By Nisreen Shehada, MPH IMPERIAL, ArPHA Intern
Amplifying Voices, Honouring Strength: Maternal and Reproductive Health in Gaza
In this article, Nisreen Shehada, ArPHA intern and a postgraduate public health student at Imperial College London, interviews Dr Israa Saleh, a sexual and reproductive health (SRH) specialist working with Médecins du Monde in Gaza. Their conversation sheds light on one of the world’s most urgent public health emergencies: the collapse of maternal and reproductive healthcare in Gaza. Dr Saleh offers powerful testimony from her experience as a frontline SRH doctor, revealing the reality on the ground and exploring broader implications for maternal health in conflict settings.
How War, Displacement, and Neglect Are Devastating Care for Women and Girls in Gaza
In the besieged Gaza Strip, where war is a brutal constant and the healthcare system is collapsing, pregnant women and new mothers carry an often-invisible burden: the trauma of surviving and giving life amid destruction. Maternal and reproductive care, already fragile during peace, has disintegrated. With hospitals bombed, healthcare workers displaced or overwhelmed, and even basic hygiene products scarce, women are giving birth in tents, classrooms, and the ruins of homes, often alone, frightened, and without adequate care. (UNFPA, 2024; WHO, 2024; Médecins Sans Frontières, 2024).
“We are not just delivering babies,” says Dr Israa Saleh. “We are holding the front line of dignity, survival, and hope.”
Dr Saleh, with years of SRH experience in both clinical and humanitarian settings, describes the daily challenges: “Displacement, trauma, and the collapse of the health system have created an unbearable situation. Women are giving birth in unhygienic conditions, without skilled attendants, pain relief, or postnatal care. Some are forced to cut their umbilical cords under fire.”
Adolescent girls are particularly vulnerable. A recent UNFPA report (2024) highlights how their SRH needs, including menstrual hygiene, contraception, protection from early marriage, and prevention of sexual violence, are routinely neglected. Many live in shelters without privacy, safety, or accurate information, posing severe risks to their long-term well-being.
These are not isolated cases. According to UN Women and UNICEF, this is the norm in a context where, according to UNRWA, nearly 2 million people have been displaced and healthcare infrastructure has been systematically targeted. The toll is not only physical but deeply psychological.
The Maternal Mental Health Crisis Beneath the Surface
War intensifies every vulnerability a pregnant woman faces. Constant bombardment, loss of loved ones, food insecurity, and lack of shelter turn a time of hope into one of fear. Mental health programmes run by organisations like the World Health Organisation (2024) have been severely disrupted. The impact is devastating, women and children are left without access to psychological care, facing trauma and grief in isolation.
The breakdown in maternal mental health has ripple effects. “When a mother suffers, her child suffers too,” Dr Saleh explains. “We’re seeing developmental risks in babies born during this crisis. They enter a world of fear, hunger, and displacement, which affects bonding, breastfeeding, and early development.”
Frontline Resistance: Healthcare Workers Under Siege
Despite the odds, Gaza’s healthcare workers show unmatched resilience. Community health workers and midwives, many of whom are themselves displaced, are delivering babies in shelters, offering emergency contraception, and counselling women under extreme pressure. (UNFPA, 2024a). But the risks are immense. “Health workers are being killed, detained, or working without protection,” says Dr Saleh. “We’ve lost colleagues. The few who remain are traumatised and exhausted, working in unsafe conditions without supplies.”
NGOs have established mobile clinics and relocated services to displacement camps, but these efforts are constrained by insecurity, fuel shortages, and repeated displacement (Médecins Sans Frontières, 2024). The blockade has further choked supplies, leaving women to give birth without antibiotics, sterile tools, or clean water. (WHO, 2024).
A Story of Survival
Dr Saleh shares a story of a woman who gave birth during a ground invasion in Al-Nuseirat. Alone, she cut the umbilical cord herself and walked for hours with her baby to reach safety. Months later, she returned for her child’s vaccination, smiling.
“She reminded me,” Dr Saleh says, “that Palestinian mothers are not just victims. They are the resistance. They are the reason we keep going.”
Beyond Survival in Gaza: The Fight for SRH Equity
In 2025, the World Health Organization launched a global campaign titled “Healthy Beginnings, Hopeful Futures,” urging accelerated efforts to end preventable maternal and newborn deaths Maternal and newborn health, encompassing pregnancy, childbirth, and the postpartum period, is essential for achieving SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality). (WHO, 2025)
Although maternal mortality declined by 40% globally, from 328 per 100,000 live births in 2000 to 197 in 2023, progress has stalled since 2016. To reach the SDG target of fewer than 70 deaths per 100,000 live births by 2030, the pace of decline must double. (UNICEF, 2023).
Maternal and reproductive health still faces enormous challenges. In 2023, maternal mortality in conflict settings was 504 per 100,000 live births, compared to 99 in non-conflict zones. Women and girls in these areas are disproportionately affected by unsafe abortions, malnutrition, sexual violence, and lack of access to care. (WHO, 2023)
A rights-based, comprehensive approach is urgently needed: expanding access to care, strengthening health systems, providing sexuality education, and supporting women’s economic and social empowerment. Only then can every mother and child not just survive, but thrive.
Mothers’ Lives at Risk: A Political and Structural Failure
The maternal health crisis in Gaza is not only a consequence of war but of systemic, deliberate policies. “The blockade, targeting of health facilities, and delays in aid create a structure where women’s lives are treated as expendable,” Dr Saleh states.
The breakdown of the referral system makes managing complex pregnancies nearly impossible. With destroyed roads and hospitals, and ambulances unable to move safely, even basic procedures can become fatal (UNFPA, 2024b; WHO, 2024).
Dr Saleh reminds us: “Pregnancy doesn’t pause during war. Neither should our responsibility to protect those giving life.”
Call to Action
Dr Saleh calls on the international community to prioritise SRH services in humanitarian response plans. “Women are not afterthoughts. Menstrual health, safe delivery, and post-violence care are basic rights, not luxuries.” She advocates for targeted adolescent programming, increased funding for frontline workers, and immediate protection of health facilities under international law.
To political leaders, she offers a powerful reminder: “Gaza is not just a place on a map. It’s a home full of mothers, children, and futures. Your silence enables violence. Your action can stop it.”
References
- Médecins Sans Frontières. (2024). Gaza: maternity care in the line of fire. Available at: https://www.msf.org [Accessed 9 Jun 2025].
- UNFPA. (2024a). Adolescent girls in crisis: the Gaza emergency. Available at: https://www.unfpa.org [Accessed 9 Jun 2025].
- UNFPA. (2024b). Gaza situation report: reproductive health needs and challenges. Available at: https://www.unfpa.org [Accessed 9 Jun 2025].
- UNFPA. (2024c). Obstacles to maternal referrals in conflict zones. Available at: https://www.unfpa.org [Accessed 9 Jun 2025].
- UN Women and UNICEF. (2024). Impact of conflict on women and children in Gaza. Available at: https://www.unwomen.org and https://www.unicef.org [Accessed 9 Jun 2025].
- UNICEF. (2023). Maternal mortality. Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/ [Accessed 9 Jun 2025].
- UNRWA. (2024). Gaza emergency situation update. Available at: https://www.unrwa.org [Accessed 9 Jun 2025].