"“Five Babies in One Incubator” Violations of Pregnant Women’s Rights Amid Israel’s Assault on Gaza" Human Rights Watch. January 28, 2025. Key Points of the Report.

 

Key Points with Important Highlights

1. Severe Malnutrition & Health Risks for Pregnant Women

• A Palestinian woman pregnant with triplets suffered from extreme anemia and malnutrition due to food shortages in a displaced persons camp in Rafah, Gaza (February 14, 2024).
• Food scarcity led to significant weight loss, dizziness, and fainting.
• Lack of medical care—clinics had no medicine, vitamins, or essential supplies for pregnant women.

2. Dangerous & Neglectful Childbirth Conditions

• The woman went into labor at 2 a.m. on May 5 but struggled to find transportation to a hospital.
• At the hospital, she received no medication or epidural and had to change her own pads post-delivery.
• No nurse or medical staff assisted her after childbirth, forcing her to leave within four hours.
• She had to find a ride back home while exhausted, carrying her newborn.

3. Emergency Obstetric Care Severely Limited

• As of January 2025, only 7 out of 18 hospitals, 4 out of 11 field hospitals, and 1 community health center were providing emergency maternal care.
• Shortages of 19 types of medical equipment & 24 essential medications for prenatal and postnatal care.
• Medical facilities are unsanitary, overcrowded, and face critical shortages of medicine, vaccines, and essential supplies.

4. High Risk of Infant and Maternal Mortality

• Rising miscarriage rates—up by 300% since October 2023.
• UN Women’s survey (March-April 2024) found:
  • 68% of pregnant women had medical complications, including:
    • 92% with urinary tract infections
    • 76% with anemia
    • 44% with hypertensive disorders
    • 28% with preterm labor
    • 16% with hemorrhage
    • 12% with stillbirth

5. Famine & Starvation as a War Tactic

• By October 2024, 133,000 people in Gaza faced famine-like conditions, while 664,000 experienced extreme food shortages.
• 60,000 cases of acute malnutrition among children and 16,500 cases among pregnant and breastfeeding women.
• 48,000 pregnant women were experiencing catastrophic food insecurity by December 2024.
• Severe dehydration due to lack of access to clean water—some women could only drink highly saline water and couldn’t wash during pregnancy.

6. Mental Health Crisis Among Pregnant Women

• Pregnant women suffer from immense psychological stress and trauma due to constant displacement and food insecurity.
• Lack of community networks & support systems prevents tracking of pregnancies and access to postnatal care.

7. Israeli Blockade & Restrictions on Medical Evacuations

• Medical evacuations severely limited—out of 12,000 patients needing urgent transfer, only 5,383 were approved.
• Rafah border closure (May 2024 - January 2025) left only 436 patients able to evacuate for urgent medical care.

8. Violations of International Law

• Israel’s military offensive led to the forced displacement of 90% of Gaza’s population (1.9 million people).
• Fourth Geneva Convention mandates that occupying powers ensure food, water, and medical supplies for civilians, particularly pregnant women.
• Starvation as a method of warfare is a war crime, and denial of medical aid violates international humanitarian law.

9. Starvation & War Crimes Against Civilians

• Israeli forces imposed a near-total ban on water, food, and electricity in Gaza.
• Starvation used as a method of warfare, which constitutes a war crime and crime against humanity.
• Repeated forced transfers of the population, targeting women, children, and the sick.
• Attacks on medical facilities and personnel, obstructing humanitarian aid delivery.

10. Deliberate Deprivation of Water & Acts of Genocide

• Between October 2023 and July 2024, over 2 million Palestinians in Gaza had access to only 2 to 9 liters of water per day (far below WHO’s emergency standard of 15 liters per day).
• Israel intentionally deprived civilians of water, violating international law and committing acts of extermination and possible genocide.

11. Blockage of Humanitarian Aid

• Israeli military first banned aid outright, then imposed severe restrictions.
• Humanitarian aid plummeted after May 2024, worsening in October 2024.
• 43% of aid deliveries denied, the highest rate since the conflict began.

12. Violations of Pregnant Women’s Rights & Healthcare

• Israel violated the right to health under the International Covenant on Economic, Social, and Cultural Rights (ICESCR).
• Pregnant women lack basic medical care—no prenatal checkups, inadequate childbirth facilities, and limited postpartum support.
• Right to food, water, and housing denied, worsening maternal and infant mortality risks.

13. Israel’s Legal Obligations & Violations of Genocide Convention

• International Court of Justice (ICJ) ordered Israel to prevent genocide, ensure humanitarian aid access, and punish incitement to genocide.
• Israel continues unlawful attacks on:
  • Hospitals & healthcare workers
  • Essential civilian infrastructure (food, water, shelter)
  • Aid workers & transport
• Pregnant women, disabled civilians, and the sick are not considered in evacuation orders, violating international humanitarian law.

14. Forced Displacement & Humanitarian Crisis

• 90% of Gaza’s population displaced (1.9 million people), many multiple times.
• Constant displacement disrupts medical care, leaving pregnant women disconnected from healthcare providers.
• Newborns are dying from preventable conditions—as of January 8, 2025, at least 8 infants died from hypothermia due to lack of shelter in winter conditions.

15. High Death Toll & Lack of Data on Pregnant Women

• As of January 9, 2025, over 46,000 Palestinians killed and 100,000+ injured.
• 14,555 children killed, including 793 infants under one year old.
• Unknown number of pregnant women killed or injured due to Gaza’s destroyed health monitoring system.

16. Attacks on Pregnant Women & Families

• Israeli forces shot and killed a pregnant woman during a raid on a home in Gaza City (December 2023).
• Airstrikes killed entire families, including pregnant women—one attack on October 19, 2023, killed 30 members of a family, including a six-month pregnant woman.
• Pregnant women lost their babies due to blast injuries from Israeli attacks.

17. Denial of Medical Evacuations

• Thousands of pregnant women needing urgent care were unable to leave Gaza.
• Israel continues to block civilian movement, violating the right to leave for medical reasons.

18. Urgent Calls for Action

• Israel must restore Gaza’s healthcare system to ensure maternal and newborn survival.
• Lift the blockade and allow free movement of civilians for medical care.
• End attacks on hospitals, aid workers, and essential infrastructure to comply with international law.

Lack of Communication Mechanisms

• Destruction of Infrastructure: Israeli airstrikes have severely damaged Gaza’s phone and internet networks.
• Humanitarian Impact: The lack of communication has completely halted the delivery of aid.
• Effects on Maternal Health: Hotlines for pregnant women giving birth at home have become unreachable.
• Operational Challenges: UN teams could not print flyers to inform women where medical services were available.

The Israeli Blockade and Its Restrictions

• Decades of Occupation: Israel has controlled Gaza since 1967 and imposed a blockade for 17 years.
• Severe Supply Shortages: Israel restricts essential goods, including food, medicine, and fuel.
• War Crimes Allegations: Israeli actions—such as cutting off water and electricity—are considered war crimes.
• International Orders Ignored: The ICJ has repeatedly ordered Israel to allow humanitarian aid, but Israel continues to block essential supplies.

Limited Medical Evacuations

• Restricted Exits: Israel and Egypt block most medical evacuations, even for critical patients.
• Overwhelming Need: 12,500 cancer patients require treatment outside Gaza.
• Strict Clearance Process: Israel’s COGAT decides which patients receive evacuation permits.
• Minimal Evacuations: Only 436 patients left Gaza between May 2024 and January 2025.

Near Collapse of Gaza’s Maternal Healthcare System

• Widespread Attacks on Healthcare: Since October 2023, 591 attacks on health facilities have killed 854 people and injured 1,262.
• Loss of Medical Personnel: Over 1,054 health workers have been killed, and 330 detained.
• Severe Hospital Damage: Only 7 out of 18 hospitals provide emergency maternal care.
• Drastic Resource Shortages: Incubators, anesthesia, and surgical tools are critically lacking.

Quality of Care Degraded

• Medicine and Equipment Shortages: Essential medications and power-generating equipment are unavailable.
• Painful Birth Experiences: Pregnant women undergo C-sections without anesthesia, only receiving Tylenol for pain relief.
• Unhygienic Conditions: Lack of clean water, disinfectants, and medical tools worsens care quality.
• Dangerous Improvisations: Midwives use mask strings soaked in alcohol to tie umbilical cords.

Overcrowded Conditions

• Hospitals Overwhelmed: One maternity hospital handled 78 births in a single night.
• Rapid Discharges: New mothers are discharged within four hours due to lack of space.
• Risk of Postpartum Complications: Lack of post-birth monitoring increases sepsis and maternal deaths.

Access to Medical Care Severely Restricted

• Travel Dangers: Pregnant women face unsafe routes and limited transportation to hospitals.
• Movement Restrictions: Israel enforces strict travel bans, forcing civilians to walk long distances.
• Tragic Cases: A pregnant woman’s child had to have an amputation without anesthesia due to lack of medical care.

Impact of Poor Nutrition, Water, and Sanitation

Prenatal Health Care & Challenges

• Essential prenatal care includes proper nutrition, clean water, and medical checkups.
• Conflict in Gaza has severely limited access to these essential services.
• UN Women’s report (March-April 2024):
  • 99% of pregnant women faced nutrition-related challenges.
  • 78% had no access to health tests.
• Human Rights Watch: Pregnant women reported specific negative health effects due to lack of prenatal care.

Nutrition

• Proper nutrition during pregnancy is crucial for maternal and fetal health.
• Gaza’s conflict has made proper nutrition nearly impossible.
• Global Nutrition Cluster (February 2024):
  • Reported a steep rise in malnutrition among pregnant women and children.
  • Food and clean water shortages worsening malnutrition.
• Food Security Crisis (October 17, 2024):
  • 133,000 people at famine levels of food insecurity.
  • 664,000 people facing severe shortages.
• Pregnant Women & Malnutrition:
  • WHO (December 2024): 50,000 pregnant women in Gaza.
  • 16,500 cases of acute malnutrition among pregnant/breastfeeding women (IPC, October 2024).
  • 48,000 pregnant women experiencing emergency food insecurity (UNFPA, December 2024).
• Malnutrition’s Effect on Children:
  • 1 in 6 children under 2 (16%) in Gaza were acutely malnourished (February 2024).
  • Severe wasting (3%) – the most life-threatening form of malnutrition.
  • 60,000 cases of acute malnutrition in children (October 2024).
  • Malnutrition can cause physical/cognitive disabilities.

Water and Sanitation

• Access to clean water is extremely limited.
• Testimonies from pregnant women:
  • Drinking sea water due to lack of alternatives, causing vomiting and health risks.
  • Shared, unsanitary bathrooms spreading infections.
  • Severe water shortages leading to diarrhea and dehydration.
• Medical reports:
  • Hepatitis A outbreaks among pregnant women due to poor sanitation.
  • Infections from shared toilets are widespread.
  • Overcrowded shelters with no proper hygiene facilities worsen health conditions.

Healthcare Issues

Miscarriage

• Risk of miscarriage increases with physical trauma and psychological stress.
• Since October 7, 2023:
  • Miscarriage rates increased by 300%.
  • Human Rights Watch documented cases of miscarriages due to injuries from attacks.
  • Lack of medical care worsened outcomes for pregnant women.

Preterm Birth & Low Birthweight

• No official statistics, but healthcare providers report a sharp increase.
• Causes of preterm birth:
  • Malnutrition, stress, exhaustion, and infections.
• Medical observations:
  • Many babies are born underweight.
  • 4 out of 10 babies in some hospitals are preterm.
  • Hospitals lack incubators, forcing multiple babies to share – increasing infection risks.
  • Electricity and fuel shortages causing deaths of preterm babies.

Poor Postnatal Care & Follow-Up

• New mothers are discharged too soon due to overcrowding in hospitals.
• Postpartum complications are common but medical follow-ups are difficult.
• Lack of support for:
  • Healing after childbirth.
  • Breastfeeding guidance.
  • Basic hygiene and infection prevention.

Inadequate Nutrition for Babies

• Breastfeeding challenges:
  • Malnourished mothers struggle to produce milk.
  • Stress and displacement hinder breastfeeding.
• Formula shortages & unsafe water:
  • Water contamination makes formula unsafe.
  • Infants suffering from diarrhea and malnutrition.
  • UNICEF (December 2023):
    • 3,200 new cases of diarrhea per day in children under 5.
    • 2000% increase compared to pre-war levels.
• Medical professionals report:
  • Newborns dying from starvation and dehydration.
  • Hepatitis A, skin infections, and digestive illnesses rising among children.

Psychological Impacts

• Deep Psychological Scars: Israel’s military offensive has left many Palestinians in Gaza traumatized, with loss of homes, security, and community.
• Pregnant Women in Crisis: Many suffer from extreme mental strain, stress, fatigue, and anxiety, fearing for their lives and pregnancies.
  • Constant Fear: “I kept thinking about giving birth during the war, day and night… the worst days of my life.” – R.M.
  • Exhaustion and Trauma: “I had a difficult birth… my body couldn’t handle it with displacement and exhaustion.” – Ridana Zukhra
• High Levels of Psychological Distress:
  • 75% of surveyed women regularly felt depressed.
  • 65% frequently had nightmares.
  • 62% suffered from insomnia.
• Limited Mental Health Support: Due to Israeli restrictions, mental health services have become even scarcer.

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Pregnancy During Armed Conflict

• Lack of Research on Maternal Health in Conflict Zones, but studies indicate:
  • Higher Maternal and Child Deaths: Armed conflict triples the mortality rate for reproductive-age women.
  • Increased Miscarriages and Stillbirths due to inadequate nutrition and lack of medical care.
• Mental Health Risks:
  • WHO confirms conflict increases mental disorders in pregnant women.
  • Poor prenatal mental health leads to serious maternal health illnesses, low birth weight, and behavioral problems in children.

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Relevant International Laws

• International Humanitarian Law (Laws of War)

  • As the occupying power, Israel must ensure food, water, and medical supplies for Gaza’s civilians (Fourth Geneva Convention, Article 55).
  • Special Protections for Pregnant Women:
    • Expectant mothers must receive adequate medical care and priority treatment.
    • Warring parties must facilitate humanitarian aid.

• Violations and War Crimes

  • Human Rights Watch Findings:
    • Israel’s blockade constitutes collective punishment.
    • Deliberate destruction of water and sanitation systems.
    • Mass killing and extermination of civilians as part of state policy.
    • Possible acts of genocide under the Genocide Convention.

• International Human Rights Law

  • Israel is bound by the International Covenant on Economic, Social and Cultural Rights (ICESCR) to ensure:
    • Access to food, water, shelter, and healthcare.
    • Minimum essential medical services, including reproductive and child health.
  • The Convention on the Rights of the Child obligates Israel to protect children affected by armed conflict.

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Recommendations

To the Israeli Government

• End Attacks on Civilians & Essential Infrastructure: Protect hospitals, water, and sanitation facilities.
• Restore Basic Services: Electricity, water, and healthcare must be restored.
• Allow Full Humanitarian Aid Access: Stop blocking food, water, and medical supplies.
• Permit Civilians to Leave Gaza: Allow those needing medical treatment to travel.
• Improve Evacuation Measures: Ensure safe zones, proper medical care, and support for vulnerable groups.
• Mental Health Support: Provide psychosocial assistance for pregnant women and new mothers.

To the Egyptian Government

• Keep the Rafah Crossing Open: Allow safe passage for Palestinians fleeing Gaza.
• Ensure Basic Services for Refugees: Provide healthcare, education, and protection.

To All Governments

• Condemn Violations: Speak out against Israel’s forced displacement and war crimes.
• Support UN Relief Efforts: Fund sexual and reproductive health services and essential medical aid.
• Suspend Military Aid to Israel: Halt arms sales due to ongoing war crimes.
• Enforce International Law: Support the International Criminal Court (ICC) and impose sanctions on Israeli officials responsible for human rights abuses.

Acknowledgments 

• Report Authors & Researchers:

  • Belkis Wille, Associate Crisis, Conflict, and Arms Division Director – Lead researcher & writer.
  • Skye Wheeler, Senior Women’s Rights Division Researcher – Research support.
  • Milena Ansari, Israel and Palestine Assistant Researcher – Research support.

• Editing & Review:

  • Anagha Neelakantan, Senior Crisis, Conflict, and Arms Division Editor – Edited the report.
  • Ida Sawyer, Crisis, Conflict, and Arms Division Director – Editorial oversight.
  • James Ross, Legal and Policy Director – Legal review.
  • Tom Porteous, Deputy Program Director – Programmatic review.

• Specialist Reviewers:

  • Milena Ansari – Israel and Palestine issues.
  • Heather Barr, Associate Women’s Rights Division Director – Women’s rights perspective.
  • Emina Ćerimović, Associate Disability Rights Division Director – Disability rights expertise.
  • Lama Fakih, Middle East and North Africa Division Director – Regional expertise.
  • Niku Jafarnia, Bahrain and Yemen Researcher – Regional conflicts.
  • Balkees Jarrah, Associate International Justice Program Director – International justice insights.
  • Matt McConnell, Economic Justice and Rights Division Researcher – Economic justice focus.
  • Skye Wheeler – Women’s rights & humanitarian issues.
  • Margaret Wurth, Senior Children’s Rights Division Researcher – Children’s rights perspective.

• Publication & Administrative Team:

  • Nīa Knighton & Mennah Abdelwahab, Crisis, Conflict, and Arms Division Associates – Prepared report for publication.
  • Travis Carr, Publications Officer – Publication coordination.
  • Fitzroy Hepkins, Senior Administrative Manager – Administrative support.

This acknowledgment section highlights the multidisciplinary expertise and extensive collaboration involved in producing the report.

Source:

https://www.hrw.org/report/2025/01/28/five-babies-one-incubator/violations-pregnant-womens-rights-amid-israels-assault