Prevention of births in Gaza: Where lies the future?

Abstract

The decimation of maternal health in Gaza is a direct consequence of the ongoing Israeli military assault.^{1, 2} Our medical teams have witnessed countless tragedies that showcase the severity of this crisis. One of our physicians recounts the heartbreaking story of a pregnant woman who developed acute fatty liver during pregnancy. She delivered via cesarean section (CS) but suffered from severe wound infections, abscesses, and fistulas due to the lack of adequate medical care. Despite being treated at both the Gaza European hospital (EGH) and the Al-Helal Al-Emirati Maternity hospital (Emirati), her survival remained uncertain. Another poignant case involved a pregnant woman with type 1 diabetes, who was admitted to the intensive care unit (ICU) with severe diabetic ketoacidosis due to shortages of insulin. A stillbirth occurred. These are not isolated incidents; they are part of a broader pattern of suffering.² Many pregnant women have suffered miscarriages in the resuscitation room after being victims of airstrikes and constant aerial bombardment.² One woman developed fulminant hepatitis A and died after weeks in the ICU during Ramadan, her fetus's fate unknown to us.

With the Nasser hospital out of service at one stage, only the Emirati hospital remained partially operational in Rafah for obstetric and gynecologic emergencies. A 35-week pregnant woman, who had previously undergone two cesarean sections, had a breech presentation, a condition that typically necessitates a CS delivery in a well-equipped facility due to the high risk of complications. Living in a tent in Al-Mawasi without proper medical care, she underwent labor that resulted in her baby's death from asphyxia prior to the arrival of a doctor. In another case in Al-Mawasi, a 28-week pregnant woman carrying twins went into preterm labor. With no possibility of transferring her to a hospital with neonatal intensive care unit (NICU) capabilities, both babies died shortly after birth. These deaths were a direct consequence of the lack of basic medical interventions that could have otherwise saved their lives.

The case of a woman who suffered postpartum hemorrhage (PPH) highlights the severe consequences of delivering under such inhumane conditions. After giving birth outside of a hospital, she arrived at Emirati hospital in hypovolemic shock. Although she was resuscitated and transferred to the ICU at EGH, she developed Sheehan syndrome, a postpartum necrosis of the pituitary gland due to severe blood loss. There is also the case of a pregnant woman who missed her follow-up visits due to transportation challenges amid the constantly evolving designations of “red” zones and was found to have experienced intrauterine fetal demise two months prior. She narrated that her mental and physical exhaustion caused her to lose perception of fetal movement and was uncertain about attributing it to a specific cause due to the myriad of psychological and physical challenges, resulting in a wide array of symptoms, being faced at once. There was an eight-month pregnant woman who suffered severe burns and explosion injuries and had to experience a spontaneous abortion; these stories are a mere fraction of the daily horrors faced by pregnant women in Gaza.

In Gaza, the systematic destruction of healthcare infrastructure and attacks on medical facilities and personnel have created a perfect storm of neglect and violence.^3-5 At the time of writing, patients in the Kamal Adwan hospital in northern Gaza are starving following weeks of siege, with evacuations of newborn babies to the nearby Al-Ahli Arab hospital being impeded. The tightening of the blockade has placed punitive restrictions on the entry of food, clean water, and medical supplies into Gaza, leading to widespread malnutrition, increased risk of infections and complications, and highlighting the need for tailored sustainable medical interventions.^{6, 7} The WHO has warned that maternal deaths are expected to increase given the lack of access to adequate care.¹ The psychological toll extracted in this environment cannot be overstated. Pregnant women live in constant fear, stress, and anxiety, exacerbating direct and often fatal outcomes for reproductive health, resulting in a surge of stress-related miscarriages, stillbirths, and premature births.² The trauma of losing children, the uncertainty of survival, and the relentless violence leave indelible scars.⁸ As healthcare professionals, we bear witness to these atrocities and are compelled to speak out.

We urge our colleagues in the global medical community to raise their voices and advocate for the protection of maternal and infant health in Gaza. The world cannot remain silent as an entire population is deprived of basic rights, including the right to bring new life into the world safely. The unfolding tragedy in Gaza reflects not just a healthcare crisis but a collapse of collective moral responsibility. This is a call to action for all who believe in the sanctity of life and medical ethics. Therefore, we ask our colleagues and the world, what will you do?

Bilal Irfan: Conceptualization, methodology, investigation, writing-original draft, writing-review and editing, supervision and project administration. Abdallah Abu Shammala: Investigation, data curation, writing-review and editing. Khaled J. Saleh: Investigation, data curation, writing-review and editing.

The authors have no conflicts of interest to declare.