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A C-section in Gaza

Doctors and nurses hold a newborn in a hospital

Moments after Zenab’s* successful C-section. All photos: CARE/Team Yousef Ruzzi

Moments after Zenab’s* successful C-section. All photos: CARE/Team Yousef Ruzzi

Zenab* had left her tent in Khan Younis the night before the C-section and stayed in Deir Al Balah, about halfway to the hospital in Nuseirat. She was too scared that road blockages, bombings, and bad traffic would make her late to her appointment

I joined Zenab in Deir Al Balah in the morning, and we left at about 7:30 a.m. According to United Nations estimates, more than 70 percent of all homes in Gaza have been destroyed, and that is what we saw on our ten-mile journey to the hospital. There was destruction all around us. All the buildings were flattened to the ground. We passed ghost towns of bombed out houses, schools, and health centers. The streets were now filled with people who have fled after the Rafah offensive, who have set their tents up here in the rubble because there is nowhere else for them to go.

A wide-angle shot of a woman wearing black walking through a tent.
Since the Rafah invasion, Zenab has lived with her three-year-old daughter in a tent in the Khan Younis area.

Zenab was looking out of the window, taking in all the destruction.

“I am terrified, I am scared, I am really stressed,” she said. “I feel so different from when I was about to give birth to my first daughter. I miss my husband so much; it really pains me that he is not here. At the same time, I cannot wait to hold my baby in my arms. It is strange having these feelings of horror mixed with something so beautiful.”

She was also, she said, thankful she would be able to give birth in a hospital.

A woman wearing surgical town and head covering, lying on a gurney and holding up two fingers on her left hand.
Zenab on her way to surgery.

Approximately 50,000 women are currently pregnant in Gaza, with an estimated 183 women giving birth every day. Most do not have access to midwives, doctors, or any healthcare facilities during the delivery.

Only 16 out of 36 hospitals in Gaza are still partly operational, and few maternity units are still working, Like Zenab, most pregnant women had few or no check-ups to make sure their growing baby is healthy, or to see whether they suffer from pre-eclampsia or anemia, both leading causes for maternal death. Many of them won’t know if their baby is in the right position, if they will have twins, or whether there are signs of preterm labor. Like Zenab, most of these tens of thousands of women in Gaza have experienced extreme stress and fear during their pregnancies, struggling to protect and feed themselves, and nourish their developing babies. These women in Gaza face starvation, dehydration, death or injury from airstrikes, and they are dying in scores from otherwise preventable pregnancy complications.

In the hospital

A male doctor in scrubs.
Dr. Raaed says there are now 50-55 women giving birth every day at his hospital in Gaza.

Al-Awda Hospital in Nuseirat Camp in the central Gaza Strip is a very small, previously private hospital. When we arrived, there were people everywhere.  Dr. Raaaed, one of the doctors, told me that they used to have around 4-6 women giving birth daily. Since the war started, they have up to 55 women giving birth every day. In addition, up to 220 women come here for check-ups and when experiencing pregnancy complications.

When it was Zenab’s turn to go into surgery, we had to put on sterile covers for our clothes. They have run out of disinfectants a while ago, the doctors told me.

We struggle a lot, because we've simply run out of some medication.

Dr. Raeed

“We have run out of some needles, antibiotics and anesthesia drugs, and we cannot give women the needed vitamins during pregnancy anymore.

“A lot of women give birth before they reach our hospitals. Some gave birth in their tents, some on the street, others on the doorstep of the hospital, or in the reception area. We have had a lot of critical cases, especially of women who suffered from internal bleedings because they needed a C-section. A lot of women suffer from hemorrhaging after birth and quite frankly, most women also suffer from postpartum depression due to everything they are coping with.”

Dr. Raaed also told me that some women set up their tents next to the hospital, knowing from previous childbirths they will not survive unless they have a C-section. So far, Dr. Raaed and his team fortunately have not experienced any maternal death cases, though some of the recently-delivered babies have not survived because of the hunger and medical complications that have become all too common. According to the London School of Hygiene and Tropical Medicine, maternal and neonatal mortality in Gaza has quadrupled since the escalation of the war.

The birth

A smiling woman lying down next to a newborn, with her arm around the child.
Zenab and Laila* in the Naseirat hospital.

Zenab shared a room with four other women. There wasn’t a lot of space, but the room was clean, and she said the bed was certainly more comfortable than the hard floor she had been lying on in her tent.

The operation was a success.

It was a beautiful baby girl, and, at six and a half pounds, a healthier weight than many other babies born in Gaza right now.

A newborn, lying down in a red striped swaddling blanket.
Baby Laila just moments after her birth.

Because they lacked the proper equipment, the doctors could not do all the routine examinations of the baby, and they also didn’t have the threads they usually use to stitch up the six-inch c-section incisions.

“We have to improvise,” Dr. Raaed said.

Despite these complications, Zenab looked joyous. I barely recognized her from how much her face had changed with the successful birth of little Laila*, named after Zenab’s mother.

“I am so happy to have the most beautiful girls in the universe,” Zenab said. “I hope I can raise them in the best possible way and educate them in the best schools and universities in the world. My husband would have been so happy and proud!

“I just want this war to end. I wish peace for all of us; for everyone. Enough is enough with all this destruction. Enough with all this death, enough! I hope my baby never sees what I saw and that she will never know what war feels and looks like.”

Two hours later

Close-up of a newborn hand gripping an adult's thumb.
Newborn Laila grips her mother's thumb tightly.

“After a caesarean, women used to stay in hospital around two days,” Dr. Raaed said. “Unfortunately, we do not have enough beds and the numbers of people in need are increasing every day.”

There were too many urgent cases, so just two hours after giving birth, Zenab and Laila were discharged. Dr. Raaed and his team know what that means: The women will return to their tents, often without sufficient pain medication, they might have trouble breastfeeding, and they will not have sufficient hygiene and sanitation material. They also often must take care of older siblings and might have to walk miles every day just to have some water to drink and cook with.

Soon, Zenab and her expanded family would be back living in a tent under grueling heat, with barely enough money to afford safe drinking water. But, for the moment, Zenab didn’t seem to be thinking of any of this. She was holding a healthy baby girl in her arms.

CARE continues to call for an immediate ceasefire, the return of all hostages, and the passage of unfettered humanitarian aid into Gaza.

*Names changed

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