Israel on Oct. 7.
The Lebanese army said the soldier, a sergeant, was killed when an army position was shelled by Israel on Tuesday.
The Israeli army said its soldiers had acted in “self defense to eliminate an imminent threat that had been identified from Lebanon” from a “known launch area and observation point” used by Hezbollah.
The UN peacekeeping force in Lebanon UNIFIL noted in a statement on Tuesday it was the first Lebanese army soldier killed during the hostilities, and that the Lebanese army had not engaged in conflict with Israel.

The Gaza Strip: Tiny, cramped and as densely populated as London

Updated 06 December 2023

The Gaza Strip: Tiny, cramped and as densely populated as London

  • Gaza has a population density of about 5,500 per square kilometer

GAZA: The war between Israel and Hamas has seen fierce Israeli bombardment that has flattened broad swaths of the Gaza Strip. Thousands of people have been killed and hundreds of thousands have been displaced.
And all that is happening in a tiny, densely populated coastal enclave.
Gaza is tucked among Israel, Egypt and the Mediterranean Sea. The strip is 25 miles (40 kilometers) long by some 7 miles (11 kilometers) wide. It has 2.3 million people living in an area of 139 square miles (360 square kilometers), according to the CIA Factbook.
That’s about the same land size as Detroit, a city that has a population of 620,000, according to the US Census Bureau. It’s about twice the size of Washington and 3½ times the size of Paris.
Gaza has a population density of about 14,000 people per square mile (5,500 per square kilometer). That’s about the same as London, a city brimming with high-rise buildings, but also many parks. Gaza has few open spaces, especially in its cities, due to lack of planning and urban sprawl.
Gaza’s density is even tighter in its urban cores like Gaza City or Khan Younis, where tens of thousands are packed into cramped neighborhoods and where density rates become more comparable to certain cities in highly populated Asia.
An Israeli-Egyptian blockade, imposed after the Hamas militant group seized power in 2007, has greatly restricted movement in and out of Gaza, adding to the sense of overcrowding.


‘Living dead’: Tunisian villages suffer drought, climate change

Updated 06 December 2023

‘Living dead’: Tunisian villages suffer drought, climate change

  • About 300,000 of Tunisia’s 12 million people have no drinking water in their homes, according to the Tunisian Forum for Economic and Social Rights

OULED OMAR, Tunisia: Tunisian villager Ounissa Mazhoud ties two empty jerry cans to a donkey and cautiously descends a stony hill toward the last local source of water.
The North African country, in its fourth year of drought, is grappling with its worst water scarcity in years.
Mazhoud — like other women in the remote village of Ouled Omar, 180 kilometers (110 miles) southwest of the capital Tunis — wakes up every morning with one thing on her mind: finding water.
“We are the living dead ... forgotten by everyone,” said Mazhoud, 57, whose region was once one of Tunisia’s most fertile, known for its wheat fields and Aleppo pines.
“We have no roads, no water, no aid, no decent housing, and we own nothing,” she said, adding that the closest source of water is a river about an hour’s arduous walk away.
Providing water for their families, she said, means that “our backs, heads and knees hurt, because we labor from dawn to dusk.”

The World Bank predicts that by 2030 the Middle East and North Africa region will fall below the “absolute water scarcity” threshold of 500 cubic meters yearly per person.
Tunisia, already the 33rd most water-stressed country according to the World Resources Institute, has dropped to 450 cubic meters per inhabitant.
Its dams — the primary source for drinking water and irrigating crops — are filled at just 22 percent capacity, despite brief showers recently, according to official figures.
Some 20 dams have already gone out of service, mostly in the most arid south.
Last spring, Tunisian authorities introduced water rationing to limit household use even in major cities.
But in remote villages, where water scarcity impacts crucial farming and livestock, the issue takes on even greater weight.
Ounissa’s 65-year-old husband, Mahmoud Mazhoud, said their village has become unable to support livestock, forcing him to sell half of his cow herd so he could afford to keep the rest alive.
Ouled Omar is home to 22 families who share the only remaining spring.
They say it yields only about 10 liters (2.6 gallons) of water per day in total, but that it is undrinkable.

Ramzi Sebtaoui, a stockbreeder in his thirties, brings water to his family every day by driving to the closest source, some 20 kilometers away in the city of Maktar.
“Two or three years ago, the situation was much better, with many natural sources of water that we could use for livestock,” he said.
“Today, due to climate change and other factors, almost all sources have dried up, and the roads are destroyed.”
Last week, Ouled Omar residents traveled almost 50 kilometers to the city of Siliana to protest outside governorate offices, demanding a paved road and access to clean water.
“They don’t have a source of drinking water, not even taps,” Houda Mazhoud, a researcher who has been advocating for Ouled Omar’s access to clean water for years, told AFP.
“As a result, they use a natural source. But with climate change, it’s starting to disappear.”

The only road that leads to the village is decrepit and hasn’t been paved in decades, and residents say this only deepens their sense of isolation.
Some villagers have felt pushed to move to urban areas or abroad.
About 300,000 of Tunisia’s 12 million people have no drinking water in their homes, according to the Tunisian Forum for Economic and Social Rights.
Ounissa’s cousin, Djamila Mazhoud, 60, said her son and two daughters had all left in search of better lives.
“We educated our children so that when we grow old, they take care of us, but they couldn’t,” she said.
“People are either unemployed or eaten by the fish in the sea,” she added, using a common phrase for migrants who attempt the dangerous sea voyages for Europe.
Entire families have already left the village, said Djamila.
“Their houses remain empty,” she said, explaining that elderly people feel they have no choice but to follow their sons and daughters.
“Can an 80-year-old go to the river to get water?“