If these mothers and their children manage to survive the war, they will grapple with its effects for the rest of their lives. Health research into multiple areas of armed conflict (such as Syria, Afghanistan, Somalia and Kosovo) reveals that these kinds of conditions are linked to an increase in miscarriages, congenital abnormalities, stillbirths, preterm labor and maternal mortality. Other studies of armed conflict from 1945 to 2017 show that children exposed to war are more likely to suffer from poor living conditions and sanitation, and multigenerational poverty caused by the loss of educational and economic infrastructure.
“Gaza has simply become uninhabitable,” Martin Griffiths, the under secretary general for humanitarian affairs and the emergency relief coordinator at the United Nations Office for the Coordination of Humanitarian Affairs, has said. Women and children have experienced the brunt of this tragedy. The only chance they have at living healthy lives free from lifelong consequences is for the fighting to stop now, and for health services to be restored and rebuilt immediately — a prospect that becomes more challenging and elusive the longer the war is waged.
Pregnancy and childbirth occur in a sociopolitical context; repeated military assaults, the collapse of the health care system and food supply, the absence of adequate shelter and general safety, have lasting impacts on mothers and babies — well after the fighting is quelled.
Before the war, life for pregnant women in Gaza was very challenging. Women there are expected to have large families, and are cared for by overworked doctors and midwives with an unreliable supply of electricity and oxygen. There was already little time for each patient. Despite efforts by the Gaza Health Ministry and the United Nations Relief and Works Agency, obstetric practices tend to be a blend of the developed and the developing world. Doctors are rarely allowed permits to leave Gaza to update their skills, and Israeli authorities restrict the kinds of medications and equipment that are allowed in. Infant mortality rates are about seven times higher than they are in Israel. For mothers, hemorrhage, infection, thromboembolic disease, pregnancy-induced hypertension, obstructed labor and unsafe pregnancy terminations have been the leading causes of maternal mortality. Those complications are largely preventable or manageable in the developed world.
Those dangers have worsened during the war as hospitals and health services deteriorate. Some women are giving birth in cars, on the street and in overcrowded shelters at a time when there are increasing infectious diseases such as respiratory illness, hepatitis A and meningitis. Some hospitals, including Al-Nasr Medical Center in Gaza City, and Kamal Adwan in northern Gaza, have reported direct hits on neonatal and maternity departments with deaths to babies and injuries and death to mothers. There are reports of women having C-sections without anesthesia and mothers being discharged as quickly as three hours after birth. The trauma of war can also directly affect newborns: During the 2014 conflict in Gaza, mothers with high exposure to war trauma gave birth to infants who suffered negative sensorimotor, cognitive and emotional development.