Gaza: Physicians Call For Unimpeded Aid To Restore Reproductive Healthcare

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Armed Conflicts

Cardiologist Dr. Marwan Sultan, then Director of the Indonesian Hospital in north Gaza, in February 2025 showing damage to hospital equipment following an Israeli attack on the facility a few months prior. In July 2025, Dr. Sultan was killed in an Israeli strike on the apartment where he was sheltering with his family. Credit: PHR/GHRC

Cardiologist Dr. Marwan Sultan, then Director of the Indonesian Hospital in north Gaza, in February 2025 showing damage to hospital equipment following an Israeli attack on the facility a few months prior. In July 2025, Dr. Sultan was killed in an Israeli strike on the apartment where he was sheltering with his family. Credit: PHR/GHRC

BRATISLAVA, Jan 14 2026 (IPS) – Israel must lift all restrictions on medicine, food and aid coming into Gaza, rights groups have demanded, as two reports released today (Jan 14) document how maternal and reproductive healthcare have been all but destroyed in the country.

In two separate reports released jointly, Physicians for Human Rights (with the Global Human Rights Clinic at the University of Chicago Law School) and Physicians for Human Rights–Israel (PHR-I) show how the war in Gaza has led to rising maternal and neonatal mortality, births under dangerous conditions, and the systematic destruction of health services for women in Gaza.

The reports from the two groups, which are independent organizations, provide both detailed clinical analysis of the collapse of Gaza’s health system and its medical consequences as well as firsthand testimonies from clinicians and pregnant and breastfeeding women in Gaza forced to live and care for their newborns in extreme conditions.

And the organizations say that with conditions improving only marginally for many women despite the current ceasefire, Israel must roll back restrictions placed on aid and immediately help ensure people in Gaza get access to the healthcare they need.

“Israel’s destruction of Gaza’s health infrastructure, combined with untreated malnutrition resulting from restrictions on food and medical supplies, including baby formula, has created an environment in which the fundamental biological processes of reproduction and survival have been systematically destroyed, resulting in known and foreseeable harm, pain, suffering, and death,” Sam Zarifi, Physicians for Human Rights (PHR) Executive Director, said.

“Israel must immediately allow food and essential medical material to enter Gaza with a proper medical plan for helping the besieged population,” he added.

Israeli military operations following Hamas’s attack on Israel on October 7, 2023, have left massive destruction across Gaza, including to healthcare facilities. According to UNICEF, 94 percent of hospitals have been damaged or destroyed.

1.Destroyed incubators and equipment at the Kamal Adwan Hospital Neonatal Intensive Care Unit in north Gaza, following the targeting and raid of the facility by the Israeli forces in December 2024. Credit: PHR/GHRC

Destroyed incubators and equipment at the Kamal Adwan Hospital Neonatal Intensive Care Unit in north Gaza, following the targeting and raid of the facility by the Israeli forces in December 2024. Credit: PHR/GHRC

Maternal and reproductive healthcare has suffered. Before the war, Gaza had eight neonatal intensive care units with 178 incubators. Today, the number of incubators has dropped by 70 percent. In the north, there were 105 incubators across three NICUs, now there are barely any functional units remaining, UNICEF told IPS.

It says that the numbers of low birth weight babies have nearly tripled compared to pre-war levels and the number of first-day deaths of babies increased by 75 percent.

The PHR and PHR-I reports paint a similar picture.

The PHR report, which focuses on the period between January 2025 and October 2025 when a ceasefire was agreed, details how between May and June last year, the Palestinian Ministry of Health reported a 41 percent decrease in the birth rate in Gaza compared to the same time period in 2022; there was a significant increase in miscarriages that affected more than 2,600 women, and 220 pregnancy-related deaths that occurred before delivery.

The ministry also reported a sharp increase in premature births and low birth weight cases; over 1,460 babies were reported to be born prematurely, while more than 2,500 were admitted to neonatal intensive care. Newborn deaths also increased, with at least 21 babies reported to have died on their first day of life.

Meanwhile, the PHR-I report includes personal testimonies illustrating the severe problems pregnant women and women with newborns have faced in Gaza during the war, from lacking safe routes to care and being forced to give birth in unsanitary, dangerous conditions to battling hunger and severe food shortages as they try to breastfeed their children.

One woman, Samah Muhammad Abu Mustafa, a 30-year-old mother of two from Khuza’a, Khan Youni, described how when her contractions began in the middle of the night, because there were no vehicles and very few ambulances, which are reserved for shelling or other critical emergencies, she had to walk a long distance through rain. When she eventually reached the hospital, she said it was “horrifying.”

“I swear, one woman gave birth in the corridor, and her baby died. It was very crowded, and the doctors worked nonstop. I felt as though I could give birth at any moment. After giving birth to my eldest daughter, I was told I should not deliver naturally again because my pelvis was too narrow. Despite this, the doctors said I would have to deliver naturally because a cesarean section required anesthesia, and there was not enough available. I stood for three hours until it was finally my turn, without sitting even for a moment,” she said.

But despite the October 2025 ceasefire, massive problems remain with women’s access to and the provision of, maternal and reproductive healthcare in Gaza.

“Maternal health units in Gaza are largely non-functional and face critical shortages of essential medicines, consumables, and equipment,” Lama Bakri, project coordinator in the Occupied Territories Department at PHR-I, told IPS.

“Neonatal and diagnostic equipment remains scarce or blocked, including portable incubators for premature and low-birth-weight newborns. Although some aid has entered since the ceasefire, these gaps are not being addressed at the scale required, and meaningful improvement in the immediate future remains unlikely.”

Malnutrition also remains a serious problem.

“The ceasefire has allowed us to significantly scale up our nutrition response, but we are still treating pregnant and breastfeeding women for acute malnutrition in alarmingly high numbers,” Ricardo Pires, Communication Manager, Division of Global Communications & Advocacy at UNICEF, told IPS.

He said that between July and September 2025 about 38 percent of pregnant women screened were diagnosed with acute malnutrition.

“In October alone, we admitted 8,300 pregnant and breastfeeding women for treatment, about 270 a day, in a place where there was no discernible malnutrition among this group before October 2023,” he added.

UNICEF has documented almost 6,800 children admitted for acute malnutrition treatment in November 2025 compared to 4,700 cases in November 2024. So far, the number of admitted cases more than doubled in 2025 compared to 2024: almost 89,000 admissions of children to date in 2025, compared to 40,000 cases in 2024, and almost none before 2023.

“What we’re seeing is that no child meets minimum dietary diversity standards, and two-thirds of children are surviving on just two food groups or less. Around 90 percent of caregivers reported their children had been sick in the previous two weeks, which compounds the malnutrition crisis,” Pires said.

And there are fears for the longer-term demographic future of Gaza given the damage to maternal and reproductive healthcare.

“For Gaza’s demographic future, the implications are serious. Even with reconstruction, we will be dealing with a generation of children who were scarred before they took their first breath, children who may face lifelong health complications, developmental challenges, and the effects of stunting. The rebuilding must start now, but we should be clear-eyed: the damage to maternal and newborn health will echo for years, potentially decades,” said Pires.

But others say that with cooperation between international actors and the right political will, the situation need not remain so dire.

“To rehabilitate the population after everything that has happened is going to be a real issue, [but] now there is a Board of Peace, the needs of pregnant women and maternal and reproductive healthcare can be prioritized,” Zarifi told IPS.

“The capacity and the will exist among Gazans and Gazan healthcare workers to rebuild the healthcare system, including maternal and reproductive health services,” added Bakri. “The primary obstacle is not technical or professional but political: Israel’s control over Gaza’s borders and the restrictions on the entry of essential equipment, medical supplies, and reconstruction materials. With unrestricted access to what is needed to rehabilitate hospitals, rebuild destroyed units, and restock essential medicines, recovery is entirely feasible. Whether maternal and reproductive healthcare can return to pre-war levels depends on sustained international pressure to allow that access.”

Although some aid has entered since the ceasefire, these gaps are not being addressed at the scale required, and meaningful improvement in the immediate future remains unlikely.

However, while both NGOs like PHR and PHR-I and others, alongside international bodies like the UN, stress that any recovery and reconstruction in Gaza requires the ceasefire to hold and consolidate, repeated violations underline its fragility, and the effect that has on women.

Meanwhile, PHR and PHR-I point out that extreme weather and ongoing Israeli restrictions on medicine and food getting to Gaza to this day continue to severely affect pregnant women, new mothers, and babies. On top of this, Israel has also announced it will bar 37 international aid groups from working in Gaza, potentially compounding the problems.

Bakri said such measures were jeopardizing what small gains had been made since the ceasefire and “raise serious concerns about whether the situation can improve.”

“Even after the ceasefire, while bombardment has decreased, the reality these women face remains catastrophic – not only for their bodies and well-being but for the survival of the entire society,” said Bakri.

Zarifi added, “We are worried that the restrictions placed by Israel on some of the major actors in the humanitarian response will hamper access to assistance for those that need it. We have raised questions with the Israeli government as to why specific medicines are not allowed to be brought into Gaza and they say that they are not stopping them from being brought in but they can be brought in by commercial means. That is hard for people who can barely put any money together. These medicines should definitely be coming in through humanitarian channels.”

He also highlighted how important the issue of accountability is in ensuring any progress is made in rebuilding healthcare in Gaza and also limiting the probability of similar devastation in the future.

Both reports concluded that the harms caused by Israeli attacks are not isolated incidents but part of an ongoing pattern of systematic damage to the health of women and their children in Gaza, amounting to reproductive violence.

Israel has denied this and said that attacks on hospitals in Gaza have been because the medical facilities are being used by Hamas, and it has maintained that its forces adhere to international law.

While under international law healthcare facilities have special protection even in war, and attacks on them are prohibited, that protection is lost if they are deemed to fulfill criteria to be considered military objectives, such as housing militaries and arms.

However, any attack on them must still comply with the fundamental principles of distinction, proportionality and precautions in attack and failure to respect any of these principles constitutes a breach of international humanitarian law, according to the UN.

“These attacks are part of a deliberate policy designed to create a domino effect of suffering. From starvation and militarized aid distribution by the GHF, to lack of access to clean water, repeated displacement orders, living in shelters under continuous bombardment, and exposure to infections, disease, and harsh weather, the attacks on maternal and reproductive healthcare are another piece of this puzzle. Together, these conditions were created to systematically destroy the fabric of life in Gaza and reduce the population’s ability to survive,” said Bakri.

“The Israeli government has justified attacks on healthcare facilities by saying this was a problem caused by Hamas. We haven’t had an indication of this but it might be true. But in any case there has to be an investigation of these incidents and we hope the Israeli government will carry out such an investigation,” said Zarifi.

“But what is really alarming to us is that the norms prohibiting attacks on healthcare have been repeatedly violated, and there are also laws governing the protection of women and children that appear to have been violated. The only thing that makes these norms work is accountability. There has to be accountability for what happened, as it is the only way we can ensure that what has happened won’t happen in other conflicts. Impunity is watched by other actors around the world,” he added.

IPS UN Bureau Report

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Defending Democracy in a “Topsy-Turvy” World

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Secretary General of CIVICUS, Mandeep Tiwana, at International Civil Society Week 2025. Credit: Civicus

Secretary General of CIVICUS, Mandeep Tiwana, at International Civil Society Week 2025. Credit: Civicus

BANGKOK, Nov 1 2025 (IPS) – It is a bleak global moment—with civil society actors battling assassinations, imprisonment, fabricated charges, and funding cuts to pro-democracy movements in a world gripped by inequality, climate chaos, and rising authoritarianism. Yet, the mood at Bangkok’s Thammasat University was anything but defeated.

Once the site of the 1976 massacre, where pro-democracy students were brutally crushed, the campus—a “hallowed ground” for civil society actors—echoed with renewed voices calling for defending democracy in what Secretary General of CIVICUS, Mandeep Tiwana, described as a “topsy-turvy world” with rising authoritarianism—a poignant reminder that even in places scarred by repression, the struggle for civic space endures.

“Let it resonate,” said Ichal Supriadi, Secretary General, Asian Democracy Network. “Democracy must be defended together,” adding that it was the “shared strength” that confronts authoritarianism.

Despite the hopeful spirit at Thammasat University, where the International Civil Society Week (ICSW) is underway, the conversations often turned to sobering realities. Dr. Gothom Arya of the Asian Cultural Forum on Development and the Peace and Culture Foundation reminded participants that civic freedoms are being curtailed across much of the world.

Citing alarming figures, he spoke bluntly of the global imbalance in priorities—noting how military expenditure continues to soar even as civic space shrinks. He pointedly referred to the United States’ Ministry of Defense as the “Ministry of War,” comparing its USD 968 billion military budget with China’s USD 3 billion and noting that spending on the war in Ukraine had increased tenfold in just three years—a stark illustration of global priorities. “This is where we are with respect to peace and war,” he said gloomily.

Ichal Supriadi, Secretary General, Asian Democracy Network. Credit: Civicus

Ichal Supriadi, Secretary General, Asian Democracy Network. Credit: Civicus

At another session, similar reflections set the tone for a broader critique of global power dynamics. Walden Bello, a former senator and peace activist from the Philippines, argued that the United States—especially under the Trump administration—had abandoned even the pretense of a free-market system, replacing it with what he called “overt monopolistic hegemony.” American imperialism, he said, “graduated away from camouflage attempts and is now unapologetic in demanding that the world bend to its wishes.”

Dr. Gothom Arya of the Asian Cultural Forum on Development and the Peace and Culture Foundation. Credit: Civicus

Dr. Gothom Arya of the Asian Cultural Forum on Development and the Peace and Culture Foundation. Credit: Civicus

Dr. Pervez Hoodbhoy, a Pakistani physicist and author, echoed the sentiment, expressing outrage at his own country’s leadership. He condemned Pakistan’s decision to nominate a “psychopath, habitual liar, and aggressive warmonger” for the Nobel Peace Prize, saying that the leadership had “no right to barter away minerals and rare earth materials to an American dictator” without public consent.

Hoodbhoy urged the international community to intervene and restart peace talks between Pakistan and India—two nuclear-armed neighbors perpetually teetering on the edge of renewed conflict.

But at no point during the day did the focus shift away from the ongoing humanitarian crises. Arya reminded the audience of the tragic loss of civilian lives in Gaza, the devastating fighting in Sudan that had led to widespread malnutrition, and the global inequality worsened by climate inaction. “Because some big countries refused to follow the Paris Agreement ten years ago,” he warned, “the rest of the world will suffer the consequences.”

That grim reality was brought into even sharper relief by Dr. Mustafa Barghouthi, a Palestinian physician and politician, who delivered a harrowing account of Gaza’s devastation. He said that through the use of  American-supplied weapons, Israel had killed an estimated 12 percent of Gaza’s population, destroyed every hospital and university, and left nearly 10,000 bodies buried beneath the rubble.

“Even as these crises unfolded across the world, the conference demonstrated that civil society continues to persevere, as nearly 1,000 people from more than 75 organizations overcame travel bans and visa hurdles to gather at Thammasat University, sharing strategies, solidarity, and hope through over 120 sessions.

Among them was a delegation whose presence carried the weight of an entire nation’s silenced hopes—Hamrah, believed to be the only Afghan civil society group at ICSW.

“Our participation is important at a time when much of the world has turned its gaze away from Afghanistan,” Timor Sharan, co-founder and programme director of the HAMRAH Initiative, told IPS.

“It is vital to remind the global community that Afghan civil society has not disappeared; it’s fighting and holding the line.”

Through networks like HAMRAH, he said, activists, educators, and defenders have continued secret and online schools, documented abuses, and amplified those silenced under the Taliban rule. “Our presence here is both a statement of resilience and a call for solidarity.”

“Visibility matters,” pointed out Riska Carolina, an Indonesian woman and LGBTIQ+ rights advocate working with ASEAN SOGIE Caucus (ASC). “What’s even more powerful is being visible together.”

“It was special because it brought together movements—Dalit, Indigenous, feminist, disability, and queer—that rarely share the same space, creating room for intersectional democracy to take shape,” said Carolina, whose work focuses on regional advocacy for LGBTQIA+ rights within Southeast Asia’s political and human rights frameworks, especially the ASEAN system, which she said has historically been “slow to recognize issues of sexuality and gender diversity.”

“We work to make sure that SOGIESC (Sexual Orientation, Gender Identity and Expression, and Sex Characteristics) inclusion is not just seen as a niche issue, but as a core part of democracy, governance, and human rights. That means engaging governments, civil society, and regional bodies to ensure queer people’s participation, safety, and dignity is part of how we measure democratic progress.”

She said the ICSW provided ASC with a chance to make “visible” the connection between civic space, democracy, and queer liberation and to remind people that democracy is not only about elections but also about “who is able to live freely and who remains silenced by law or stigma.”

Away from the main sessions, civil society leaders gathered for a candid huddle—part reflection, part reckoning—to examine their role in an era when their space to act was shrinking.

“The dialogue surfaced some tough but necessary questions,” he said. They asked themselves: ‘Have we grasped the full scale of the challenges we face?’ ‘Are our responses strong enough?’ ‘Are we expecting anti-rights forces to respect our rules and values?’ ‘Are we reacting instead of setting the agenda? And are we allies—or accomplices—of those risking everything for justice?’

But if there was one thing crystal clear to everyone present, it was that civil society must stand united, not fragmented, to defend democracy.

IPS UN Bureau Report

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U.S. White House Executive Order Raises Concerns for Its Support to the UN

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Humanitarian Emergencies

Coly Seck (at microphone), Chair of the Committee on the Exercise of the Inalienable Rights of the Palestinian People and Permanent Representative of the Republic of Senegal to the United Nations, briefs reporters with Members of the newly-elected Committee on the Exercise of the Inalienable Rights of the Palestinian People (CEIRPP Bureau). At fourth from right is Riyad Mansour, Permanent Observer of the State of Palestine to the United Nations. Credit: UN Photo: Manuel Elías

Coly Seck (at microphone), Chair of the Committee on the Exercise of the Inalienable Rights of the Palestinian People and Permanent Representative of the Republic of Senegal to the United Nations, briefs reporters with Members of the newly-elected Committee on the Exercise of the Inalienable Rights of the Palestinian People (CEIRPP Bureau). At fourth from right is Riyad Mansour, Permanent Observer of the State of Palestine to the United Nations. Credit: UN Photo: Manuel Elías

UNITED NATIONS, Feb 6 2025 (IPS) – A new executive order from the United States White House calls for withdrawing support from major UN entities and a review of all international intergovernmental organizations which the United States is a member of. The U.S.’s orders against the UN Palestine Refugee Agency also do not bode well for ongoing ceasefire negotiations in Gaza.

President Donald Trumps comments that the “US will take over the Gaza Strip and we will do a job with it, too. We’ll own it,” have also been widely criticized.

On Tuesday, the White House issued an executive order, where they announced that they will pull out from the UN Human Rights Council (UNHRC) effective immediately and called for a review of its membership in UN and other intergovernmental organizations. The executive order singles out other UN entities that needed “further scrutiny”—the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA); and the UN Educational, Scientific, and Cultural Organization (UNESCO). The executive order suspended all funding to these organizations.

The executive order also cites that UNESCO has failed to address “mounting arrears” and reform, also noting that it has demonstrated anti-Israeli sentiments over the last decade. A review of the U.S.’s membership in UNESCO would assess whether it supports the country’s interests, and would include an analysis of anti-Semitic and anti-Israeli sentiment within the organization.

The United States announced that no funds or grants would go towards the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), citing corruption within the organization and the infiltration of terrorist groups such as Hamas.

UN Secretary-General Spokesperson Stéphane Dujarric told reporters on Tuesday that in light of the United States’ decision, this would not change the UN’s “commitment to supporting UNRWA in its work”, or the HRC’s importance as a part of the “overall human rights architecture within the United Nations”.

“It has been clear for us that U.S. support for the United Nations has saved countless lives and global security,” said Dujarric. “The Secretary-General is looking forward to speaking with President (Donald) Trump, he looks forward to continuing what was a very, I think, frank and productive relationship during the first term. He looks to strengthening the relationship in the turbulent times that we live in.”

On Wednesday the newly-elected chair of the Committee on the Exercise of the Inalienable Rights of the Palestinian People, Ambassador Coly Seck, Permanent Representative of Senegal, told a told a press conference that it condemned the ban by Israel on UNWRA .

“We strongly condemn Israel’s ban UNWRA which obstructs vital humanitarian cooperation in direct violation of the UN mandate and General Assembly resolutions in stabilizing the ceasefire and supporting Gaza’s recovery. This ban imposed immediately after the ceasefire, deal will deepen Gaza suffering.”

The suspension of aid funding from the United States is already impacting humanitarian operations across different agencies. Dujarric said that the U.S. had committed 15 million USD to the trust fund, of which 1.7 million has already been spent. This leaves 13.3 million frozen and unusable at this time.

Pio Smith, Regional Director for Asia and the Pacific, United Nations Population Fund (UNFPA) told reporters in Geneva that they had to suspend the programs funded by US grants, which included funds that were already committed to the agency. Smith warned that the lack of funding would impact programs in places such as Afghanistan, Pakistan and Bangladesh. Worldwide, more than half of UNFPA’s facilities, 596 out of 982, would be impacted by this funding pause.

Vivian van de Perre, the Deputy Head of its UN Mission to the Democratic Republic of the Congo, told reporters in New York on Wednesday that the recent pause in funding from the U.S. Agency for International Development (USAID) has forced humanitarian partners on the ground to suspend their work. “…Many of the partners, including IOM (the International Organization for Migration), which is a key partner for us, need to stop their work due to the USAID stop-work order,” she said.

The executive order, along with Trump’s announcement that the U.S. would move into and claim Gaza cast a shadow of doubt over ongoing ceasefire negotiations.

UN Human Rights Commissioner Volker Türk said that the priority now must be to move to the next phase of the ceasefire, which calls for the release of all hostages and arbitrarily detained prisoners, an end to the war, and the reconstruction of Gaza.

“The suffering of people in the [occupied Palestinian territories] and Israel has been unbearable. Palestinians and Israelis need peace and security, on the basis of full dignity and equality,” Türk said in a statement. “International law is very clear. The right to self-determination is a fundamental principle of international law and must be protected by all States, as the International Court of Justice recently underlined afresh. Any forcible transfer in or deportation of people from occupied territory is strictly prohibited.”

The forcible removal of 2.2 million Palestinians from Gaza that Trump is calling for has been decried and been called a violation of international humanitarian law.

“Any forced displacement of people is tantamount to ethnic cleansing,” said Dujarric when asked about Trump’s remarks. “…In our search for solutions, we must not make the problem worse. Whatever solutions we find need to be rooted in the bedrock of international law.”

Riyad Mansour, Permanent Observer of the State of Palestine to the United Nations, briefing reporters after the opening session of the Committee on the Exercise of the Inalienable Rights of the Palestinian People, added his condemnation of Trump’s plan.

Mansour said with regard to the idea of “kicking the Palestinian people out from the Gaza Strip, I just want to tell you that during the last 24 hours, statements from heads of states, of Egypt, of Jordan, of the State of Palestine, of Saudi Arabia and many countries, including countries who spoke in the debate in the room behind us during the meeting of the committee, condemn these efforts.”

He said Trump’s plan has been met with a “global consensus on not allowing forced transfer to take place, ethnic cleansing to take place. We Palestinians love every part of the State of Palestine. We love the Gaza Strip. It is part of our DNA.”

The march of Palestinians from the south to the north of the Gaza Strip following the ceasefire was proof of the people’s committment to rebuild their own homes, Mansour said.

“More than 400,000 of them to go to the rubbles in the northern Gaza in order to start cleaning around their destroyed homes.”

At the White House, Trump’s aids attempted a row back on his comments. Secretary of State Marco Rubio reportedly told journalists that it Trump was proposing to rebuil Gaza, and his press secretary Karoline Leavitt, said “the president has not committed to putting boots on the ground in Gaza.”

IPS UN Bureau Report

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Overwhelmed Healthcare Systems in Gaza Struggle Through Evacuation Orders

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Humanitarian Emergencies

Displaced families in Gaza are on the move after the latest Israeli evacuation orders. Around nine in 10 Gazans have been displaced at least once since the war began. Photo: UNRWA

Displaced families in Gaza are on the move after the latest Israeli evacuation orders. Around nine in 10 Gazans have been displaced at least once since the war began. Photo: UNRWA

UNITED NATIONS, Jul 12 2024 (IPS) – For nine months, over 2 million people in the Gaza Strip have been forcibly displaced in the wake of the armed conflict between Israel and Hamas. The ongoing fighting and displacement have put significant strain on humanitarian organizations on the ground to address even basic health needs.

The United Nations and other humanitarian organizations have stressed that the healthcare system in Gaza has collapsed or has suffered undue pressure as a result of the fighting. Out of 36 hospitals in the area, 13 remain open, operating with partial functionality.

This includes Nasser Hospital, which now stands as the last hospital providing comprehensive healthcare services. It has been overwhelmed with patients in the wake of evacuation orders issued on July 1 by Israeli authorities for the east and south of Khan Younis. Patients and medical personnel working in the Gaza European Hospital, located in Khan Younis, evacuated ahead of time.

Although an official from the Israeli defense force stated that patients and medical personnel were exempt from the evacuation order, this was not conveyed to the humanitarian groups on the ground. 

Andrea de Domenico, UN-OCHA’s Head of Office in the Occupied Palestinian Territory, told reporters in a virtual press briefing on July 3 that OCHA was not informed. He stated that it was likely that those who evacuated acted based on past experiences where hospitals were specifically targeted for raids or military bombardment, and so they took preemptive measures to evacuate before the Israeli military moved in on Khan Younis.

Evacuation orders have devastating implications for the fragile health infrastructure by disrupting the functionality of health facilities within and adjacent to evacuation zones, as one spokesperson from the World Health Organization (WHO) told IPS. They impede access for both healthcare providers and patients, and they compromise the efficacy and security of humanitarian operations. In addition, this only increases the burden on other hospitals that are now charged with receiving patients from evacuated areas.

As one of the remaining hospitals providing comprehensive care, Nasser Hospital has been operating beyond capacity with limited supplies, amidst destruction in the surrounding area, which WHO staff on the ground have said is ‘indescribable’. The area surrounding the hospital is laden with heavy layers of debris, destroyed buildings, and no stretch of an intact road. Its pediatric ward has now hosted more than 120 patients since July 5, despite its 56-bed capacity.

OCHA and the World Health at Nasser Medical Complex in Gaza earlier this year. UN and other humanitarian agencies have been struggling to ensure health care continues. Credit: OCHA

OCHA and the World Health at Nasser Medical Complex in Gaza earlier this year. UN and other humanitarian agencies have been struggling to ensure health care continues. Credit: OCHA

It is also operating with dwindling medical supplies and holds responsibility for sterilizing equipment for the surrounding field hospitals, according to Doctors Without Borders (DWB). Despite the critical need for supplies, DWB trucks and convoys carrying these supplies have been unable to enter Gaza since April. As recently as July 3, trucks were denied entry due to ongoing fighting in the South.

“Overall, it’s a comprehensive issue—from shortages of beds and supplies to the lack of surgeons. With yet another hospital closed, patients’ lives are even more at risk,” said medical team leader Javid Abdelmoneim, working in Nasser Hospital.

The issue of life-saving aid being restricted from entering Gaza has continued to persist and impact operations for humanitarian organizations on the ground, including the UN. As the WHO spokesperson told IPS, their trucks were unable to pass through last week as the Karem Shalom crossing remains closed.

Fuel has been identified as critical to the functionality of health facilities and aid operations, and yet shortages are rampant. A WHO spokesperson stated that hospitals have been forced to work with limited supplies of fuel, electricity and solar systems, and this has only hindered groups from properly functioning.

Power blackouts in newborn/ICU and kidney dialysis units place their patients at critical risk. The lack of fuel also impacts the water and sanitation sectors, which require at least seventy-thousand liters of fuel a day, and yet in the last few weeks, they have only received less than ten percent of what is needed.

Only 500,000 liters of fuel have been brought in during the first week of July, and 2 million liters were brought in in the month of June, which humanitarian organizations note is a fraction of the fuel needed to sustain humanitarian, medical, and WASH operations—at least 400,000 liters per day.

Trash and sewage buildup and a lack of clean water, among other factors, have all led to the spread of water-borne diseases and upper respiratory infections. According to the WHO, since mid-October 2023, they have reported cases of diarrhea, lice and scabies, skin rashes, impetigo and chicken pox.

“While a healthy body can more easily fight off diseases, a wasted and weakened body will struggle and become more susceptible,” one WHO spokesperson told IPS.

Meanwhile, acute food insecurity has ravaged Gaza. Since the start of the war, food insecurity has been a major concern for humanitarian actors in the region and globally.

The Integrated Phase Classification (IPC)’s special brief acute food insecurity projected that 96 percent of Gaza’s population, or 2.15 million people, would be experiencing extreme levels of food insecurity between June 16 and September 30, which includes over 495,000 people who face catastrophic food insecurity. More than half of the households reported that often, they did not have any food in the household, and more than 20 percent go full days and nights without eating. The violence and repeated displacement have challenged people’s ability to cope or to access humanitarian assistance.

This is further exacerbated when humanitarian workers are also forced to relocate for their own safety and move their operations. Domenico stated that the constant movement also means that warehouses containing fuel and supplies are abandoned as a result. In the case of UN agencies such as OCHA and its partners, humanitarian operations may be considered a parameter of activity that is (or should be) protected from military activity. Their presence is likely to signal to people that it may be safe to be there or that their basic needs will be met.

So far, 34 people have died from malnutrition and dehydration, according to the Ministry of Health. Of those deaths, WHO notes that 28 of them are children. A group of independent experts has warned that famine has spread throughout the Gaza Strip, noting recent cases of children who have died due to hunger and malnutrition, one of whom was as young as six months old.

“With the death of these children from starvation despite medical treatment in central Gaza, there is no doubt that famine has spread from northern Gaza into central and southern Gaza,” the experts said in a shared statement.

The IPC special brief notes that only a cessation of the armed conflict and sustained, uninterrupted humanitarian intervention could reduce the risk of famine. Humanitarian organizations have struggled to maintain their operations while hostilities have persisted in the Gaza Strip, endangering and displacing more than a million civilians multiple times over, along with humanitarian workers who have risked their lives to continue providing what little life-saving aid can cross the border. Military violence has continued despite international condemnation and repeated demands for a ceasefire.

Organizations such as WHO and Doctors Without Borders have coordinated with health partners and agencies on the ground, namely UNRWA, to provide primary care, support vaccination campaigns, and deploy emergency medical teams. As the WHO notes, however, these efforts can only support the health system; they cannot replace it.

IPS UN Bureau Report

Note: This feature was published with the support of the Riana Group.

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UNWRA Chief Warns Agency’s Fate ‘Hangs in the Balance’

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Philippe Lazzarini, Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), briefs reporters at UN Headquarters.

Philippe Lazzarini, Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), briefs reporters at UN Headquarters.

UNITED NATIONS, Mar 6 2024 (IPS) – UNRWA Commissioner-General Philippe Lazzarini asked the UN General Assembly to urge member states to support the organization’s mandate during this period of unprecedented crisis for the region and the agency. He also called for member states to facilitate a “long-overdue political process” for the two-state solution for Israel and Palestine. Only then, in this context, should UNRWA be allowed to transition.

He was speaking at an informal session of the General Assembly on the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA). This was convened to discuss the ongoing situation with UNRWA’s capacity as a humanitarian and human development agency in Gaza.

Despite its existence for 75 years, UNRWA’s presence was always intended to be temporary. “It is a stain on our collective conscience that for 75 years, UNRWA has had to fill a vacuum left by the lack of a political solution and genuine peace,” said Lazzarini.

The ongoing hostilities in the Gaza Strip and the resulting destruction of UNRWA facilities, which have disrupted humanitarian services in the region, have led to calls to seek alternatives that can deliver on the scale of the agency or to raise concern about whether other agencies can deliver the necessary humanitarian aid.

“UNRWA is facing a deliberate and concerted campaign to undermine its operations and ultimately end them,” said Lazzarini.

Lazzarini argued that dismantling UNRWA during the current crisis would be shortsighted, given that the agency was designed to provide public services such as education and primary healthcare in a region without state authority. “The notion that the Agency can be dismantled without violating a host of human rights and jeopardizing international peace and security is naïve at best,” he said.

Speaking at a press briefing that same day, Lazzarini told reporters, “We can only feel that the worst is yet to come.” He remarked that since January, aid delivery to Gaza has decreased by 50 percent. Since then, famine has become all but inevitable.

Remarking on the dual investigations into UNRWA’s operations, Lazzarini stated that the investigations were necessary as an accountability measure. These investigations were announced after it was revealed that he had terminated the contracts of 12 staff members who were allegedly involved in the October 7 attacks. Lazzarini added that the “swift decision” to terminate the contracts, as well as the investigations, would likely reflect the agency’s ability to follow through on recommendations from a risk management review.

Lazzarini admitted, however, that he had not anticipated the swift action that 16 donor countries took to suspend their funding in the wake of the allegations, which he revealed were conveyed to him in an oral manner.  “I have no regret,” he said, referring to his response to the allegations, “but to be honest, I did not expect that… over the weekend, 16 countries would take that decision.”

The UNRWA chief also indicated that most donor countries would consider resuming their support. For those donor countries, the pressure to pull support came from domestic or public opinion that seems divided over UNRWA rather than foreign policy considerations.

There is some promise that UNRWA will continue to deliver on its mandate with the help of donor states, as was seen with the European Commission’s decision to continue funding the agency, starting with a pledge of 50 million euros. However, this will only go partway into filling the gap of 450 million USD left by the 16 donor countries. Lazzarini warned that without additional funding, the agency would be in “uncharted territory” and would have “serious implications for global peace and security.”

The atrocities that were committed on and since October 7 have only resulted in increasing devastation and tragedy. The international community, as embodied by the General Assembly on Monday, seems largely united in their calls for a humanitarian ceasefire in Gaza and for the safe release of all hostages.

Yet the ongoing hostilities in the region have prevented the UN and its agencies from fulfilling their mandate to safely provide critical emergency aid. Five months on, there is a seeming lack of forward momentum within the Security Council to deliver a ceasefire resolution. UNRWA has been contending with compounding existential questions about its survival as an agency from hostile forces in the Gaza Strip and beyond who call for its dissolution.

IPS UN Bureau Report

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