The Sexual and Reproductive Healthcare Crisis in Gaza

Sexual and reproductive health doesn’t disappear in humanitarian settings. People don’t stop needing obstetric care, getting pregnant, needing birth control, needing safe abortion care, or needing gender-based violence support in emergency situations. In fact, 65% of all maternal deaths, 50% of all newborn deaths, and 51% of all stillbirths occur in humanitarian settings. Judith Starkulla, Head of Office for UNFPA in Gaza, shares her thoughts on the SRHR needs of those in the region.

UNFPA supplies medicine, dignity kits, gender-based violence services, and specialized healthcare to hospitals and individual patients. Currently, in Gaza, health infrastructure has been ruined and many people have nowhere to turn to for care. Only 3 maternity hospitals are functioning across Gaza, and they are overcrowded with people needing assistance. Stress, hunger, and fear are impacting mothers and children. Yet, UNFPA cannot deliver aid while Gaza continues to face bombardment and closed border crossings, and medicines and supplies have been destroyed by fire and explosions.

Links from this episode

UNFPA on X
UNFPA on Facebook
Sexual and Reproductive Health in Emergencies: Promising Practices to Address the Crisis  within a Crisis
It’s Time to End the 40-Year Legacy of the Global Gag Rule
Statement from UNFPA Executive Director Dr. Natalia Kanem on the potential invasion in Rafah

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health rights and justice. [music intro]

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Hi rePROs! How's everybody doing? So, I'm not gonna lie, I'm a little nervous about today's episode. The format is a little different and that is definitely making me nervous. So, I hope y'all like it. I guess before I get to the episode, we're gonna just do like a really short chit chat at the top. So, Sunday was Mother's Day and that feels especially fitting, considering today's topic. But I didn't get to see my mom because she's in Wisconsin, but I did get to talk to her and wish her Happy Mother's Day and apologize for her gifts not being there until later this week. My bad. You know, you know how you're like, I know this is coming up. I have plenty of time. Not my problem yet. I have plenty of time. Don't need to worry about it. It's still plenty of time, plenty of time. Don't need to worry about it yet. Then, oh my God, I need to order something now. That's absolutely what happened. I don't know what happened, it was just...I was on top of it, I was on top of it and then all of a sudden it was like, oh my God, it is like now I need to send something now. It's just one of those things. Anyway, oops, sorry it's late, mom. And then I think just like one other tiny bit of housekeeping before we get started. I think I mentioned this on our last episode, that we were in the process of uploading all of our old episodes to YouTube. And so, just a flag, like, all the episodes are now officially there. Woo. But just FYI, it's not a video, like, of me and the guest. It's just gonna be a regular video and if you hit close captioning, it'll have the updated and correct transcripts on it. So, if you would prefer to read the episode, follow along that way. I mean, transcripts are also available on our website and I think I've not mentioned this here, so some of you may or may not know. Did you know that Apple Podcasts now has transcripts? So, if you're like listening to an episode on your phone, you can, like, get, like, live transcription. So you can read along as you're listening. It's super cool. They only have--last I checked that could have changed--but they only have like all the ones since they made that decision. They're gonna do the back catalog at some point, but they haven't done it yet. But FYI if you wanna check it out it's pretty cool. Okay, so I think we'll leave it there today because I said I do have a bit of a heavy episode and you'll be hearing so much of me, y'all, you're gonna be so sick of my voice, so we'll just skip the usual chit chat and go to this week's episode. But I guess one more thing, sorry, sorry y'all.

Jennie: Before we begin, I do wanna give a really big trigger warning. We are gonna be talking about Gaza, especially as it relates to maternal healthcare right now. So, it is a really heavy episode and we're not gonna get into, like, any graphic descriptions of what's happening. It's still, it's gonna be pretty high level, but it still could be pretty triggering and hard to listen to. So, just please step away if you need to and come back at a better time or if you're never okay, that's fine and we'll just see you next week. I'm also gonna note, like I said, the format for this episode is a little different. I worked with the wonderful people at the United Nations Population Fund, or UNFPA for short, to get connected with one of their staff on the ground in Gaza. And as you might expect, we were unable to connect to do an interview. Like it just, it wasn't gonna happen. And we knew that pretty early going in, so we decided to just do voice memos. So, I do have a voice memo from Judith Starkulla who is UNFPA's field coordinator in Gaza. And we'll play that later in the episode, but that leaves a lot of room for some context that is gonna need to happen. So, you'll be hearing, like I said, a lot from me, but I just, I really do wanna give a ginormous thank you to everyone at UNFPA. There were so many people that had to do things to work to make this happen, to get us connected, to get that voice memo and to get it to me, like, so much effort went into that. And so I just, I really wanna thank everyone at UNFPA for that. But in particular, Rachel Moynihan, who was my point of contact, who is just one of my favorite people. So, thank you so much Rachel for everything you did to make this happen. I really appreciate it. Okay, so all of that again is just to say you're gonna hear a lot from me today. I'm gonna talk about why we need to be talking about sexual and reproductive health in humanitarian settings and what the current humanitarian situation looks like in Gaza. So, with that, let's turn to focus on SRHR in humanitarian settings. So, rePROs recently released a brief on "Sexual and Reproductive Health in Emergencies: Promising Practices to Address the Crisis within a Crisis" by our fantastic senior fellow, Gayatri Patel. It looks into what we can do to ensure sexual and reproductive health are prioritized in humanitarian settings. And I'm not gonna spend too much time talking about that now because we are planning to have Gayatri on the podcast later this summer to talk about it. So, we'll get much more in depth into it there. But I do wanna highlight some really important parts about it that I think are really important to remember as we talk later about what is happening at Gaza. So, when people think of a humanitarian disaster, whether that's an armed conflict or natural disasters or other emergencies, most people think of immediate needs such as food, shelter, water, sanitation. And when you talk about the importance of having sexual and reproductive healthcare be part of that initial package, a lot of people are just like, "what do you, like, that’s...no, why? Like, that doesn't...no, like that's so unimportant and trivial,” but it is so important. Sexual and reproductive healthcare is just as important when there is a humanitarian disaster, people do not stop being pregnant. They do not stop getting pregnant so they don't stop needing reproductive healthcare because there is an emergency. They don't stop having obstetric emergencies in a humanitarian setting where you need to see somebody right away. You don't stop needing birth control during a humanitarian crisis, right? So, sexual and reproductive health, it's a part of your life. And so, it needs to be part of disaster planning. And if all of those reasons were not important enough, just thinking about them on face value, it's really important to just, like, there are stark numbers behind that. 65% of all maternal deaths, 50% of all newborn deaths, and 51% of all stillbirths occur in humanitarian settings. So, this clearly shows why we now need to prioritize obstetric care and sexual reproductive healthcare during a humanitarian crisis. Access to sexual and reproductive health services is disrupted, right? So, you're not gonna have easy access to your doctor. It may mean you have a hard time accessing birth control or other sexual and reproductive healthcare that you rely on. You can't just run to the local pharmacy. And especially if there's a crisis where you have so much uncertainty in your future, that may be even more important to you to ensure that you are not getting pregnant if you do not want to be. So, it is really important to have that stability and to know that you have access to sexual and reproductive healthcare from the very start.

Jennie: Another really important note that people may not necessarily think of when I say sexual and reproductive health needs to be included from the beginning but is gender-based violence that is part of that umbrella. It's all part of it. So, gender-based violence occurs in nearly every emergency and certain forms of gender-based violence like child marriage, intimate partner violence and sexual violence can distinctly rise during a crisis. That means that for survivors, they need a place, they need a safe place to go, and it needs to be in place from the start, right? Because they need time-sensitive clinical interventions such as things for treating injury, for preventing sexually transmitted infections or preventing unintended pregnancy. That means you need access to emergency contraception, you need psychosocial support to address the trauma that you have undergone, including depression or any suicidal behavior. It can all save lives. And so, it's really important that this is all built in as part of the care that is being offered immediately when a crisis starts. Among that sexual reproductive healthcare, it is also really important to ensure that survivors or anyone honestly have access to safe abortion care. And it's really important at this moment to put a flag here and say, this is a place where US anti-abortion policy is doing actual harm. And this is something we have talked about before, but the Helms amendment prohibits the use of foreign assistance to pay for the performance of abortion as a method of family planning. And it has always been implemented as this blanket ban saying no funding of abortion, even in cases of rape and incest, where there have been those exceptions throughout US policy generally. So, this harmful policy, the Helms Amendment, it needs to be repealed like now and we need to pass the Abortion Is Healthcare Everywhere Act that has been introduced in both the House and the Senate. Full stop. Ultimate goal. Helms needs to go. But in the meantime, the Biden administration can do real harm reduction by changing the way that this policy is implemented by allowing funding for abortion in cases of life, rape, and incest. This means that survivors of sexual violence won't have to turn to unsafe abortion and put their lives at risk to prevent an unplanned or unwanted pregnancy. Like I said earlier, I'm gonna talk to Gayatri all about this later this summer and we'll dig further into the sexual and reproductive health in humanitarian settings. But it really just seemed important to have that as context as we talk about what is happening in Gaza. But we know this context doesn't just apply in Gaza, it applies to humanitarian crises and emergency situations all around the world, like what is happening in Sudan right now. So, as I turn the conversation to Gaza, it's important to note that I'm recording this on Friday, May 10th, and some things may change between when I record and when this comes out on Tuesday because everything is moving so fast in Gaza right now. So, just FYI things could change. Okay, so with that, now seems like a really good time to play the voice memo I got from Judith Starkulla, UNFPA's field coordinator in Gaza.

Judith: Hi, my name is Judith. I'm the Head of Office for UNFPA in Gaza. I'm currently in Cairo in Egypt, waiting to be able to cross back into Gaza. I have been a humanitarian aid worker for the last 17 years and worked pretty much in every major crisis and emergency around the world, either as a clinician or in a management role. I have seen and felt the horrors of war many times before, but what is happening in Gaza? The level of destruction and the utter disregard for human life is unprecedented. And I'm deeply concerned that the worst is yet to come. UNFPA works around the world to ensure that women and girls caught up in emergencies, can access lifesaving reproductive health and protection services. We distribute supplies and equipment to health facilities and hospitals in crisis settings. We bring medicines that prevent women from bleeding heavily during childbirth and to manage obstetric complications, including C-sections. We also deploy mobile teams and set up mobile health clinics to reach displaced women and girls with maternal health services and to establish safe spaces and services to prevent and respond to gender-based violence. The situation for women and girls, including pregnant women and new mothers in Gaza today is desperate. People are exhausted, hungry, and living in constant fear. They have nowhere safe to flee to. The estimated 180 women who give birth everyday face unimaginable challenges in accessing adequate maternity care as the health system has been ruined, leaving only three maternity hospitals functioning across Gaza and those three are overcrowded. Malnourishment, stress, and fear have led to a rise in complications during pregnancy and childbirth. Newborns are also dying because their mothers are unable to attend prenatal or postnatal check ups or because their birth weight is simply too low to survive. We simply cannot deliver aid at the scale needed while Gaza is under bombardment. Despite a recent increase in truck numbers, there are still denials of access, delays, impediments, and multiple dangers. Two mobile maternity units which are equipped and stuck to provide reproductive health services, including surgical capacity to provide emergency obstetric care, are currently sitting in Al-ʿArīsh in Egypt, waiting for transportation into Gaza. But women, however, cannot and will not wait to give birth. The operating environment is also incredibly dangerous. Gaza is littered with unexploded bombs and eight workers have come under life fire and even lost their lives. Life-Saving medicines, equipment and supplies that UNFPA delivered to hospitals earlier in the war have been destroyed in the fighting. For example, at Al Amal Hospital, medicines and supplies for pregnant women are lying under the rubble of a destroyed medical store. At Nasser Medical Complex, the same supplies had been destroyed by fire. These acts of destruction are not happening by accident. This is a manmade disaster. There are also restrictions on the kind of aid that can be brought in. For example, flashlights for midwives to work in the dark were removed from UNFPA midwifery kids. Safe, rapid and sustained access of aid supplies, a working deconfliction mechanism to move aid across Gaza, the opening of all border crossings, and an immediate humanitarian ceasefire are urgently needed. We are now in the eighth month of this conflict. Gaza's women and girls need peace now. Help us keep all eyes on Gaza and join calls for an immediate ceasefire and the unconditional release of all hostages. Support petitions and campaigns to increase awareness of what is happening to women and girls in Gaza. And the urgent need to end their suffering. Stand up for international humanitarian law, which is being violated in Gaza every day. The relentless targeted attacks on and around healthcare facilities, services, healthcare workers, and patients is abhorrent and violates international humanitarian law. Hospitals are not a battleground. They must be respected and protected. The global community can also donate to UNFPA to support more women and girls with lifesaving reproductive health and protection services.

Jennie: I just have to say thank you again to Judith and everybody at UNFPA who made that possible. I just think it's so important to ground this conversation with somebody who was on the ground and working to ensure that maternal healthcare is provided in Gaza. So, thank you Judith. Thank you to everybody at UNFPA who worked to make this happen, especially Rachel. Thank you. Thank you, thank you. Okay, so it's also worth sharing a statement by Natalia Kanem, the Executive Director of UNFPA that she put out on May 5th because it really just sums up everything that is going on right now. "Close To seven months of war has inflicted unimaginable suffering on the people of Gaza, including hundreds of thousands of pregnant and breastfeeding women and newborns. Many have been displaced multiple times, living in inhumane conditions with too little to eat, hardly any access to medical care, and nowhere to go. People are hungry, exhausted and scared, and they cannot keep running. More than 1 million people are crammed into Rafah, sleeping in the streets and makeshift shelters in a city that is hosting five times its natural capacity. A ground invasion in Rafah would be a catastrophe for traumatized pregnant women and new mothers and gravely impact humanitarian aid operations that are already struggling to reach people in desperate need throughout Gaza. Today, major hospitals lie in ruins across Gaza and not a single health facility is fully operational following more than 440 attacks on healthcare since the war began in October. Rafah is the main hub for the humanitarian response in Gaza and has some of its last functioning health facilities. This includes the Halal Al Emirati Maternity Hospital, which is now the health main facility for pregnant women in Rafah, managing around 60 deliveries per day. An attack in Rafah could turn this and other health facilities from places of hope into rubble and dust putting at risk the lives of tens of thousands of pregnant women. UNFPA delivered reproductive health kits have enabled safe births for more than 20,000 women in Gaza. The kits include life-saving medicines and equipment for maternal health, including emergency obstetric care. We have set up a mobile maternity clinic in Rafah with two more on the way. Hundreds of UNFPA-trained midwives are supporting pregnant women and new mothers unable to access health a health clinic or hospital. UNFPA has also distributed essential supplies to thousands of new mothers, and we are providing psychosocial support for thousands of women, adolescents, and children. We call for all hospitals, healthcare workers and patients to be protected. Civilians must never be a target and their needs must be met. We call for an immediate ceasefire and for the unconditional release of all hostages in Gaza. The women and girls of Gaza need peace now." So, with that, I mean things have even changed since Natalia's statement, but we'll get to that.

Jennie: So, let's start with the big picture. More than 34,000 Palestinians have been killed since the start of the conflict, and this includes more than 14,500 children and more than 78,000 have been injured. 75% of the population in Gaza has been displaced and that means nearly 1.5 million Palestinians have been displaced and more than half of those are children. The situation in Gaza is dire in every way. As of this recording, no aid has entered Gaza in three days from the southern crossings and according to the World Food Program, only one bakery in Rafah is functioning. With no one being able to cross the border, that means no food, no fuel, water, medical supplies have gotten in and supplies were already dangerously short. People are moving to sites that do not have latrines or water access points, proper drainage or even shelter. The UN has said that there is already a full-blown famine in Northern Gaza and the famine is progressing south. We know that there are around 155,000 pregnant women and new mothers who are currently struggling to survive. They're suffering from hunger and related diseases that show up when there is hunger. They're dealing with life-threatening shortages of food, water, and medical care. And only 33% of Gaza's 36 hospitals and 30% of its primary healthcare centers are functional in some capacity. Some capacity, right? Not even full capacity, some amid repeated attacks and shortages of vital medical supplies, fuel and staff. The main maternity hospital in Rafah, the one that Natalia was talking about, has stopped seeing patients. Before that it had been seeing about 85 out of the average of 180 births a day in Gaza before this current escalation and fighting outside of Rafah. Other hospitals had been focusing on treating the war-wounded and directing women in labor to the Al Emirati hospital. And there are about 5,500 women who will give birth in the coming month. And it is not clear where these women will go. This is an unimaginable challenge. Doctors and midwives are desperate for medicines and supplies and they're struggling to provide adequate care. Beds are in such short supply that women who manage to deliver in a hospital often have to be discharged mere hours after undergoing a C-section. And there are an estimated 30,000 pregnant women living in Rafah in desperate conditions. It's also imperative to remember that if the women and children do survive pregnancy and childbirth, they must return to overcrowded shelters and informal sediments that lack clean water or hygiene facilities. I mean, and food too, right? So according to the International Rescue Committee, as of December, 155,000 pregnant and breastfeeding women were at high risk of malnutrition. And unfortunately, that number has likely just continued to rapidly grow since then. It's just the scale of this is just beyond imagining. UN Women recently released a survey they conducted, and it had some shocking statistics. More than six out of 10 women that they interviewed who are currently pregnant or have been pregnant since October 5th, reported complications including 95% reporting urinary tract infections, 80% reporting anemia, 30% reporting preterm labor, 50% reporting hypertensive disorders. In households with nursing mothers, 72%, 72% reported there are challenges in breastfeeding and meeting the nutritional needs of their babies. Y'all, this is beyond devastating and heartbreaking and it is way past time to act.

Jennie: So, what can you do? If you can, donate to groups that are working on the ground to get aid into Gaza? Some possibilities are Doctors Without Borders, The International Rescue Committee, CARE, Save the Children, the Palestine Children's Relief Fund, World Central Kitchen, and there are so many more. Call your members of Congress and tell them that you support a ceasefire. Ask them to fund UNFPA and its important work to fund groups that are doing the work to ensure sexual and reproductive health are prioritized in humanitarian settings. And UNFPA is one of those groups. UNFPA is on the ground before, during, and after a crisis. They work closely with governments and local NGOs and other UN agencies to ensure that sexual reproductive health and rights and responses to gender-based violence are integrated into emergency responses from day one. They ship hygiene supplies and reproductive health kits to crisis settings, providing core life-saving services. UNFPA also deploys trained personnel and provides other crucial support to affected populations, working to ensure the needs of women and girls are served through preparedness, emergency, and reconstruction phases. So, it is just, it's so important to make our voices heard in this moment. Make sure that people know about this humanitarian crisis. You know, some of that is getting lost in the fight over protests on college campuses, right? They're losing sight of what is happening on the ground and this unimaginable tragedy. So, make sure to talk to people, make sure to tell your members of Congress what you think. It is so important. And I think the way to end this episode is to just share this quote from Martin Griffiths, the UN Under Secretary General for Humanitarian Affairs and Emergency Relief Coordinator. This is from May 7th. "The Conflict in Gaza is at another critical juncture. Israel's latest evacuation orders and their ground operations will bring more death and displacement. In just a matter of days, tens of thousands of people have been forcibly displaced yet again. The closing of the Rafah Crossing severs access to fuel and shuts off the movement of aid and staff to and from Gaza. Civilians must be protected and have their basic needs met whether they move or stay. Those who evacuate must have enough time to do so, as well as a safe route and a safe place to go. Our teams are still in Rafah, where over 1 million people, including 600,000 children remain. We are also extending our presence northwards to assist the families who have moved there. We remain committed to providing aid to people regardless of where they are. The decisions that are made today and their consequences in human suffering will be remembered by the generation that follows us. Let us be ready for their reproach."

Jennie: [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!