Some are forced to deliver alone. Others rely on neighbours with no medical training. For many, childbirth has become a matter of survival.

Before the fragile ceasefire got underway in October, the UN reproductive health agency, UNFPA, estimated that 55,000 pregnant women were trapped in “a spiral of displacement, bombardment and acute hunger”, with no reliable access to care.

Matter of life and death

The impact has been devastating: premature births have risen sharply, along with miscarriages and stillbirths linked to severe malnutrition, exhaustion and constant fear.

I used the knife to cut the umbilical cord and wet wipes as bandages

Around 130 babies are born each day across Gaza. More than a quarter are delivered by caesarean section. One in five is born too early or underweight, often with complications that would normally require specialised care.

UNFPA is now supporting 22 health facilities, including five hospitals, and has deployed 175 midwives across the Strip. “Our support has made a difference,” said Nestor Owomuhangi, UNFPA’s representative in Palestine, speaking to our UN News correspondent in the enclave.

Maternity wing: ‘Nothing short of extraordinary’

Visiting Al-Shifa Hospital – once Gaza’s largest maternity hospital, now largely in ruins – he said its continued operation was “nothing short of extraordinary”.

One of the midwives, Sahar, described delivering a friend’s premature baby in the besieged Zeitoun neighbourhood with nothing but a kitchen knife heated over a fire. “I had no gloves, no tools,” she said. “I used the knife to cut the umbilical cord and wet wipes as bandages.”

She recounted another attempt to reach a woman in labour while drones circled overhead.

“They were shooting at anything that moved. I had to shout instructions from a distance,” she said.

By the time she reached the woman, the baby had already emerged, blue and struggling to breathe. “He needed an incubator, but there was none.”

Tragic birth

Mr. Owomuhangi said UNFPA is helping to ensure 98 per cent of births still take place in facilities but warned that 18 births a day are happening well beyond the hospital gates, often with tragic consequences.

Sahar described one such case where a woman haemorrhaged after delivery. “There was no blood, no transport, no doctor. We couldn’t stop the bleeding,” she said. The mother died, leaving behind her newborn.

UNFPA continues to bring medicines, dignity kits and reproductive health supplies through Egypt whenever possible.

UNFPA’s pledge

The agency also provides cash assistance to vulnerable women, a helpline for women and young people, and hygiene items and clothing for displaced families.

“We will keep bringing supplies from around the world,” Mr. Owomuhangi said, “until every birth in Gaza can happen safely.”