Every day, an estimated 180 women – many who have been displaced from their homes amid the bombings and are experiencing malnutrition, dehydration and lack of safety – go into labor.

According to the United Nations, women in Gaza are “being forced to give birth in inhumane, degrading and dangerous conditions,” with at least 15 percent of those births “requiring either basic or comprehensive obstetric care.”

With anesthetic medications in short supply, and operating theaters barely functioning in the last remaining hospitals across Gaza, physicians are having to make excruciating decisions for their patients who need emergency care – including performing cesarian section operations sometimes without anesthesia.

“I can’t imagine what goes through the mind of the mother and the poor father who’s watching his wife having to go through this, the physician who has to make that choice, and then what the parents have to endure, even if they could survive that,” Laila Baker, the regional director of UNFPA, the United Nations’ agency for sexual and reproductive health, told The Electronic Intifada.

“Despite the suffering of all women and girls in the Gaza Strip, things are completely different for pregnant women and mothers,” the Palestinian human rights groups found.

“There has been an increase in miscarriages and fetal deaths as a result of bombing and the use of dangerous weapons such as white phosphorus,” the groups added.

Doctors Without Borders said that the mass displacement of more than half of Gaza’s population, along with Israel’s systematic targeting of healthcare facilities, “has completely disrupted access to maternal healthcare, exposing both mothers and their children to serious and even life-threatening health risks.”

“Over 5,000 new babies every month are coming into this life with no hope, and with [their mothers’] fear of being bombarded or dying giving birth,” Baker told The Electronic Intifada.

“No one should have to have that fear,” she added.

“When you’ve already annihilated over one percent of the population – and we know that those constitute genocidal acts as validated by the International Court of Justice – you can only imagine the plight of a woman who’s trying to bring a baby into this world.”

Baker explained that her agency is helping provide basic birthing kits to shelters across Gaza.

The kits contain sterile scissors, a rope to tie off the umbilical cord, a blanket and a bar of soap, Baker said, “in the event that you can wash your hands.”

And she talked about the precarious health situation for menstruating women and girls, who are not able to find sanitary products and are resorting to using scraps of scavenged cloth and material.

“There aren’t enough supplies, and it requires the commercial market – and here is where we say the UN is not a replacement for the commercial market,” Baker noted.

“There is an onus of responsibility on the occupying force, in this case Israel, to keep the border open and to maintain commercial flow so that the market is available.”

Not having proper menstrual hygiene products, she explained, especially in overcrowded shelters with barely any water for bathing, can lead to infections. Some parents are trying to locate contraceptive medications for their pubescent daughters, she said, in an effort to suppress their menstruation.

Watch the entire interview with Laila Baker above, or listen via Soundcloud below.

Full transcript

Lightly edited for clarity.

Nora Barrows-Friedman: Welcome back to The Electronic Intifada Podcast, I’m Nora Barrows-Friedman. In mid-January, UNICEF’s Communication Specialist Tess Ingram said that nearly 20,000 babies have been born into the war on Gaza: “That’s a baby born into this horrendous war every 10 minutes.”

A nurse, she said, had “performed emergency cesareans on six dead women in the last eight weeks.” The nurse told Ingram that there have been more miscarriages because of the unhealthy air and smoke due to Israel’s incessant bombing.

“The situation of pregnant women and newborns in the Gaza Strip is beyond belief, and it demands intensified and immediate actions,” Ingram said. “The already precarious situation of infant and maternal mortality has worsened as the healthcare system collapses.”

“Becoming a mother should be a time for celebration,” Ingram said. “In Gaza, it’s another child delivered into hell.” Meanwhile, menstruating girls and women have little access to hygiene products in Gaza, and have forced many to improvise with scraps of fabric which can lead to infections.

To talk more about the situation women, girls and infants face in Gaza right now, I’m joined today by Laila Baker. Laila is the Regional Director for Arab States at UNFPA, the UN agency for sexual and reproductive health. She has worked at a number of UN agencies, including UNRWA, and was previously the regional director for Arab States at the UN Development Coordination Office.

Laila, it’s an honor to have you with us, and thank you for joining me today to talk about a very important and incredibly difficult subject.

Laila Baker: Thank you so much for having me on the program.

Nora Barrows-Friedman: Thank you. Let’s jump in: what is the typical labor and delivery experience for women in Gaza right now, compared to what it was like during the 17-year blockade before October 7th, which was already pretty precarious to begin with?

Laila Baker: Well, I think you said it was pretty precarious to begin with, but UNFPA and all of our partners, both the UN agencies like UNICEF, the World Health Organization, but also our national partners on the ground, we are looking to build whatever capacity that we can, and the infrastructure that’s necessary to support women and girls, wherever they may be, but particularly in crisis.

So during the 17 years of blockade that we had experienced prior to the war, we spent quite a bit of time working with all of those partners that I just mentioned, to see how could we substantiate primary health care, ensure that women who were trying to get pregnant or who were pregnant, got the care that they needed, both the physical care but also the support network. It can be incredibly lonely, especially if you’re a first-time mom, to have the network around you to quell that anxiety, to make sure that there’s somebody there to help you through it. If you have any questions about what it might be to be a mom, there are lots of peers and so forth. And we’re very proud of the work that we have done with our partners.

Fast forward to October 7th, and the destruction and near annihilation of the health system in a mere four months, has left everyone very fragile, pregnant, woman, man child, it doesn’t matter. When you’ve already annihilated over one percent of the population, and we know that those constitute genocidal acts as validated by the International Court of Justice, you can only imagine the plight of a woman who’s trying to bring a baby into this world. You said it – that it should be a joyous moment, even if there is anxiety, but you would hope that she and her family would have access to at least a skilled person, not necessarily a physician, we have great midwives there. And we’ve always been able to cope.

Even during the most vicious Israeli incursions, we’ve been able to ensure that we have a hotline, have trained midwives, physicians on the line if you needed help. We have safe birthing kits that were delivered to women through our primary healthcare networks. That’s not even possible right now – with communication cuts, we haven’t even been able to do that. It’s a horrible – I can tell you terrible stories, but one that stayed, there are two that stayed with me actually, one is a woman who was heavily pregnant and fleeing from the bombing in the early days. And she said “every step was a race to death. I could feel it. And though I feared for my own life, I feared more for that of my baby.”

And the second one is a rather unhappy ending, a woman who was wounded, she came into the hospital. They were trying to save her life before the baby’s. Unfortunately, she died. And she was one of those women that we had to conduct a cesarean section on while she was dead.

Nora Barrows-Friedman: It’s just unimaginable. I mean, I just can’t – I can’t even begin to understand how this is happening in 2024. It’s – it’s terrifying. For anyone who’s been around labor and delivery, or has been through it, or knows someone who has, there are so many things that can go wrong. It’s such a delicate and careful process. And there are lots of medications and medical supplies that need to be on hand. What about medications, such as Pitocin, or epidural nerve blockers, analgesics, antibiotics, in Gaza? Are any of those available?

Laila Baker: Oh dear, I fear that this is probably one of the worst situations I have ever faced. I’ve spent 30 years with the United Nations, the majority of my time working on humanitarian situations, and I have never faced a single, a single incident like this. There’s just nothing comparable, not in the scale, not in the magnitude. And I put myself in the shoes of a woman, I’m a woman myself, everyone has a baby in their family that they remember the first time you held that baby, when you looked at them, all of the aspirations and the hopes that you had for this child to grow up. Even in the imagination of the parents or the family, those good wishes for this newborn child that brings hope, all of those have been dashed – partly because of the situation and the circumstances that I talked about before.

But in part because there are so few healthcare facilities that can even possibly deliver a baby when something goes wrong. And like you said, many things can go wrong. And I think because childbirth is a common and a natural event in human reproduction and in human biology and even the social nature of of people, we all too often take it for granted. In the situation in Gaza, first of all, the antenatal care before the baby is born – what kind of care does the mother have, and many women put the health of their unborn child and their family members before themselves. So where food is scarce, where water is scarce – and just for your information, women need three times the amount of water when they’re pregnant and lactating than the normal, average person does.

Imagine that you don’t even have enough water as a normal regular person, where less than one liter of clean water is available for the day per person. Imagine that poor woman who’s trying to get her unborn child to safety. Even if you could get to the hospital – we have tried, through UNFPA, through our own channels of procurement and delivery, to provide a few things: safe delivery kits for pregnant women in the shelters, and this is a very simple package, the basics of basic, a clean sheet that’s plastic so that it’s sterile and clean in this environment where health and hygiene are very scarce, a rope to tie off the umbilical cords, clean sterile scissors, and a bar of soap in the event you can wash your hands. That’s it, but it can mean the difference between life and death.

And we do deliver the more sophisticated packages of equipment, supplies, epidurals, lots and lots of different types of medications that you mentioned, to the hospitals. The situation is so dire that when our our technical team was able to get in, and it took almost three months before we could get people into Gaza, they were – the equipment and supplies were being used directly from the boxes as they came in, the situation was so desperate. And what we’re very concerned about is, is that in any emergency, a physician, and the hospital staff who are left, and I really want to salute the hospital staff who have endangered their own lives, they’ve put the safety and care of their patients before their own, they’ve worked around the clock.

But when you’re working at 300 percent capacity with very little supplies, and a pregnant woman comes in for a C-section, and you have people who need an amputation, who are bleeding to death, the prioritization for pregnant women becomes naturally not secondary, but they’re left in the hallways, they’re left in the care of lesser-trained people, they may have to wait for a while. And that is an added burden, and an added stress and strain. So this is why we’re seeing more fetal death, we’re seeing more stillborns, we’re seeing more maternal, more probably more morbidity than mortality. But the bottom line is we don’t know; it’s hard to get in there and get accurate numbers, unfortunately.

Nora Barrows-Friedman: Amazing. What can you tell us about cesarean births over the last four months? You know, as you mentioned, just horrifying stories about cesarians after death. But cesarians, sometimes they need to be done immediately, in very fraught emergency situations. What do you know about the rate of cesarians and the safety of cesarians right now?

Laila Baker: It’s hard for me to give you exact rates, like I said, the situation is very precarious. It’s always moving. And we have had very little access, almost none in the north, for example. But even in the areas where there are existing facilities, we get bits and pieces from the shelters where births are taking place. Just to give you an idea, it’s about 180 births per day. So we have no idea what happens, even if you could get to safety, what happens to those mothers and children afterwards? We only have anecdotal evidence.

But let me just give you probably, again, some of the most difficult circumstances that no human being, no woman, and certainly no physician should ever have to be put in that situation – where a woman arrives and there is no anesthesia. And she needs to undergo a C-section to save her life. And the choice then becomes C-section without anesthesia, without hygienic situations; in some cases that we know of in a corridor, not even in a proper operating theatre, and where she would have to go home, if she could survive that, within hours, pick up her baby, there may be a blanket or not to wrap the child in, and walk.

Now, for anyone who’s ever had surgery, particularly in their lower abdomen, you know that getting up and walking after a few hours and carrying another small human being is incredibly painful. I can’t imagine what goes through the mind of the mother and the poor father who’s watching his wife having to go through this, the physician who has to make that choice, and then what the parents have to endure, even if they could survive that. For me, it’s not only unbearable, it’s inhuman, to put anyone in that in that predicament.

Nora Barrows-Friedman: And then, assuming that she is able to walk, we’re seeing thousands and thousands of people crammed into these shelters, especially in the south, little to no access to bathrooms, let alone sanitary supplies to change the dressings – I mean, this is major abdominal surgery, plus trauma, emotional and physical trauma. What happens after? I have no words to even try to imagine.

Laila Baker: You know, this must be maybe my 40th interview, if not more. And I wonder what it’s going to take for people to connect, to say, it’s so horrendous to ever have to put someone in that situation. These are the lives of people. So when we say that there are 180 births a day, that’s 181 women who have to go through excruciatingly painful, physically and emotionally, circumstances. And then those are the lives of herself, her new child, there may be other family members, and the community at large. So for me, it goes way beyond just getting through the safety of that birth, which is incredibly important. Don’t misunderstand me.

But I fear for the collective at this point. What will it take also for the international community to wake up and say, this is inhumane? It’s unacceptable, it must stop. And we have to focus on ensuring that everyone, especially women and children, who have by no fault of their own, they were just born into Gaza. They just want to live a good life. They want to bring their children into this world with dignity and raise them happily and healthily, and are prohibited from doing that. They’re actively, actively handcuffed to the situation, this horrendous – I hate to call it a war. It’s an aggression, a continuous, relentless bombardment of an innocent civilian population, and the Palestinians are paying the price of just being Palestinians.

Nora Barrows-Friedman: Laila Baker, we also know the dire situation of for premature infants in NICUs, in the neonatal intensive care units in Gaza. And now as the temperature in Palestine plummets, and there’s still no electricity four months into this genocide. What can you tell us about these fragile babies and their mother’s health?

Laila Baker: Again, exact information, we only have facilities that are still functioning, and those who are a fraction of the ones that were operating before. I think everyone has seen the heart-wrenching pictures when the Israelis cut off the electricity. And the doctors heroically swept in to try and save at least 24 infants, carried them through a war-torn Gaza under bombardment to safety in another place. Right now the situation for many of those babies, which should take a single newborn infant of premature infant to one incubator, it was already stressed before, there weren’t enough units to take care of the number of births in the hospital facilities.

At the moment, there may be three or four newborns in one single unit. Now, while doctors are heroically, again, trying to save lives and doing the best with what they have, the risk of infection – don’t forget that a newborn who’s that fragile comes with a whole slew of fragility. The lungs are not yet developed usually, there may be other problems with the liver, still not developed enough to fight infection. And having those children in those circumstances, those very fragile, tiny babies, crammed into a single unit, decreases the success rate of their lives. It breaks my heart every time I see them.

And I can’t imagine a single person with a human heart who could agree to this aggression. I often tell people, you don’t need to know the politics. all you need to know is that there are 2.2 million people, of which almost 5,500 women every four weeks, who give birth to a baby. Over 5,000 new babies every month coming into this life with no hope and with the fear of being bombarded or dying giving birth. No one should have to have that fear.

Nora Barrows-Friedman: Indeed, indeed. You mentioned the homebirth, or midwifery kits, that UNFPA is helping to supply. Can you tell us a little bit more about the home birth and midwifery community in Gaza, especially, as what you’ve been describing in terms of hospital births, is horrific and there are no basic supplies or medicine. What can you tell us about the community there in Gaza?

Laila Baker: Well, first of all, luckily, we have been training people on community birthing, skilled birth attendants who are not physicians, but trained midwives, nurses, etc., and who can both do the delivery, assuming that it’s an uncomplicated delivery, a normal delivery. And in normal circumstances, when there isn’t a war, that could be about 85 percent of the births, which is a pretty good ratio. There are a few things that hinder that.

The first, of course, is the fact that those skilled birth attendants, those midwives, those nurses, who are embedded in the community, are hard-pressed to find, and in the majority of cases, because over 95 percent of the population is now themselves, finding themselves in a place of internal displacement, forced displacement. So they are without their normal situation, they are not in, they don’t have their normal equipment with them. And they certainly don’t have the communication system, the phone lines, the internet that would enable them to provide that support, unless they’re in the same shelter.

So we’ve tried to do a few things. One is that wherever you have the most skilled midwives, we’ve tried to put them in the facilities where they will be needed to support the other health professionals to deliver the more complicated cases of hemorrhage, of the needed emergency C-sections. And we’ve tried to identify in some of the more cramped shelters, and by cramped I think that’s a gross underestimation, a shelter that should be housing 400 people has 23,000, for example.

But we’ve tried to identify who has experience in birthing, we have provided them to the best of our ability, but we are hindered from bringing in those supplies, both the clean delivery kit, and that was the one that I described that has the sheet and scissors and a bar of soap. And there’s a slightly more advanced one as well that has suturing, that has, you know, that has gauze, and that can help a midwife also bring the baby into the world and also wrap them in a thermal sheet.

Right now there aren’t clean blankets, it’s cold, like you said. So we want something to keep the mother warm, something to keep the baby warm. And this is just a thermal piece of plastic with the kind of looks a little bit astronautic, if you might imagine, a piece of plastic with some silver foil on the other side. But it does retain the heat for the mother and for the child, so that at least they don’t freeze to death in giving birth. It’s really, it’s really awful. I can’t even imagine. I really can’t.

Nora Barrows-Friedman: And as I mentioned at the beginning, there have been reports about menstruating women having to use scraps of cloth and other scavenged materials, leading to infections. How are girls and women able to take care of themselves while they’re on their period? What do they need right now, and what is most pressing?

Laila Baker: You know, thank you for the question. Most people, again, because menstruation in the Middle East is considered a private matter. But many girls, especially in this new generation, if you’re getting your period and you’re an adolescent girl, you’re finding yourself and your womanhood. And it can be also a moment where really you’re starting to feel proud. You’re developing your own sense of self and coming into a new, a new era of your own life. It does require a few things, though it does require understanding of that process.

We haven’t been able to continue with that. It can be a very scary moment for people who don’t understand what’s happening, especially if this is your first period. There aren’t enough supplies, and it requires the commercial market – and here is where we say the UN is not a replacement for the commercial market. There is an onus of responsibility on the occupying force, in this case, Israel, to keep the border open and to maintain commercial flows so that the market is available.

Not having menstrual hygiene products available in the local market and at the level that they can accommodate nearly 700,000 menstruating women and girls every month means a few things: One is that you’re going to use whatever you have, you will cut the tent up, you will use your sweater, you will do whatever it takes. Because again, you don’t want to be embarrassed. And it can be – it can have a long-lasting mental impact on many of the women and girls that we’re seeing.

The second impact is that, given the unhygienic situations in the cramped quarters, where there could be 1,000 women to one single toilet facility, the ability to even maintain hygiene, much less during your period, is pretty, pretty scarce. And so we are worried about not having enough products, certainly about not having enough dignity to be able to manage your menstruation.

Thirdly, about the infections because people will use whatever they have. And we have evidence that parents are also trying to locate contraceptive pills that would suppress the period so that you don’t have to deal with it. I can’t imagine giving contraceptive pills to a 12-year-old girl where no physician has checked her and where her period is just starting – the long-lasting impact of all of those concerns that we’re seeing on the ground I think we’ll only know as the stability hopefully comes to Gaza, and we’re able to really go in at scale and support the community there.

Nora Barrows-Friedman: Finally, you mentioned some of these at the beginning, but what are some stories or reports that you’re reading that keep you up at night? And how are UN workers or agencies able to operate in these conditions? I mean, you know, what about your colleagues on the ground in Gaza? What’s that like for them?

Laila Baker: My poor colleagues have been displaced like everyone else. Two of my colleagues were in the Khan Younis Training Center. They were two women, very well educated, one of them handling our gender-based violence program and one of them handling, strangely enough, our sexual reproductive health and emergencies program. Both of them had children, beautiful, healthy, vibrant. One of the colleagues had a baby that was a little less than 10 months when the aggression started. Within the first month, the baby had lost five kilograms of weight, five kilograms.

Now this is my colleague, who has a master’s degree, is well-educated, very sophisticated, a wonderful colleague to work with. And I have seven wonderful colleagues who are Palestinian, who have worked tirelessly, Mustafa, who’s given everything that he has, not thinking about his own life, in some cases to deliver a safe birthing kit, or get water supplies to other colleagues. But as we’ve seen, there’s no place safe in Gaza. And the so-called evacuation orders into safety we’ve seen are false. The attacks on the UN facilities are a gross violation, the attacks on hospitals, all of the civilian infrastructure.

And for us, what keeps me up at night is the fact that we, as the international community, have failed the Palestinian people and the people of Gaza. And I put myself in that category because for everything that we have tried to do, our Secretary-General has been very vocal about it. Our executive director Natalia Kanem, at every turn, speaks about saving the lives of women and girls and protecting the civilian population of Palestine, in Gaza.

But it falls on deaf ears and the narrative is constantly derailed, by propaganda, by a lot of misinformation, and by the continued aggression that just never seems to desist. And I think that’s what troubles me most, is that in this world where the United Nations is the only entity that really still tries to uphold universal rights, we are unable to garner our member states to see the legitimacy of the Palestinian people’s right to self-determination, for people to live in peace and dignity and to allow for those women and girls to grow up safely and securely, without any fear of dying, not as a girl, not as a woman who wants to have a family of her own and certainly not in childbirth.

Nora Barrows-Friedman: Is there a way that people around the world can support the UNFPA in terms of helping to deliver these labor and delivery kits? Is there any way that – I know that people will be emailing and asking how they can be a part of that.

Laila Baker: You bet. We have an individual giving campaign, and I have to say that we raised the most amount – we always have this for all of our crises, and Palestine has garnered the most money for that. UNFPA’s website, you can go, you can look at the individual giving campaign, you can dedicate it to someone. You can also help, and I must say here that UNRWA is under an enormous amount of strain.

I urge everyone to campaign to ensure that the United Nations Relief and Works Agency continues to work and flourish. They are the largest protectorate of the Palestinian refugee community in Gaza. And they have been actively denied funding to continue their work, after what I would consider unsubstantiated allegations that the UN is investigating. But I urge you to give both to UNRWA to UNFPA, and to continue locally, wherever you are. Let people understand what’s going on, give them the information, take from our website.

And if you need anything, we have a huge number of people who are happy to speak to your communities, to provide you with more information, I think really just countering a lot of that disinformation that’s out there. Please continue to do so. And we’re happy to step in if you need any other support.

Nora Barrows-Friedman: Laila Baker, thank you so much for joining us. You are the Regional Director for Arab states at the UNFPA, that’s the UN agency for sexual and reproductive health. Thank you for all the incredible and important and difficult work that you and your colleagues are doing. We are very appreciative of the time that you spent with us today and we will check back with you shortly. Thank you so much.

Laila Baker: Thank you for having me. I really appreciate it and best of luck to you too.

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