In Gaza, women and girls face a unique hell

Palestinian women have always suffered under occupation. Since Oct. 7, their reproductive health has been under siege.
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Shortly after the bombardment of Gaza began in October, many Palestinians began stockpiling supplies like seeds, canned food and more. They’d been through these bombings before and knew that necessities would soon be hard to come by. For women, that included menstrual pads, sanitary supplies — and birth control pills.

“They started to use the anti-pregnancy pills or hormonal pills just to stop or delay [their] period from coming while they are literally running from place to place,” says Hala Hanina, a Palestinian women’s rights activist. 

But the pills soon ran out, and their periods returned — often even heavier and more painful than before, due to the hormonal changes and stress of war.

Some were dealing with their periods as they evacuated from one place to the next to escape bombardment, Hanina says. “Many of them had their trousers full of blood … but it was something that they would not care about [amid] that atmosphere of fear and running.”

For countless Palestinian girls and women living in these catastrophic conditions, the difficulties of menstruation, pregnancy, childbirth, breastfeeding and more have reached new heights under Israel’s siege of Gaza. Experts say this gender-based violence and “reproductive genocide,” as some activists are calling it, is by design.

Since a few weeks into Israel’s war on Gaza, human rights organizations have sounded the alarm as women became one of Israel’s biggest targets. By November 2023, about two-thirds of all those killed were women and children. Five months in, with at least 25,000 of the more 30,000 Gazans killed being women and children, the current percentage seems to be roughly the same.

“We are shocked by reports of the deliberate targeting and extrajudicial killing of Palestinian women and children in places where they sought refuge, or while fleeing,” the U.N. Office of the High Commissioner for Human Rights said last month. “Some of them were reportedly holding white pieces of cloth when they were killed by the Israeli army or affiliated forces.”

The life of a woman in Gaza under the occupation had long been a “series of restrictions and violations, increasing one by one,” Hanina says, but that has now climaxed into “deliberate”  attacks on women’s reproductive health. 

“This level is unprecedented,” Hanina tells Analyst News. She left Gaza just days before Hamas’s Oct. 7 attack but still has many friends and family members trapped in the besieged Strip — where two mothers are killed every hour amid constant evacuation notices, unrelenting bombardment and limited aid deliveries. 

“Women and children are the main targets of the Israeli occupation. It’s a tactic to kill women.”

Women’s reproductive health has often been the target in past conflicts and genocides. Acts of reproductive violence have been used to assert dominance over the victims and gain a demographic control over the target population. Sexual and gender-based violence have been heavily documented against the Tutsi women in the 1994 Rwanda genocide, as well Bosnian women in the early ’90s and Yazidi women in Iraq more recently. 

In Gaza, since Oct. 7, the percentage of women killed has surpassed those of all former aggressions, she says, indicating the aggressors are determined to dwarf the “demographic distribution of Palestinians.” In the 2008-2009 Israeli offensive against Gaza, 110 women were killed. In the summer of 2014, the U.N. reports, 253 of the 2,104 Palestinians killed in the Gaza War were women.

“The percentage is not even comparable to any other aggression,” she says. “Women and children are the main targets of the Israeli occupation. It’s a tactic to kill women.”

Reproductive violence

Under a 14-year air, sea and land blockade on Gaza, women have struggled to access health care services within the territory even before the war, leaving many desperately seeking permits to cross into Israel for medical treatment. In 2016, 1,726 of these permits were denied, according to a report by the Women’s Centre for Legal Aid and Counseling. 

But nothing could prepare Palestinians for the dire conditions that set in after Israel began its indiscriminate bombardment of the Gaza Strip.

With utility stores bombed, hygiene supplies depleted and aid deliveries blocked in large parts of the territory, including Rafah, many of Gaza’s more than 690,000 menstruating women and girls are left to use old rags or clean and reuse old pads and baby diapers. Others are taking period-delaying pills. In one video, journalist Bisan Owda documented residents using pieces of garbage as makeshift toilets. 

“It’s like hell,” Frances Leach, who works for the international charity ActionAid, told BBC Newsnight. She added that desperate women in Rafah were using “scraps of refugee tents as sanitary towels.”

With no pain medications or pads, only one toilet for every 220 people, and a single shower for 4,500 people, women in Gaza are at serious risk for urinary tract infections, pelvic inflammatory diseases and potentially fatal toxic shock syndrome.

For pregnant women about to give birth, there is no safe place left to access maternal care, jeopardizing their and their babies’ chances of survival. 

As the Israeli bombardment began, there were 50,000 pregnant women in Gaza, with 160 expected to deliver each day, according to U.N. estimates. Five months in, it is difficult to say how many of these mothers and their infants are alive. 

Miscarriages have ballooned 300%, local health workers report, as stillbirths become more frequent. C-sections without anesthesia are now a common delivery procedure. Normal post-birth complications like postpartum hemorrhage have turned fatal because doctors lack the supplies they need to stop the bleeding, says Hanina, some of whose friends are doctors working in Gaza’s stretched hospitals.

As a result, post-birth women are undergoing hysterectomies, amid mounting concerns that Israel is breaking the International Court of Justice’s interim ruling condition requiring Israel to halt measures intended to prevent births among Gazans. 

“Many of those women were pregnant for the first time in [their] life and now they have lost any ability of having any other child,” Hanina says. 

Only 12 out of 36 hospitals in Gaza are partially functional, the International Rescue Committee reports. At the few hospitals that escaped total decimation, finding maternal care services is difficult if not impossible, as one obstetrician who returned from Gaza’s Al-Aqsa Hospital recounted.

“One of the concerns for women is that hospitals have become overwhelmed with trauma cases,” British obstetrician Deborah Harrington told the New Yorker. “So the provision for women, the infrastructure, the obstetric units, the delivery wards, the operating theaters for obstetrics are all moved out because the hospital is overwhelmed with trauma, and it needs those theaters, and that ward space, for patients with injuries.” 

Prior to Oct. 7, 15% of pregnant Gazan women suffered complications during labor. That percentage jumped to 40% soon after the war began, says Harrington. With over a dozen Western donors cutting aid to UNRWA, the main healthcare provider for Palestinian refugees, experts predict the worst for women’s health services.

“Everybody now is displaced, and there’s no food or clothing, so that even after the newborns are born, they don’t have anything to dress them in. There’s nothing — no medicine, no food, shelter,” Ammal Awadallah, the executive director of the Palestinian Planning and Protection Association, told Jezebel. “Much more is needed, not less.”

Double standards

As the U.S. presidential election nears, some activists are accusing President Joe Biden of enabling a reproductive health crisis through his unflinching support and ongoing funding for Israel. In December alone, the U.S. government bypassed Congress twice to send Israel $147.5 million worth of military equipment. 

“No one is making the connection that there’s a huge repro genocide happening in Gaza that we are funding, and the big repro organizations that are endorsing him are pretending like it’s not happening,” one reproductive activist told HuffPost.

Palestinian women feel there are “double standards” at play in Western feminist circles, Hanina says.

“I don’t know any feminists around the world who knows the names of the 7,000 women who are killed in Gaza now.”

About a year and half ago, women’s rights campaigns flooded social media feeds and protests erupted across the world when Mahsa Amini died in the custody of Iran’s morality police. Back then, Hanina was one of the many advocates who raised their voices demanding justice. Now, Hanina wonders where the outrage in support of Gazan women and girls is. 

“I wanted to see this reaction, at least on the same level, for the more than 7,000 women who have been killed in 92 days,” Hanina says. “They were killed intentionally. It wasn’t by accident. I don’t know any feminists around the world who knows the names of the 7,000 women who are killed in Gaza now.” (Since the interview, that number has increased to an estimated 9,000 women killed.)

As U.N. experts and the International Court of Justice affirm that Gaza is at a real risk of genocide, Hanina is struck by the deafening silence of feminists icons in the West, including U.S. Vice President Kamala Harris and former U.S. First Ladies Hillary Clinton and Michelle Obama.

“If they are not standing with the women who are under oppression, they’re either not feminists, or they’re choosing their double standard feminism according to who is doing the oppression,” Hanina says.

That silence, she says, compounds the trauma that her loved ones still trapped in Gaza are experiencing. 

She shares a story from a friend who had been visiting hospitals in Gaza to cheer up young patients trapped in the chaotic and overcrowded hospital. A 12-year-old girl, the sole survivor of her family, lay silently on her hospital bed with bloodied dressings on her freshly amputated leg. 

Hanina’s friend approached the girl and began conversing with her — then saw blood stains between the girl’s legs. “She asked the girl if she had a period, and the girl said, ‘What do you mean?’” Hanina says. 

Amidst the horrors of bombing and destruction, this newly-orphaned, newly-disabled girl had just gotten her first period. She had no mother or family around to teach her about her period, let alone to help her through her amputation without anesthesia.

“With all the layers of suffering of women in Gaza, children who are having their periods for the first time are going through a new level of suffering,” Hanina says.

Shumaila Iftikhar is a senior writer at Analyst News. Atiyya Tul Munim is a medical doctor based in Germany.