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Serious Violations Against Pregnant Women During the War on the Gaza Strip (Deterioration of Reproductive Health)
Introduction:
Over the past decades, Gaza has experienced recurrent military escalations. However, since October 7, 2023—and as a result of the genocidal war on the Gaza Strip—human life has been subjected to unprecedented levels of destruction and intense humanitarian pressure. Notably, the ongoing hostilities have forced approximately 1.9 million people to flee their homes. Within this context, pregnant women in Gaza have suffered particularly dire conditions, as their health and reproductive status have deteriorated due to restrictions on movement, the targeting of healthcare infrastructure, and a critical shortage of essential resources—clear violations of international law.
The humanitarian impact of worsening reproductive health among pregnant women reflects a broader tragedy affecting families and communities across the Gaza Strip. Far-reaching repercussions of the conflict extend beyond physical well-being to encompass psychological and social dimensions. In the most recent conflict (2023–2024), the crises confronting women in general—and pregnant women in particular—have intensified due to the absence of healthcare services, repeated incidents of forced displacement, and the lack of privacy in shelter centers.
Violations Against Pregnant Women: Context and International Laws
In light of the ongoing genocidal war following the October 7 attacks, the Israeli occupation launched a broad military operation in the Gaza Strip that has targeted infrastructure, agriculture, civilians, and healthcare and civil facilities—thereby deepening the crises experienced by vulnerable groups. As a result, pregnant women in Gaza face numerous challenges, summarized as follows:
1. Targeting Health Infrastructure
Attacks on hospitals and medical clinics represent a clear violation of international humanitarian law, which stipulates in Article 18 of the Fourth Geneva Convention that hospitals and medical facilities must be protected against military targeting. Yet in Gaza, reports indicate that over 50% of health facilities have been destroyed or damaged in recent wars, causing the disruption of basic healthcare services, including care for pregnant women. Many pregnant women have been forced to give birth at home or in under-equipped shelters, significantly increasing the risk of death. For instance, one woman named Layla recounted walking long distances under bombardment to reach the nearest health center, only to discover that it was unequipped for emergency situations.
Additionally, hospitals that remain in service suffer from severe shortages of medications and medical supplies. Data shows that over 40% of essential medicines are unavailable, including life-saving emergency drugs needed during childbirth. This situation violates the right to health guaranteed by international law. During the genocidal war on the Gaza Strip, the Israeli occupation deliberately targeted major hospitals and medical centers to push them out of service and exacerbate the population’s suffering—particularly for pregnant women. In an unprecedented war crime on November 10, 2023, the Israeli occupation besieged Al-Shifa Hospital in Gaza, forcing it to cease operations and endangering the lives of premature infants by preventing the entry of fuel needed to operate incubators.
Under international law, attacks on healthcare facilities are considered crimes, as stipulated by the following laws and charters:
- International Humanitarian Law (IHRL During Armed Conflicts)
- The Fourth Geneva Convention (1949): Prohibits the targeting of health facilities and medical personnel during armed conflicts. Article 18 of the Fourth Geneva Convention states that “medical establishments must be respected and protected at all times.”
- The First Additional Protocol (1977): Extends protections to health facilities, emphasizing that they must remain protected from attacks for the duration of the armed conflict unless used exclusively for military purposes. It also prohibits targeting medical personnel, including doctors and nurses.
- Principles of the Laws of War (The Hague Law)
- The Hague Conventions (1907): Contain a set of principles aimed at protecting civilians and facilities not involved in military operations, such as hospitals. This includes prohibiting attacks on healthcare facilities unless they are used for military objectives.
- International Human Rights Law
- International Human Rights Declarations: Affirm the right to health and prohibit attacks on healthcare facilities that impede civilians’ ability to access healthcare. These rights are set out in the Universal Declaration of Human Rights and in the International Covenant on Economic, Social and Cultural Rights.
- United Nations Resolutions
- UN Security Council Resolution 2286 (2016): Calls on all parties in armed conflicts to respect and protect hospitals and medical staff, and stresses the need to hold violators accountable. This resolution was issued amid repeated attacks on healthcare facilities in conflicts such as those in Syria and Yemen.
- International Court of Justice (ICJ)
- Judicial Precedents: The ICJ has affirmed in its rulings the protection of healthcare facilities and medical staff during armed conflicts. Any attack on a hospital or medical facility is deemed a violation of international law.
2. Food Insecurity and Malnutrition
Pregnant women are among the groups most affected by the food insecurity afflicting the Gaza Strip. According to humanitarian organizations, 70% of Gaza’s population experiences food insecurity, a situation that disproportionately impacts pregnant women. Food shortages lead to acute malnutrition, which increases the risk of miscarriage, preterm births, and death during childbirth. Israel has employed a clear policy of starvation by imposing severe retaliatory measures on the Gaza Strip—cutting electricity and water, prohibiting the entry of all food trucks, and allowing fewer than 500 aid trucks throughout an entire month. Previously, Gaza used to receive this number of trucks on a daily basis to meet its residents’ needs.
These measures are compounded by strict limits on importing essential food items into Gaza, further hindering pregnant women from accessing a balanced diet. According to Médecins Sans Frontières (Doctors Without Borders), most pregnant women in Gaza rely on food aid that often fails to meet their specific nutritional requirements.
International law prioritizes civilians’ food security, stipulating that civilians—particularly women and children—must be safeguarded during armed conflicts through guaranteed food supplies and fulfillment of their basic needs:
- (International Humanitarian Law)
- The Geneva Conventions (1949): The Fourth Convention on the Protection of Civilians in Time of War safeguards civilians in armed conflict and obliges warring parties to provide them with food and water.
- Article 23 of the First Additional Protocol (1977): Requires warring parties to take all feasible measures to ensure the entry of humanitarian aid, including food, to civilians in conflict zones.
- The Rome Declaration on World Food Security (1996):
Emphasizes that food security must be a top international priority and underscores the obligation to ensure food as a fundamental human right, including in scenarios of armed conflict.
3. Forced Displacement and Lack of Shelter
Military escalation has forced tens of thousands of families from their homes, exacerbating the conditions of pregnant women who face serious health and psychological risks due to displacement. Many of the displaced live in crowded, unsanitary shelters, increasing the spread of infectious diseases among pregnant women. This situation contravenes Article 49 of the Fourth Geneva Convention, which prohibits the forcible transfer of civilian populations and has triggered a humanitarian crisis that imposes additional burdens on pregnant women.
Forced to remain in tents and shelters unequipped with basic services, many pregnant women also endure lengthy waits in lines for water and food, worsening their reproductive and psychological well-being. Samar, a 28-year-old woman who lost her fetus, describes her ordeal: “The surrounding conditions were extremely difficult. The constant displacement and moving between unsafe places, coupled with the lack of basic necessities such as food and shelter, caused me persistent fear and anxiety.”
Reports indicate that pregnant women in shelters suffer from a lack of privacy and proper medical care, often being left without any medical support during childbirth. This represents a profound failure to provide the minimum standards of humanitarian protection.
4. Gender-Based Violence
The conflict has heightened the risk of gender-based violence (GBV), including psychological and physical abuse. Reports document instances of exploitation of pregnant women in camps and shelters, a violation of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which mandates the protection of women from violence in conflict settings. In addition, pregnant women are subjected to severe psychological pressure due to the loss of loved ones and the destruction of their homes, increasing the likelihood of depression and anxiety.
The war has also led to the collapse of safe spaces and specialized services for gender-based support; women now face significantly restricted access to secure environments and assistance for survivors of sexual and gender-based violence, aggravated by recurrent displacement, insufficient funding, and communication challenges. A director of a women-led institution in Gaza stated, “Some women got divorced during the war, and we were unable to support them as we did before. There were no communication mechanisms, and our staff could not reach them.”
The Impact of War on Reproductive Health
Owing to the aforementioned violations, the effects of the Israeli war on pregnant women in the Gaza Strip can be summarized as follows:
1. Rising Rates of Miscarriage and Preterm Birth
International reports indicate a notable rise in miscarriages and premature births, attributed to psychological stress and malnutrition. Research shows that approximately 30% of pregnant women in Gaza experienced serious complications during pregnancy due to a lack of healthcare and absence of safe conditions. The ongoing stress of bombardments and explosions affects the mental health of pregnant women, triggering hormonal changes that negatively impact pregnancy. The absence of proper medical attention for such cases further complicates the situation. Ghada, a midwife at Al-Awda Hospital in the Nuseirat refugee camp—the only functioning maternity hospital in the central area—says, “We have encountered many cases of miscarriage during the war due to limited follow-up, the blockade, and insufficient medications. We also have cases of preterm births, putting both mother and newborn in grave and unstable conditions.”
2. Shortages in Reproductive Health Services
Reproductive health services are a fundamental component of human rights; however, in Gaza, women face acute shortages in these services. Violations include the absence of regular check-ups and insufficient prenatal and postpartum care, heightening the risk of maternal and neonatal mortality. It is estimated that more than 60% of pregnant women in Gaza could not access consistent medical care during periods of conflict. The shortage of obstetricians in many locations further constrains emergency services, escalating health risks for women. This situation clearly contravenes states’ obligations under the Global Strategy for Reproductive Health.
3. Malnutrition and Its Effects on Fetal Health
Malnutrition poses a major threat to pregnant women and their fetuses, with around 46,300 pregnant women suffering from severe malnutrition. This increases the risk of anemia and preeclampsia, while directly compromising the health of fetuses—many of whom are born underweight and face a heightened likelihood of early death. Samar herself noted losing her first fetus due to malnutrition and the lack of medical follow-up. Another woman, Hana, lost her fetus after standing in line for many hours to get food, leading to severe exhaustion and malnutrition.
International Laws and Legal Framework
The Fourth Geneva Convention
The Fourth Geneva Convention explicitly provides for the protection of civilians during wartime, paying special attention to vulnerable groups such as pregnant women. Yet in Gaza, recurrent breaches of this Convention occur through attacks on hospitals and the forcible displacement of the population.
The International Covenant on Economic, Social and Cultural Rights
This Covenant obliges State Parties to ensure that every individual can enjoy the highest attainable standard of physical and mental health, which includes appropriate prenatal and childbirth care. The conditions in Gaza represent a stark violation of these international obligations.
CEDAW
The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) requires states to protect women from discrimination and violence while ensuring they receive necessary healthcare. The situation in Gaza reflects a clear failure to safeguard pregnant women and uphold their rights.
These accounts are not merely personal anecdotes; they represent the suffering of thousands of pregnant women in conflict zones. They should serve as a call to action for humanitarian and international stakeholders to fulfill their responsibilities and ensure the protection of pregnant women—yet another chapter in Israel’s long record of violations and war crimes against civilians. They must also urge international bodies to enforce the law and treaties, hold Israel accountable for adhering to them, and strive to provide healthcare services to Gaza’s population in general and to women and children in particular. Additionally, there is an urgent need to ensure sufficient, nutritious food supplies, establish safe healthcare centers shielded from conflict in accordance with international law, and address psychological trauma by offering psychosocial support services.
Above all, meeting these needs is not solely a humanitarian imperative; it is a legally binding moral duty and a set of rights guaranteed by international law.
