- Cameron Sabet, medical researcher1,
- Dang Nguyen, clinical research coordinator2,
- Sarah A. Nada, medical researcher3,
- Samer Abuzerr, assistant professor of public health4,
- Amira Mohamed Taha, medical researcher56
1Georgetown University School of Medicine, Washington, DC, USA
2Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, MA, USA
3Faculty of Medicine, Menoufia University, Menoufia, Egypt
4University College of Science and Technology-Khan Younis, Gaza, Occupied Palestine Territory
5Faculty of Medicine, Fayoum University, Fayoum, Egypt
6Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA
The current conflict in Gaza has significantly impacted women in the region, beginning with its inception from the Hamas attack on Israel on 7 October 2023. A United Nations group revealed that the Hamas terrorists raped women at the Nova music festival and found evidence that some were bound naked before being shot.1
Women in Gaza have also experienced deadly horrors, which have been compounded by the region’s growing health crisis. Border blockades have severely limited access to essential resources like sanitation, medical supplies, food, and hot water.2 While all women and girls are affected in terms of their physical and mental health, managing menstrual and maternal health presents a particularly acute challenge amid these dire conditions. Now, among pregnant women in Gaza, 1 in 5 are malnourished.3
Over one million Gazans face an increasingly bleak situation as they seek refuge in the city of Rafah, a designated safe zone that is under threat of an imminent Israeli offensive.4 Until February 2024, Gazans had been supported by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) with education, medical care, and other resources. However, numerous nations withdrew funding from the agency after alleged involvement of a small number of UNRWA staff in the 7 October attacks on Israel. Ireland, Spain, and Portugal committed further funding to UNRWA and urged other nations to re-fund the organisation.5
Consequently, the displaced population in Gaza face even more severe shortages of food and water, heightening the risk of starvation. As a result, many women are forced to prioritize feeding their children at the expense of their own nutritional needs, adversely affecting their health and ability to breastfeed.6 The scarcity of clean water for drinking, cooking, bathing, and washing clothing has left many women and girls unable to maintain basic feminine hygiene. As limited resources continue to strain women’s health, their capacity to care for their families diminishes.
The acute lack of feminine hygiene products and convenience stores across Gaza is forcing women to resort to unsanitary and potentially hazardous menstrual management supplies like baby nappies and cloth strips. Some have even turned to oral contraceptive pills as an ad hoc measure, exposing themselves to a range of health risks, including nausea, dizziness, abnormal bleeding, and mental health impacts.7 Mental distress and trauma as a result of the conflict has been reported to trigger multiple menstrual cycles per month in these women, further increasing demand for these increasingly scarce sanitary products.6
Access to clean water is crucial for feminine hygiene and women’s health, but Gaza is experiencing a severe water shortage emergency. Daily per capita water availability has dropped to just three litres for essential tasks like washing, drinking, and cooking.8 This scarcity places immense psychological strain on women and families as they attempt to allocate the minimal supply across competing needs for hydration, hygiene, and food preparation for their families. They are forced to strike impossible balances between these fundamentally important activities which directly jeopardizes their own, and their children’s, physical and mental wellbeing. The UNRWA has warned that the lack of water elevates the risks of preventable infections, including reproductive and urinary tract infections, among Gazan women, as well as other infectious diseases.89
Attacks on healthcare infrastructure have rendered Gazan hospitals partially functional, with intensive care units reaching an occupancy rate of 250%. Médecins Sans Frontières have warned that the healthcare system in Gaza is no longer functioning, leaving women and their families nowhere to seek medical care.10 Consequently, women are forced to give birth in overcrowded, unsanitary conditions without medical assistance.1011 The declining hygiene conditions in Gaza have severe consequences for maternal healthcare, such as the scarcity of clean medical instruments leading to the use of contaminated equipment, and heightening the risk of infections during childbirth.8 Many of the 17 000 women giving birth during the conflict so far have undergone caesarean sections without anaesthesia, resulting in extreme pain and psychological trauma.12 Additionally, there has been a 300% increase in miscarriage rates since the latest outbreak of conflict.6 Contributing factors include a critical shortage of medical supplies, with only 50 functional incubators available, and a severe fuel shortage in the northern regions, placing the survival of premature infants in grave jeopardy.8
To tackle these challenges, the United Nations Population Fund (UNFPA) and the Gender-Based Violence (GBV) Sub-Cluster have developed the Menstrual Health Management (MHM) Strategy in the Gaza Strip. This initiative focuses on meeting the menstrual hygiene and reproductive health needs of women and girls in conflict conditions.13 It integrates elements of water, sanitation, and hygiene (WASH), health, shelter, child protection, and gender based violence, emphasising the distribution of essential menstrual health supplies via ground transportation. The strategy also includes the provision of facilities for menstrual health management and the promotion of menstrual health management education, aiming to protect the dignity, privacy, and safety of women and girls in crisis situations.
With the current blockade on Gazan imports, many of these ground supply-based interventions are becoming increasingly challenging—yet that much more timely. As such, the International Federation of Gynaecology and Obstetrics (FIGO) has issued an urgent appeal calling for a cessation of violence, the establishment of humanitarian corridors, provision of essentials products, and protection of healthcare workers.14 Urgent international action is imperative to amplify awareness, advocate on behalf of civilians affected by the conflict, and stand in unyielding solidarity to safeguard the human rights, dignity, and crucial access to medical care for women in Gaza during this devastating conflict.
Footnotes
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Competing interests: none declared.
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Provenance and peer review: not commissioned, not externally peer reviewed.