GAZA – Unheard voices: Addressing sexual and reproductive health in Gazan women

International Journal of Gynecology & Obstetrics

Editorial, by Hasan Naeem Jangda, Kanza Farhan, Aymar Akilimali, 9 May 2024 (Open access)

As the conflict in Gaza approaches its sixth month, the humanitarian crisis is increasing with every passing day. Millions of Palestinians in Gaza are suffering from poverty, lack of basic services, and limited access to food, education and health care. According to the UN, lack of clean drinking water, no proper sanitation, and poor nutrition in Gaza are a “textbook formula for epidemics and a public health disaster.” Amidst all these challenging conditions, one thing that gets particularly ignored is concerns for sexual and reproductive health in women and girls of Gaza. With a staggering 4.3 million sexually active persons worldwide receiving poor and/or limited access to sexual and reproductive health (SRH) services in their lifetime, one can easily conclude that the percentage of women not receiving appropriate care in war-torn areas such as Gaza is much higher. This editorial therefore addresses concerns regarding sexual and reproductive health of these women.

In Gaza, over 18 205 people have died and almost 1.9 million people have been displaced which accounts for 85% of the total population. Of those who have died, 7729 were children and 5153 were women, making up 70% of the casualties. Women are facing a myriad of challenges related to sexual and reproductive health, which are made worse by the long-standing conflict, embargo, and restricted access to medical treatment in Gaza. Women are also deprived of sexual and reproductive health services, sanitary and hygiene products. Further obstetric complications are expected to contribute increasingly to death due to displacement. In Gaza, an estimated 183 women give birth per day, 15% of whom are anticipated to require additional medical attention because of pregnancy or delivery-related problems. Lack of fuel and hospital capacity prevent women who are in labour from getting to hospitals and thus they are being forced to give birth in overcrowded healthcare facilities, shelters, their homes, or on the streets among debris where sanitation is worsening, and the risk of infection and medical complications is increasing.

During the ongoing war, many expectant mothers have been deprived of prenatal care and screening due to the lack of access to maternal health services. The first 24 hours after childbirth are the most critical for potential complications, yet the mothers are often discharged within hours of giving birth, receiving minimal post-partum care as a result of the healthcare system being overwhelmed.

Medical supplies such as sanitary products and contraceptives are very limited, which places women and their families at an acute disadvantage as they cannot achieve their chosen family sizes, leading to unsafe attempts to terminate pregnancies in some cases. Moreover, this violence is placing some 60 000 pregnant women in the Gaza Strip at risk of malnourishment and dehydration due to impending famine. It would not be wrong to conclude that the worst humanitarian crisis is being experienced by Palestinian women, especially in Gaza, “of killing, displacement, arrest, miscarriage, epidemics and death from hunger.”

There is a need to find an immediate solution to this conflict as the psychological toll of the hostilities also has direct—and sometimes deadly—consequences on reproductive health, including a rise in stress-induced miscarriages, stillbirths and premature births. According to the WHO, there is a need for an immediate ceasefire and to establish and sustain protected humanitarian access for immediate entry of adequate quantities of humanitarian supplies. There is a need for prioritization of the shipment of fuel to operate desalination plants, hospital generators and ambulances and to ensure safe passage for medical supplies and civilians within the Gaza Strip. There is also an immediate need to make sure that female hygiene products are made accessible to all women of Gaza and obstetric health care provided to all those needing it in the form of doctors, nurses, equipment and medicines. This can easily be accomplished by the help of international communities—in the form of donations and volunteers—provided safe access is granted to them. It is therefore important that the seriousness of this matter is recognized to prevent a large-scale catastrophe from happening—not just in the form of sexual and reproductive complications for the women of Gaza, but also for an entirely new generation born during this conflict in the form of stunted growth, which would in turn result in a huge burden on the already fractured healthcare system of Gaza.