Reproductive Health Crises in Gaza Will Only Worsen as U.S. Withdraws UNRWA Funding

In January, a woman in Gaza named Mashael was pregnant when an Israeli airstrike hit her home, burying her and her husband under rubble for several days, a UNICEF official recounted to Jezebel. While under the rubble, Mashael’s baby stopped moving; a month later, she learned she’d miscarried while waiting for medical care at the overcrowded, under-resourced Emirati maternity hospital in Rafah. “She was heartbroken that this, her second pregnancy, had ended, but said she felt it was best ‘a baby isn’t born into this nightmare,’” Tess Ingram, a communications specialist for UNICEF, said.

Mashael is one of many pregnant women who’ve experienced miscarriage as a consequence of Israel’s ongoing war on Gaza, which has included continued airstrikes, hospital sieges, and a blockade preventing basic medical and sanitary supplies from entering the Gaza Strip. An official from Care International told Jezebel in January that the miscarriage rate in Gaza has increased by 300% since the start of this iteration of Israel’s attacks, according to tracking from their health care workers on the ground. Now, Ingram warns that the reproductive crises are certain to get worse as the U.S. joins 15 other countries in suspending funding to a key humanitarian agency providing medical aid and other basic resources to Gaza.

 

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That agency is UNRWA, the United Nations Relief and Works Agency for Palestine Refugees. The agency was created by the UN General Assembly in 1949 to offer basic resources like food, health care, and education to tens of thousands of Palestinians who were displaced by Israel. But, in January, Israel claimed that 12 of UNRWA’s 13,000 employees were connected to the Hamas attacks on Israel on October 7. Secretary of State Antony Blinken conceded that Israel’s claims haven’t been fully investigated but still called the allegations “highly, highly credible” and stood by the Biden administration’s decision to defund the agency. Meanwhile, as the U.S. continues to send unconditional aid to Israel, over 100 UNRWA employees were killed while aiding Palestinians in just the first month of Israel’s attacks.

“I feel helpless. I don’t have diapers for my four-month-old baby, and I cannot wash his clothes.”

Ingram called UNRWA “indispensable” to Palestinians in Gaza, including pregnant women and new mothers already struggling with malnourishment, infection, and disease amid Israel’s ongoing blockade. According to Ingram, 135,000 children under two years old are already “at risk of severe malnutrition.” That’s because baby formula is inaccessible, and starving and malnourished mothers are unable to nurse. Over the weekend, a video shared by U.K. outlet Middle East Eye showed a newborn forced to suckle on a date because their mother can’t produce breast milk. It’s not just formula and food: Menstruating women and children have almost no access to sanitary products, resulting in surging rates of infection like bacterial vaginosis, and, in severe cases, hospitalization. And, per UNICEF, they’re experiencing these conditions amid increasingly severe winter weather conditions without shelter, as respiratory infections and a range of diseases—known and unknown—spread across Gaza.

In written testimony that Care International shared with Jezebel, a 27-year-old mother in Gaza, called Farah, describes living in “a small house in Rafah with 25 people,” calling her family (including her five-month-old baby) “lucky that we do not have to live in a tent or on the streets, like so many others.” In shelters, Farah says “women must sometimes queue for hours to use the bathroom while feeling unwell” and are “unable to dispose of tissues soaked in blood, as they do not have any hygiene pad.” It’s “impossible” to “adhere to even basic hygiene standards such as washing hands without clean water and soap,” and consequently, “diseases and epidemics are spreading everywhere.”

“I feel helpless. I don’t have diapers for my four-month-old baby, and I cannot wash his clothes,” Farah wrote. “In the past four months, some of my friends had their babies without anesthesia, even when having caesareans, and others had to give birth in shelters on dirty, cold floors, only aided by their mothers or other elderly women.”

A Palestinian child is seen at a camp affiliated with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in the southern Gaza Strip city of Khan Younis in November.

Historically, the U.S. has given UNRWA $300 to $400 million per year. Meanwhile, the U.S. gives about $4 billion in annual aid to Israel and has already given about $18 billion between just 2023 and early 2024. State Department deputy spokesperson Vedant Patel said the U.S. will send aid to Gaza through other agencies, like the U.N.’s World Food Program (WFP) and UNICEF—but, as Ingram explained to Jezebel, “No other entity has the capacity to deliver the scale and breadth of assistance that the more than two million people in Gaza urgently need.” Distribution of resources is already severely strained as infrastructure across Gaza has largely been destroyed by the war. Without the minimal medicine and aid that UNRWA has been able to provide to Gaza, Ingram predicts “the already precarious situation of infant and maternal mortality” will only worsen, as mothers already “face unimaginable challenges in accessing adequate medical care, nutrition, and protection before, during and after giving birth.”

At the end of January, Samah Shamali, a former lecturer at the Islamic University in Gaza, shared a Facebook post detailing horrific stories of pregnancy and birth in Gaza. Shamali described a pregnant woman who was repeatedly run over by an Israeli tank until her fetus came out. She claimed another woman who went into early labor had to walk 10 hours; upon giving birth, the woman’s newborn twins died from a lack of available oxygen supply at the hospital. One woman who went into labor where she was sheltering was unable to call an ambulance because of a blackout imposed by Israel, and was forced to walk to the hospital. Shamali said she’s also heard of another woman who went into a coma as a result of having a c-section without anesthesia.

The experiences Shamali described haven’t been confirmed or independently verified. But Ammal Awadallah, executive director of the Palestinian Family Planning and Protection Association, told Jezebel she’s heard similar stories from patients and health care providers on the ground in Gaza—in fact, these experiences “are more common than not.” She’s heard of at least one displaced pregnant woman who started having contractions while walking on foot in search of a safe place to give birth. Awadallah heard from another woman who was dismissed from a hospital immediately after having a c-section with nowhere to go, since she and her husband feared going to an overcrowded shelter, especially since her cesarean wounds made her vulnerable to infection. “[They] were calling out into the streets for anyone to take them in,” Awadallah said. She also learned about a woman who “didn’t know she was pregnant and didn’t find out until miscarriage, for which she was relieved and felt she was fortunate” to not give birth during the war. “Everybody now is displaced, and there’s no food or clothing, so that even after the newborns are born, they don’t have anything to dress them in. There’s nothing—no medicine, no food, shelter.” When there’s already “nothing,” Awadallah said she’s stunned by the cruelty of withdrawing UNRWA funding: “Much more is needed, not less.”

Earlier this month, Doctors Without Borders shared in a press release that one woman in Rafah was forced to give birth in a public bathroom because there was no capacity at her hospital. Another woman told the organization she hasn’t received prenatal care since before Israel’s war on Gaza started. Ingram also described a horror story from a woman named Iman, who had to run on foot from an attack while she was eight months pregnant; Iman had a c-section, and then had to be hospitalized for a severe infection that left her too weak to hold her own baby. One mother of 13 “barely ate for two weeks near the end of her pregnancy” and is worried about “having clothes, diapers, or food for him.” Another woman was buried under rubble by an Israeli attack while six months pregnant. Her fetus didn’t move for a week; she still gave birth to a healthy baby but was “injured and sick” and forced to care for her baby while living in the streets of Rafah.

“The situation of pregnant women and newborns in the Gaza Strip is beyond belief, and it demands intensified and immediate actions,” Ingram said. “The decision to pause funding for UNRWA will be nothing short of catastrophic for the women and children of the Gaza Strip. With almost a million children displaced, disease spreading due to unsanitary conditions and lack of clean water, and Gaza facing the risk of famine, we should be rapidly scaling up, not down.”