Rafah, southern Gaza: Displaced, pregnant, and living in a tent

MSF medical staff discussing with patient and checking on newborn child in the Emirati hospital, Rafah, southern Gaza.
29 Jan 2024
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Occupied Palestinian Territory

Maha* went to the hospital as her labor had just begun, only to be turned away because all delivery rooms were full. Discouraged, she returned to her makeshift tent, one of many in Rafah’s camps for internally displaced people, in the cold winter weather. Rafah, a city in southern Gaza, housed 300,000 Palestinians before the war; that number soared to 1.5 million as Gazans fled bombings and evacuation orders in the North and Middle Area of the enclave. Unfortunately, Maha wasn´t able to return to the hospital. She gave birth to her deceased son in a public bathroom.

The war in Gaza, marked by the dire lack of humanitarian aid and attacks on health care facilities, has completely disrupted access to maternal health care, exposing both mothers and their children to serious and even life-threatening health risks. In the Rafah area, the Emirati maternity hospital stands as the main remaining facility attending to the maternal health needs of displaced pregnant women.

The needs are enormous: According to the World Health Organization, an estimated 50,000 women are pregnant, and according to UNICEF an estimated 20,000 babies have been born since the start of the war.

Grappling with an overwhelming surge in needs and lack of capacity, the Emirati hospital can now only respond to the most urgent and life-threatening deliveries. Médecins Sans Frontières/Doctors Without Borders (MSF) teams are deeply alarmed by the deteriorating lack of obstetric care in Gaza, caused by the continuous bombings, restrictions on humanitarian aid, and attacks on healthcare facilities.

With so many people displaced, the situation in Rafah is terrifying,” said MSF emergency coordinator in Gaza Pascale Coissard. “All places are overcrowded, with people living in tents, schools, and hospitals. The Emirati hospital is now dealing with three times the number of deliveries it handled before the war.”

The humanitarian crisis unfolding in Gaza has left expectant mothers without medical check-ups for months, as primary healthcare services are virtually unavailable and women in labor are unable to reach hospitals because of the lack of fuel and capacity in the few remaining hospitals. Displaced women living in deplorable conditions are giving birth in plastic tents and public buildings. Those who manage to deliver in a hospital often return to their makeshift shelters mere hours after undergoing a Caesarean section.

To reduce the risk of morbidity and mortality among mothers and newborns, MSF is supporting the Emirati hospital with postpartum care by adding 12 beds to the ward, to reach a 20-bed capacity, allowing more patients to receive proper monitoring post-delivery.

Without enough supplies and too many patients, the healthcare system is overstretched, and mothers are forced to be discharged just hours after giving birth,” explains MSF midwife activity manager Rita Botelho da Costa. “The first 24 hours postpartum are the riskiest for complications, and with people living in dire conditions, it´s important to keep the patient in the hospital as long as possible.”

With so little access to maternal health services, many pregnant women have not received any care since the start of the war, and haven´t been able to check on the health of their child. 

At six months pregnant, 33-year-old Rana Abu Hameida was admitted to the maternity ward at the Emirati hospital because she was suffering from pregnancy complications. Rana never had an ante-natal checkup since the start of the war.

After I was displaced, it became difficult to get transportation and to find healthcare services,” she said. Abu Hameida was displaced from Beit Lahya, in North Gaza, and like Maha, is now sleeping in a tent. “It´s challenging to find a place for treatment or organizing my life so I can resume monthly checkups. I´m staying in a tent; life is hard, especially when it comes to finding food or water and sleeping without proper bedding.”

When pregnant women don´t have proper access to healthcare, enough food, or adequate shelter, they and their children are more likely to experience health issues, including infections. The children of malnourished pregnant or breastfeeding women are at immediate risk of health issues and potential long-term developmental challenges.

Over a third of patients seeking antenatal care exhibited anemia, a condition often associated with an iron deficiency, which is a critical concern for pregnant women who often require iron supplementation. Additionally, nearly half of these women had genitourinary infections, such as urinary tract infections.

In Rafah, MSF teams are providing postpartum care as well as mental health support in the Emirati hospital. In Al Shaboura Clinic pregnant women are provided antenatal care including screening for malnutrition and given supplementary therapeutic food if needed.

In the first week of January, MSF gynecologists and obstetricians provided antenatal care to over 200 patients at the Al Shaboura clinic. In the Emirati hospital’s post-natal care ward, within the first week of expanding the ward, MSF teams received over 170 patients. However, without sufficient humanitarian aid to Gaza and protection for the few health facilities that remain functioning, the provision of care will continue to be a drop in the ocean.

MSF reiterates our call for an immediate and unconditional ceasefire, and for the protection of health facilities to safeguard lives. We also stress the urgency to promptly restore the flow of humanitarian aid into Gaza and re-establish the healthcare system, upon which the survival of mothers and children in Gaza critically depends.