The Israeli government's blockade of Gaza and attacks on healthcare facilities have created serious and sometimes life-threatening danger for women and girls during and after pregnancy and delivery since hostilities began in October 2023, Human Rights Watch said in a report released today.
The 50-page report, "'Five Babies in One Incubator': Violations of Pregnant Women's Rights Amid Israel's Assault on Gaza," finds that Israeli forces' unlawful blockade of the Gaza Strip, its severe restrictions on humanitarian aid, and attacks on medical facilities and healthcare personnel have directly harmed women and girls during pregnancy, childbirth, and the postpartum period. The Israeli government, as the occupying power in Gaza, has violated the right to the highest attainable standard of health and other rights of pregnant women and girls, including the right to dignified, respectful health care throughout pregnancy, childbirth, and postpartum, as well as the right to newborn care.
"Since the start of the hostilities in Gaza, women and girls are going through pregnancy lacking basic health care, sanitation, water, and food," said Belkis Wille, associate crisis, conflict and arms director at Human Rights Watch. "They and their newborns are at constant risk of preventable death."
The report is based on interviews with 17 people between June and December 2024, including 8 Palestinian women who were pregnant while living in Gaza during the hostilities, medical workers from Gaza, and international medical staff working with international humanitarian organizations and agencies' operating teams in Gaza.
As of January 2025, emergency obstetric and newborn care is only available at 7 out of 18 partially functioning hospitals across Gaza, 4 out of 11 field hospitals, and one community health center, compared to the 20 hospitals and other smaller healthcare facilities that functioned before October 7, 2023.
Read a text description of this video
Shaima Suhail Abu Jazar, Medical evacuee from Gaza:
It was 2 a.m. The bombing started.
The bombing was very, very heavy.
At 2:30 a.m., Hudaifa (son) and Jenan (daughter) came together from their room.
They said: "Mom, we can't sleep."
"We're very scared."
Narration:
When the bombing started, Shaima was at home in southern Gaza with her husband, and three of their four children.
Their youngest child was staying the night at her grandparent's' house.
Shaima was nine months pregnant with their fifth child.
Shaima Suhail Abu Jazar:
Jenan was in the middle, so I told her, sleep on this side and leave (twin) brother next to your (older) brother."
It was barely a minute after I switched them when the bombing happened.
Jenan was martyred, may God have mercy on her.
Her two legs were cut off, and she had a big piece of shrapnel in her head.
Mohammed, my son, was also martyred.
Narration:
Israel's military offensive in Gaza following the Hamas-led attacks on October 7, 2023, has severely harmed the healthcare system there.
Israeli authorities have also unlawfully restricted humanitarian aid and medical supplies to people in Gaza, amounting to the war crime of collective punishment.
As the occupying power in Gaza, Israel's actions violate the right to the highest attainable standard of health for pregnant women and girls and their children across Gaza.
Israeli authorities should facilitate the urgent restoration of Gaza's healthcare system so that all people, including pregnant women and babies, have access to quality medical care.
Shaima Suhail Abu Jazar:
This leg was next to my husband.
When the bombing happened, it was set on fire, flesh was melting before my eyes fat was dripping, as if it was a barbecue.
It was a very scary sight.
When the bed flew and I fell to the ground, water containers flew, and fell next to me, and I started scooping water from it to cool my leg down.
Half of my foot has melted away.
If I hadn't poured water on it all of it would have melted.
My gut feeling was that Jenan, Mohammed and my husband had been martyred.
The paramedics took a long time to find me because I was under the rubble and among the ruins.
As soon as they found me, I told them, "I'm pregnant, save the baby."
Narration:
The first hospital Shaima was taken to in Gaza, among the few still functioning at limited capacity, was full, so she had to be moved to another one.
Shaima's legs were broken in seven places, and a metal fragment had pierced her abdomen.
She felt the baby move and begged doctors to perform a caesarean section, but they said she was not stable enough for the surgery.
Two days later, the baby stopped moving.
Three days after the bombing, Shaima had a stillbirth.
Shaima Suhail Abu Jazar:
As soon as I reached the maternity hospital, I told the doctor,
"I am not able to have a single contraction".
He said to me, "I want you to lift your leg, and God will help you."
After one contraction the fetus came out dead.
I held him for four minutes, and they took him from me and shrouded him.
I told them to name him after his father, Abdullah.
Narration:
Doctors in Gaza told Shaima that her legs needed amputating.
She was eventually evacuated along with her two surviving children to Egypt to get a second opinion, and from there to Qatar.
Shaima has had over forty operations.
Shaima Suhail Abu Jazar:
I was bed-ridden for five months.
In Gaza, if anyone as much as just walked by my bed I would scream from pain.
But thank God, now I can move my legs.
Narration:
While Shaima's physical wounds are beginning to heal, her emotional scars remain raw.
But she puts on a brave face for the sake of her two surviving children, seven-year-old Maryam and ten-year-old Hudaifa, who are with her in Doha.
Shaima Suhail Abu Jazar:
I wait for the children to sleep so I can cry. I don't want to cry in front of my children. I flip through photos of my husband and children, and I cry.
Narration:
Hudaifa's grief over the loss of his older brother Mohammed, and his twin sister Jenan, runs so deep that sometimes he acts out imaginary role-plays.
Shaima Suhail Abu Jazar:
At night Hudaifa puts a doll next to him here and here.
One named Jenan and one named Mohammed.
He talks to them at night. He says, "Forgive me, Jenan, I used to hit you."
And then he turns to the other doll and says, "forgive me Mohammed. "Yes, brother, you were my support.
You defended me at school.
If anyone wanted to do anything to me, you would come to my defense.
Who will defend me from now on?"
Text on screen
Following 48 surgeries and extensive physiotherapy, Shaima began to walk again.
The international community should press Israel to lift its unlawful blockade on Gaza, cease all unlawful attacks on healthcare facilities, and stop obstructing the delivery of lifesaving assistance.
In mid-January, Israeli authorities and Hamas agreed to a multi-phase ceasefire that includes the entry into Gaza of humanitarian aid, the return of Israeli hostages held in Gaza, and the release of Palestinian prisoners.
The quality of health care the few remaining medical facilities and service providers in Gaza are able to offer is extremely diminished. Women have been rushed out of sometimes packed hospitals within a few hours of childbirth to make room for other patients, many of them war casualties. All medical facilities in Gaza have operated in unsanitary and overcrowded conditions and have serious shortages of essential healthcare goods, including medicine and vaccines.
Two bills passed by the Israeli Knesset in October, which take effect in January 2025, threaten to further exacerbate the harm to maternal and newborn health. These new laws bar the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) from operating in Israel and occupied East Jerusalem and bar the government from contact with UNRWA, which would make it impossible for UNRWA to deliver aid into the occupied West Bank or Gaza or get permits or visas for its staff. Israel has ordered UNRWA to vacate all premises in occupied East Jerusalem and cease its operations there by January 30, 2025. UNRWA provides water, food, shelter, and other vital services to hundreds of thousands of Palestinians in Gaza, including pregnant women, nursing mothers, and newborn children.
Israeli forces' military offensive has led to the forced displacement of over 90 percent of the population of Gaza - 1.9 million Palestinians - often multiple times. It has for the most part been impossible to inform women where they can safely access health services and difficult for women to reach the few available services safely in a timely fashion. Women, girls, and newborns have had almost no access to follow-up and postnatal health care.
Little information is available on the survival rate of newborns or the number of women experiencing severe morbidities or dying during pregnancy, while giving birth, or postpartum. However, in July, maternity health experts reported that the rate of miscarriage in Gaza had increased by up to 300 percent since October 7, 2023. UNICEF reported that since December 26, 2024, eight infants and newborns have died from hypothermia due to lack of basic shelter combined with winter temperatures.
A doctor at a maternity hospital in Rafah said they had so few incubators and so many preterm babies that "we have to put four or five babies in one incubator. ... Most of them don't survive."
Israel's unlawful blockade of Gaza and the use of starvation as a method of warfare has caused acute food insecurity for most people in Gaza. Pregnant women and girls face enormous obstacles to maintaining the good nutrition and healthy diet critical for their own health and for fetal development.
The government has also deliberately deprived Palestinians of access to water, which is a crime against humanity and an act of genocide. Many pregnant women have reported dehydration or being unable to wash themselves.
Many health conditions may be caused or significantly worsened by such deprivation, including anemia, eclampsia, hemorrhage, and sepsis, all of which can be fatal without proper medical treatment.
Pregnant women in Gaza have almost no opportunity to evacuate, though under international human rights law, all civilians have the right to leave their country, including for medical reasons, as well as the right to return.
As the occupying power in Gaza, the Israeli government is also obligated under international humanitarian law to ensure that the civilian population gets food, water, and medical supplies to the fullest extent of the means available to the occupying government. Under the law, Israeli authorities are obligated to allow the free passage of all consignments of medical and hospital stores and of essential foodstuffs, clothing, and medical supplies intended for "children under fifteen, expectant mothers and maternity cases".
The Israeli government's allies, including the United States, should take all possible measures to end these and other grave Israeli violations. Governments should discontinue military assistance; review and possibly suspend bilateral agreements, such as the EU-Israel Association Agreement, as proposed by the governments of Spain and Ireland, and the US-Israel Free Trade Agreement; and support the International Criminal Court and other accountability efforts.
They should continue to support the efforts of UNRWA in Gaza, including all needed resources for sexual and reproductive health services. They should press Israel to ensure sexual and reproductive health and mental health specialists can enter Gaza without restrictions.
"Israeli authorities' blatant and repeated violations of international humanitarian law and human rights law in Gaza have had a particular and acute impact on pregnant women and girls and newborns," Wille said. "The ceasefire alone won't end these horrific conditions. Governments should press Israel to urgently ensure that the needs of pregnant women and girls, newborns, and others requiring health care are met."
For the experience of one pregnant woman in Gaza, please see below.
Experience of a Pregnant Woman in Gaza
R.M., 31, was two months pregnant when the Israeli government began its military campaign in the Gaza Strip.
R.M.'s family struggled to find food. "I was literally starving," she told Human Rights Watch. "We were all in famine in northern Gaza. We had no gas to cook with. We had one meal a day to conserve firewood. … Flour was very, very expensive. No food. No chicken. No meat. I lost a lot of weight."
She also had health problems: "I already had low blood pressure and would faint a lot. I got lightheaded and dizzy. I had no energy, couldn't stand on my own." The family took her to a private clinic in Rafah, but the doctor could not provide any examination beyond an ultrasound or give her any vitamins or calcium. R.M. suffered multiple urinary tract infections but did not go to a clinic because she had heard they had no medicine.
The fighting complicated R.M.'s difficult delivery on May 5. "I went into labor at 2 a.m.," she said. "I was in so much pain, and we were trying to find a way to reach the hospital." She said that at the hospital, "not a single nurse came to check up on me, monitor me, or ask how I was."
R.M. left the hospital at 6 a.m., just over four hours after giving birth to a girl. "I was exhausted and couldn't walk," she said. "I was holding my newborn, and with my husband and three other children, we had to look for someone willing to drive us [to my parents' home]. It took hours until a car stopped for us. My husband told the driver we would give him anything [if he drove us]."
A few days later, R.M.'s family was forced to evacuate Rafah for Khan Younis, where they have been living in a tent under harsh conditions. Her newborn daughter quickly developed diarrhea, which can be life-threatening.
R.M.'s difficult pregnancy and delivery reflect the extraordinary challenges faced by many Palestinian women and girls in the Gaza Strip since the beginning of the hostilities in 2023.
