Women in Gaza giving birth without enough painkillers, clean water or food

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After eight years of trying to get pregnant, finally helped along by IVF, Alaa Jabr is preparing to give birth to her baby girl in some of the most difficult conditions imaginable.

The 30-year-old expectant mother from Jabalia, in northern Gaza, is eight months’ pregnant and living in an overcrowded displacement camp in the southernmost city of Rafah.

“The doctor says I’m dehydrated, and I have to drink more water, but we don’t have drinkable water,” Jabr told Mohamed El Saife, a videographer working for CBC News, who interviewed her in the camp.   

Even when there is clean water to drink, she says, she avoids doing so because it means she would have to make more trips to the toilet.

“I have caught infections and bacteria from the state of the toilets,” she said.

United Nations agencies say that on average, 340 people share a single toilet in camps throughout Gaza, and the sanitary conditions are close to unbearable.

WATCH | In Gaza, new and extectant mothers under duress:

Displacement, unsanitary conditions and a lack of fresh, healthy food are just a few factors increasing the health risks for new or expecting mothers in Gaza as the war between Israel and Hamas rages on around them.

Having access to running water for bathing is also extremely rare. The same report said an average of 1,290 people in Gaza share a single shower.

But it is a lack of proper, nutritious food that may be the most lethal threat for mothers and infants.

“The doctor told me [the baby’s] weight is low because there is no food,” Jabr said. “We get one meal a day — canned food, peas and hummus. We don’t get anything other than that.”

Fresh fruit — which Jabr’s doctor told her would help build up her strength — is rare, and even when it is available in local markets, it’s priced beyond the means most people have to pay for it.

Overcrowded wards

UNICEF estimates there are about 50,000 pregnant women in Gaza and every day about 180 women give birth in unimaginable conditions.

In a recent report, the UN agency warned that the babies of 5,500 women due to be born in March will be at risk of dying, as their mothers do not have access to proper prenatal or postnatal care.

The report also said anxiety caused by the war is causing many women to go into labour early, further reducing their newborns’ chances of survival.

Babies are seen in an incubator at the preemie ward of the Emirati Hospital in Rafah, Gaza Strip, Friday, March 8, 2024.
Babies are seen in an incubator at the preemie ward of the Emirati Hospital in Rafah on March 8. (Fatima Shbair/The Associated Press)

“So often we think about pregnancy as a time of joy and of new life, but for these women, their pregnancies are a time of fear and horror,” said Tess Ingram of UNICEF, who visited Rafah’s main maternity hospital in January and met with women who had just delivered babies.

“Bringing a baby into such an unsafe, unsanitary environment where there’s risk of disease and death, it’s every mother’s worst nightmare.”

The Al-Helal Al-Emirati Maternity Hospital in Rafah is handling the majority of Gaza’s maternity cases in the south. Pre-war, the city of Rafah had a population of 280,000, but it’s now housing nearly 1.5 million refugees who have fled Israeli airstrikes in the region.

War broke out in Gaza after Hamas led attacks on southern Israel on Oct. 7, in which 1,200 people were killed and about 240 were taken hostage, Israel says. More than 31,000 Palestinians have been killed in Gaza since war broke out, according to Gaza health officials. 

Displaced Palestinians, who fled their houses due to Israeli strikes, shelter in a tent camp, amid the ongoing conflict between Israel and the Palestinian Islamist group Hamas, in Rafah, in the southern Gaza Strip March 11, 2024.
Displaced Palestinians, who fled their houses due to Israeli strikes, shelter in a tent camp, amid the ongoing conflict between Israel and Hamas, in Rafah, in the southern Gaza Strip, on Monday. (Bassam Masoud/Reuters)

For pregnant women in northern Gaza, maternal health-care options are even more limited, as most of the remaining health clinics are only partially functioning and medicines and painkillers are scarce.

Médecins Sans Frontières (MSF), also known as Doctors Without Borders, has built a 26-bed annex in a parking lot of the Emirates hospital to give new mothers a few extra days of care before they have to fend for themselves again.

“It’s not enough, we are still seeing 1,000 patients per month, so it’s a lot of turnover,” said Pascale Coissard Rogeret, MSF’s emergency co-ordinator in Gaza.

“The health care we are giving in Gaza is just a drop in the ocean in terms of the needs, and this is something we will not be able to increase in significance without a sustained ceasefire in Gaza.”

Painkillers scarce

Many women in Gaza, however, don’t have the option of an extended hospital stay.

Nermin Abu Saif, 37, had her second child in November at a hospital in Khan Younis, but she said Israeli attacks forced her and the rest of her family into a displacement camp in Rafah.

“The situation was very bad, especially for a C-section,” she said of her delivery. “I only had half anesthesia.”

Nermin Abu Saif, who’s 37 years old, had her second child in November at a hospital in Khan Younis,  Gaza.  She told CBC News she didn't have enough anaesthetic to get her through her caesarean section,  and the first days of her daughter's life were spent in a dirty crowded room, making it difficult for her surgery wound to heal.
Nermin Abu Saif, 37, had her second child in November at a hospital in Khan Younis, in Gaza. She told CBC News she didn’t have enough anesthetic to get her through her caesarean section, and the first days of her daughter’s life were spent in a dirty, crowded room, which made it difficult for her surgery wound to heal. (Mohamed El Saife/CBC)

Whereas a typical post-caesarean recovery would involve two or three days in hospital, Abu Saif said she was told she had to leave after less than 18 hours because her bed was needed by another woman who was even worse off.

“I left for a shelter where there was absolutely no cleanliness for me or the baby,” Abu Saif said. “[I was] in one room with 18 people.”

She said her daughter Sali, now four months old, caught a cough in the first days of her life that she has yet to recover from.

A displaced Palestinian woman cuddling her baby sits on a stone in front of her tent at a camp in Rafah on March 11, 2024, amid ongoing battles between Israel and the Hamas militant group.
A displaced Palestinian woman cuddling her baby sits on a stone in front of her tent at a camp in Rafah on Monday, amid ongoing battles between Israel and Hamas. (Mohammed Abed/AFP/Getty Images)

Saif said the wound on her stomach from the delivery was very slow to heal, as she, too, was malnourished.

“Even me as a nursing mother, I have [no food] to make me stronger,” she said. “Right now, even formula, no one can get it.” 

Mounting pressure for aid

UNICEF said last month it expedited deliveries to Gaza of health-care equipment, medicines and nutrient supplements for 2,000 babies. 

But Ingram said deliveries aimed at pregnant mothers are subjected to the same delays and long waits for Israeli inspections as any other trucks coming into Gaza.

A nurse cares for babies at the preemie ward of the Emirati Hospital in Rafah, Gaza Strip, Friday, March 8, 2024. Sixteen premature babies have died of malnutrition-related causes over the past five weeks at the hospital, one of the senior doctors told The Associated Press.
A nurse cares for babies at the preemie ward of the Emirati Hospital in Rafah, on March 8. Sixteen premature babies have died of malnutrition-related causes over the past five weeks at the hospital, one of the senior doctors told The Associated Press. (Fatima Shbair/The Associated Press)

On Wednesday, amid mounting international pressure to get more food and other assistance into Gaza, Israel’s military announced it intends to intensify aid deliveries.

“We are trying to flood the area, to flood it with humanitarian aid,” Israel Defence Forces spokesperson Rear Admiral Daniel Hagari told foreign media.

He said that would mean expanding the number of land crossing points into Gaza, as well as using more airborne drops and barge shipments, which have just begun arriving via Cyprus.

Israel blames the sparsity of humanitarian aid reaching the needy in Gaza on the poor security situation in the territory — and not because it is holding up aid shipments at the border.

Other nations and external organizations, however, are not waiting for Israel to act. The private charity World Central Kitchen is building a pier to receive aid shipments by sea.

It’s unclear, however, precisely what assistance is being targeted toward maternal care.

‘Humanitarian catastrophe’

Dr. Hina Cheema, an American OBGYN from the Dallas area, arrived in Gaza last week on a volunteer medical mission with the group MedGlobal.

She told CBC News she’s overwhelmed by what expectant mothers go through at the Emirates hospital in Rafah.

“There are only five labour beds, and they are delivering between 70 to 100 patients every single day, which is a humanitarian catastrophe,” she said of the overworked staff.

Dr Hina Cheema, an American OBGYN from the Dallas area,  is volunteering in Gaza at the territory's only functioning maternity hospital.
Dr. Hina Cheema, an American OBGYN from the Dallas area, is volunteering in Gaza at a maternity hospital. (Mohamed El Saife/CBC)

Cheema also said the constant Israeli attacks, food shortages and the extreme stress the women are under is leading to tragedy.

“I’ve been seeing so many more stillbirths,” Cheema said. “All the OB staff here are talking about how much that rate has increased…. They’re seeing preterm labour, preterm deliveries, which were not happening at the volume that are happening right now.”

Ingram, the UNICEF staffer, said the agency does not know how many stillbirths there have been in Gaza, but on her own visit to Gaza in January, she heard terrible stories of nursing staff members trying to deliver babies from mothers injured by Israeli attacks who were rushed to hospital and didn’t make it.

“A nurse told me that she’d performed six emergency caesareans on dead women in the last eight weeks,” Ingram said.

Amid such dire circumstances, expectant mother Alaa Jabr said the prospect of delivering and raising her child in a war zone is daunting.

“Every day we wake up with hope — but there’s nothing new.” 

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