15 November 2023 - With the forced closure of Gaza’s largest hospital, Al Quds, due to the lack of fuel and incessant Israeli bombardment, and the recent storming of al-Shifa Hospital by Israeli forces, midwives are a lifeline for the estimated 180 women who are giving birth each day.  As of 13 November, all but one of the hospitals in Gaza City and northern Gaza are reportedly out of service due to lack of power, medical consumables, oxygen, food and water, compounded by bombardments and fighting in their vicinities, according to OCHA. 26 year old Narmeen Al Shafee is a midwife currently living in Deir al-Balah in central Gaza, who has previously worked with the Palestinian Family Planning and Protection Association (PFPPA) outreach team. She describes the case of a 29-year-old pregnant woman who fled along with her family from Sheikh Radwan to Deir al-Balah to seek refuge in a school shelter near her home. The women was in her ninth month of pregnancy and not long after being displaced from her home she underwent a cesarean section. Midwife Al Shafee said: “After giving birth, and for her own safety, the shelters did not want to accommodate her due to the widespread infectious diseases and [the] high risk of infection since she had a cesarean section. Her husband was calling out in the streets for someone to receive his wife and three children. My parents welcomed them into our home to take care of her. I would change her bandages daily and monitor her and her child. After ten days, I removed the stitches. Thank God, her condition is now stable, and there are no problems.” In a separate case, Al Shafee describes caring for her 23-year-old cousin who was pregnant for the first time and lost her husband early in the war. “Her delivery date was approaching, and she gave birth at Nasser Hospital in Khan Younis [in southern Gaza]. Her child faced complications during birth, and due to the bombings she sought refuge with us. I took care of her and her child until their situation stabilized. Now, I am helping her with breastfeeding, as she is finding it difficult.” Aminah*, another midwife who has also previously worked with the PFPPA outreach team, said: “I’ve been in contact with two pregnant women multiple times, providing weekly consultations. One woman experienced severe cramps, and after offering advice, she was referred to the hospital. She needed lung maturation injections for the fetus, along with rest and nutritional supplements and iron. Another woman, 29 weeks pregnant, suffered dizziness and vomiting and she took Ancozine [an antiemetic] for nausea during the visit. I also found out that she was taking iron and provided her with information on the correct way to take iron tablets in order for her to benefit from them as needed. I am also providing information to women in my area and around me hoping that it will help them if and when needed.” According to data from the UNFPA, there are an estimated 50,000 pregnant women in Gaza, with 15% expected to encounter complications. In many instances women are only admitted to hospital when they are fully dilated, with some forced to deliver their babies in cars, in the streets, and in overcrowded shelters where the risk of infection and the spread of disease is high. There are reports of c-sections bring performed without anesthesia, and there is currently no type of post natal care available in Gaza.  Levels of early labor and miscarriages are expected to increase with the trauma and conditions being faced.  Al Ahli Hospital, in Gaza City, which currently accommodates over 500 patients, is reportedly the sole medical facility able to receive patients, amid increasing shortages and challenges. In Shifa hospital, 32 patients, including three premature babies, have reportedly died since 11 November, following the power cut and amid dire conditions. Without a full and immediate ceasefire, and the unimpeded delivery of humanitarian aid across all parts of Gaza, maternal and neonatal deaths will continue to rise. For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's emergency appeal for Palestine. About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area. About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what. Banner image: Midwife Narmeen Al Shafee provides care to a newborn baby in Deir al-Balah, in central Gaza. 

Today marks one month since Hamas launched its attack on civilians that triggered Israel’s declaration of an unprecedented war in the Gaza Strip, and a subsequent humanitarian catastrophe. Since 7 October, some 1,400 Israeli civilians have been killed, 200 hostages taken, and thousands injured, according to the Israeli authorities. In Gaza, over 10,000 people have been killed, the vast majority of whom are women and children. IPPF echoes international demands for an immediate and full ceasefire to prevent further atrocities. The continued bombing and rockets will make it virtually impossible to distribute any aid to civilians. In addition to the immediate need for fuel, water, food, and medicine for civilians in Gaza, the urgency of sexual and reproductive health care needs must not be overlooked. Alvaro Bermejo, IPPF Director General said: “Our colleagues in Gaza are currently sheltering for their lives, yet still delivering sexual and reproductive healthcare in any way they can amid appalling conditions. For 30 days, bombs have been falling across Gaza, leaving behind devastation and destruction unlike anything we have dealt with before as a Federation. In the absence of a full ceasefire, we are gravely concerned for the lives of our colleagues, civilians, and humanitarians who are desperately trying to deliver aid inside Gaza.” Insufficient supplies, resources and equipment for sexual and reproductive health and rights were already a pressing issue in Gaza, which has been under Israeli occupation and blockade for decades. Since 7 October, thousands of Palestinian mothers and children have been killed, marking a recurring stifling of reproductive justice in the region. Pregnant women are miscarrying due to stress and shock, and the availability of medical facilities to birth safely is now virtually non-existent. Women and girls are reporting a severe lack of menstrual hygiene products and contraceptives, and a rise in cases of sexually transmitted diseases and urinary tract infections with little to no medical treatment available. Without a full and immediate ceasefire, we can expect to see this vicious cycle continue, with thousands more maternal and newborn deaths. On top of this, we will see a rise in unintended pregnancies, the spread of sexually transmitted infections including HIV, and a rise in psychological trauma and conflict-related sexual violence, all of which will have long-term, generational impacts. We echo calls by the UN Inter-Agency Standing Committee to establish a robust aid operation in a safe and peaceful context. Gaza needs a coordinated effort that meets the urgent needs of all its people, including the particular sexual and reproductive healthcare needs of women, girls and vulnerable groups. There are no justifications for war crimes or grave violations of international humanitarian law, regardless of who commits them or against whom they are committed. We reaffirm that all people have the right to access emergency sexual and reproductive healthcare, no matter where, and no matter what. IPPF calls for an immediate ceasefire to end the violence, deaths and suffering of civilians in Israel and Palestine. This ceasefire is an essential precursor towards a path to peace with justice.   For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's appeal for Palestine.   About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area.   About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what.  

Shelter conditions in Gaza for the estimated 1.4 million internally displaced people have become dire, with women and girls reporting a severe lack of menstrual hygiene products, cases of sexually transmitted diseases and urinary tract infections with little to no medical treatment available in the severely overcrowded shelters. Contraception is in very short supply, and according to our local team sheltering and providing services in Gaza, women are sharing contraceptive pills. Women with intrauterine contraceptive devices (IUDs) are experiencing bleeding and infections due to the unhygienic conditions in the camps. There are currently no options for IUD removal in Gaza, posing long term risks to women’s reproductive health, including severe bleeding. On 25 October, the UN said that fuel in Gaza could run out within hours, and that hospitals in the Gaza Strip are taking emergency cases only, which will prevent many women and girls from seeking sexual and reproductive health care. If Israel continues to block humanitarian aid including safe delivery kits from entering Gaza, many of the estimated 50,000 pregnant women[1] in Gaza will have no safe place to give birth, with at least 15% likely to experience complications[2], further compromising already stalled progress in reducing the rates of maternal morbidity and mortality. Wafa Abu-Hasheish, a health worker at PFPPA in Gaza said: “The shelter is suffering from a shortage of water, lack of medical care, and an increase in the incidence of diseases such as influenza, chest infections, skin ulcers, scabies, lice, and diarrheal diseases, and girls and women are reporting menstrual disturbance. There are also cases of sexually transmitted infections and urinary tract infections. Women using contraceptive pills are sharing their supplies with others." The number of internally displaced persons (IDPs) in Gaza is currently estimated at around 1.4 million (more than half the population), with a large part of that population living in overcrowded and under-supplied shelters with food, water, and fuel running out – and basic and life-sustaining services becoming more inaccessible by the hour. The mental and physical health toll on local health workers in Gaza is immense. Abu-Hasheish added: “On a personal level, being the service provider and being present in the shelter has caused me several psychological problems, stress, and fear. I also suffer problems such as neck ache and back muscle tension due to the inability to sleep or sit properly. I have contracted a flu and developed excessive breathing difficulties, but there is a lack of available treatment for displaced people due to the high number of patients and the scarcity of medicines. I had to go home for rest and relaxation, despite the dangers and lack of safety at home. Ammal Awadallah, the Executive Director of the Palestinian Family Planning and Protection Association (PFPPA) said: "If pregnant women are lucky enough to reach a health center or hospital, they are only admitted when they are fully dilated. And they must leave the hospital within three hours after delivery, due to overcrowding in hospital facilities, lack of space and resources. “Women are forced between choosing privacy and a clean space in their own homes, where they still stand, or shelters with dire conditions. It is choosing between the different evils. There is no safe place in Gaza.” For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's appeal for Palestine. About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area. About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what. [1] Source: UNFPA [2] Source: MISP

An estimated 19,000 pregnant women are part of the 1.1 million residents forced to flee from northern Gaza due to Israel’s evacuation order on 13 October, with no safe place to give birth. Women are miscarrying pregnancies due to stress and shock, and the availability of medical facilities to birth safely in Gaza’s already overwhelmed healthcare system is rapidly dwindling. Wafa Abu Hasheish, a healthcare provider with the Palestinian Family Planning and Protection Association (PFPPA), an IPPF Member Association, has been providing medical aid to residents of her neighbourhood in northern Gaza where she has been sheltering since 10 October, three days after Israel declared war on the Gaza Strip. She said: “I have dealt with two suspected cases of miscarriages already, where there was no movement for the foetus and the mother had hypotension, bleeding and back pain. There has been one case where a woman was referred to where I am staying, since they knew I was a health service provider in the neighborhood. The woman was 8 months pregnant and was suffering from severe labor pain and was having a premature birth. We were very fortunate that when she reached me that we were able to refer her to a health center in time to be able to give birth safely." Even if the delivery of limited amounts of aid is allowed into southern Gaza, as was reported on 16 October, it remains unclear exactly how this aid will reach the more than 9,600 injured and the nearly 600,000 internally displaced people in central and southern Gaza[1] who are living in increasingly dire conditions. It has also been reported that the aid will not be distributed into northern Gaza, where 1.1 million residents have been ordered to evacuate ahead of a likely Israeli ground invasion. Ammal Awadallah, Executive Director of PFPPA, said:  

Over 50,000* pregnant women will be forced to give birth with no electricity or medical supplies in Gaza in the coming months, risking life-threatening complications without access to delivery and emergency obstetric care services. Ammal Awadallah, Executive Director of the Palestinian Family Planning and Protection Association (PFPPA) said: “We don’t know what’s going to happen to these women and their newborn babies. Our center is unusable and our options to provide referrals to hospitals are decreasing by the hour. I can’t stress enough how dire the situation is and how desperately we need humanitarian aid to be allowed into Gaza.” On 8 October, PFPPA’s only center in Gaza was destroyed following an Israeli airstrike to an adjacent building, completely cutting off their ability to offer healthcare to women who have already been systematically denied sexual and reproductive healthcare and rights by the Israeli occupation. Israel’s complete blockade of Gaza, as announced on 10 October, is preventing food, water, fuel, and medical supplies into Gaza. Currently, Gazans are only able to access electricity for two hours every day - this supply is due to completely run out in the next few days. The medical system in Gaza, already severely stretched due to 16 years of an illegal blockade, cannot cope with the level of injuries from the current bombardment. Emergency services and medical supplies are not able to reach affected people, including pregnant women, women in labour and newborn babies. It's estimated that 60% of those injured and killed since 10 October are women and children. On 11 October, the only power plant in Gaza ran out of fuel, and three of five water plants are out of service due to the Israeli bombing and lack of fuel. Without clean water, food, basic medicines and vaccines, innocent women and newborn babies will continue to die. Wafa Abu Hasheish, a health worker at PFPPA in Gaza said: "As a health worker and a Palestinian woman, ever since Saturday morning I have been living in constant fear for the safety and livelihood of my family. At the same time I am not able to leave behind my commitment to providing women with health services and information. I have received calls from women having a miscarriage due to the bombings and gas, another going into labor, neighbors reaching out for help… all of which I am trying to assist but with such limited options and resources available and accessible.. I am afraid for their well beings and even for their lives. I do not know how much more the Gazans can take and I am constantly thinking how many more women around Gaza have no one or nowhere to go." Note: This figure was calculated using the Minimum Initial Service Package (MISP) calculator based on the most recent available statistics on the population of Gaza. On 16 October, UNFPA released updated statistics that show there are currently at least 50,000 pregnant women in Gaza.  For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's appeal for Palestine. About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on an adjacent building on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area. About the International Planned Parenthood Federation  IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what.   *At the time of this press release on 12 October 2023, we reported that there were an estimated 37,000 pregnant women in Gaza, which was calculated using population estimates from the MISP calculator - a tool that helps coordinators and program managers determine affected population demographics for advocacy, fundraising and programming. This statistic has since been updated to an estimated 50,000 pregnant women in Gaza, with 5,500 expected to deliver in the next month, according to the most recent available data from the UNFPA.

London, 9 October 2023 - Over the past few days, we have watched in horror the escalating violence between Hamas and Israel, the loss of civilian lives and the targeting of health facilities. In response, IPPF has released a media statement on behalf of the Federation and its Member Association directly impacted by the violence. As in all conflict and humanitarian situations, sexual and reproductive health, rights and justice (SRHRJ) challenges will increase significantly in Palestine following the latest outbreak of violence and the targeting of health infrastructure. Sexual and Reproductive Health and Rights must be prioritized now in Palestine, especially for women, girls and the most vulnerable and marginalized groups among them, who have already been facing a protracted humanitarian crisis for decades. IPPF’s Director-General, Dr Alvaro Bermejo, said: "The International Planned Parenthood Federation (IPPF) is deeply concerned about civilians caught up in the recent attacks, and we are devastated by the loss of civilian lives. At a time where human rights are increasingly under attack, we take our responsibility to preserve the enormous gains made in life-saving sexual and reproductive healthcare in this region very seriously, especially for women, girls and marginalised populations, whose vulnerability and experiences are so often overlooked in humanitarian and conflict settings. "Since its establishment in 1964, the Palestinian Family Planning and Protection Association (PFPPA), our local Member Association in Palestine has worked in the most difficult of circumstances to strengthen and protect the reproductive rights of people living in Gaza, the West Bank and Jerusalem. “Our local teams are now contingency planning to address not only the needs of those trapped in Gaza amid escalating violence, but also the more than five million Palestinians currently living under Israeli occupation who will require critical support to continue accessing sexual and reproductive healthcare. We will work closely with partners and other NGOs to ensure the least possible disruption to services, and we will continue to monitor the situation closely to ensure the safety and security of our colleagues across the region.” Ammal Awadallah, Executive Director of the Palestinian Family Planning and Protection Association (PFPPA), IPPF’s local Member Association in Palestine said: “The current situation in Palestine is different than other situations of escalating hostilities. We have many staff that are afraid to come into work, and we had colleagues that were stuck at the border and unable to return home following IPPF meetings outside of the country. On 8 October, one of our critical service delivery points in Gaza was destroyed. While this building can be compensated, lives cannot. PFPPA has been bravely providing services within this protracted humanitarian crisis setting for decades. This has made us stronger and increased our commitment to women and girls, but we are now facing a dire situation. Basic sexual and reproductive health care commodities, like condoms, are banned in Gaza. The total blockade of Gaza will only worsen the situation for millions of desperate people who are denied their most basic of human rights. Palestinians are systematically denied sexual and reproductive healthcare and rights. Our health system has been repeatedly targeted and depleted by the Israeli occupation, and the more it disintegrates, the more it will hinder the full realization of these rights for women and girls.” بالنسبة لوسائل الإعلام العربية، يرجى الاتصال بمصطفى كميل el [email protected] For UK and other international media outlets, please contact [email protected] About the Palestinian Family Planning and Protection Association (PFPPA) Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike to an adjacent building on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area.    About the International Planned Parenthood Federation  The International Planned Parenthood Federation (IPPF) is a global service provider and advocate of sexual and reproductive health and rights for all.  For 70 years, IPPF, through its 150 Member Associations and collaborative partners, has delivered high-quality sexual and reproductive healthcare and helped advance sexual rights, especially for people with intersectional and diverse needs that are currently unmet. Our Member Associations and partners are independent organisations that are locally owned, which means the support and care they provide is informed by local expertise and context. We advocate for a world where people have the information they need to make informed decisions about their sexual health and bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and freedom. We deliver care that is rooted in rights, respect, and dignity - no matter what.