Pills to prevent periods, births in tents and the feat of finding a bathroom: This is how displaced Gazans live

Shima Younes, 35, reluctantly takes pills to delay her period. The 35-year-old, already a mother of four, lives in a tent in Rafah on the southern tip of the Gaza Strip, and feels she has no choice due to the lack of running water, hygiene products, and even the slightest amount of privacy. “I have a hard time taking these pills, but it’s the only solution, even though they give me back pains and cause me some severe episodes of sadness,” she explains.

Since October, the simplest gestures of daily care, such as going to the toilet and washing with minimal privacy, have become a real feat for the displaced Gazan women in the huge makeshift camps in the south of the enclave, where tens of thousands of people are crammed together in squalor. These women, in many cases, opt for alternative and sometimes risky solutions for their health, such as taking these medicines.

“The shortage of sanitary pads and tampons aggravates this situation and many women resort to norethisterone pills, as is the case with Shima,” explains Walid Abu Hatab, a medical consultant in Gaza specializing in obstetrics and gynecology. This drug is a hormonal treatment that helps raise progesterone levels to delay menstruation. But it is a double-edged sword: it offers temporary relief in this emergency situation but can cause several adverse side effects, such as irregular vaginal bleeding, nausea, dizziness and mood swings. “These are additional health risks for those already enduring the relentless bombardment,” the expert adds.

According to United Nations figures, 1.7 million Gazans of a population of around 2.2 million have been displaced since October 7, when Hamas carried out bloody attacks in Israel, which, according to official sources, resulted in the deaths of 1,200 people and the kidnapping of over 200. The Israeli military response has killed at least 30,000 Palestinians and injured some 70,000 more, according to figures from the Hamas-controlled Gaza Health Ministry.

The shortage of toilets, washing facilities and accessible laundry services profoundly affects women’s mental equilibrium

Nivin Adnan, Palestinian psychologist and social worker

The flutter of life

“We know that deliveries are taking place, including by Cesarean section, without anesthesia. There is an almost total collapse of the education system and a serious risk that girls who are still alive will miss the entire school year, with associated increased risks, such as child marriage, family separation, or human trafficking. There are also reports of gender-based violence, including sexual abuse and threats of rape of female detainees by Israeli forces in both Gaza and the West Bank,” Dorothy Estrada Tanck, chair of the U.N. Working Group on Discrimination against Women and Girls, told this newspaper.

“The cost of the conflict on women’s well-being has a thousand faces,” says Nivin Adnan, a psychologist and social worker from Gaza, who has also been displaced. She explains that the physical discomfort and psychological disturbances that accompany menstruation are exacerbated in this context of death, fear, misery and displacement.

“The shortage of toilets, washing facilities and accessible laundry services profoundly affects women’s mental equilibrium. In addition, the shelters are meager and lack basic comforts and the slightest privacy,” she adds. The expert also warns that for “girls who experience their first menstruation in such circumstances, resorting to medication that delays the period entails enormous health risks.”

For pregnant women, the journey to motherhood is fraught with danger. In overcrowded makeshift shelters, dilapidated schools and half-destroyed homes, these women struggle to protect the life inside them amid the chaos. Some do not succeed. “I no longer feel the flutter of life inside me. My unborn child, already stripped of its innocence and condemned to ruins,” sobs Aya Ahmad, who believes she lost the baby she was expecting, but has not yet been able to confirm it because she has no access to a hospital or an ultrasound.

Marina Pomares, coordinator of the Doctors Without Borders (MSF) project in Gaza, has just returned from a month-long mission in Gaza and confirms to this newspaper that there are many women who have not been able to go to pregnancy check-ups and do not know how their baby is doing.

The MSF official also explains that there are “complications in pregnancies, abortions, and births in shelters and tents” because Gazans cannot access the few hospitals that are still functioning, or are afraid to go and not be able to receive the care they need. “And once they have their baby, they have to live with them in a tent, in precarious conditions. They are afraid that breastfeeding won’t work, because of the stress, and that they won’t find formula, or that the baby will get sick and they won’t be able to see a doctor.”

This is the case for Noor Zakari, 24, who gave birth to her second baby while living in a displaced persons camp in Rafah. “I am surrounded by many displaced people. It is unbearable to be in a tent during the harsh winter and I am worried about my baby’s health, as it is too cold at night and there are not enough clothes and blankets,” she explains.

The fears of these women are totally justified. These are women who don’t eat, don’t sleep, who have other children to take care of. They are exhausted, but their priority is to survive no matter what

Marina Pomares, Doctors Without Borders

Survival by any means necessary

“Women need sanitary pads, for example, and we can’t even find them in the stores. Nor do they have a decent, safe place to shower or a proper toilet in which to relieve themselves. Going to the bathroom is a feat, because either they are practically in the middle of the street, or they have to go far away and then they have to be accompanied,” says Pomares.

The MSF coordinator also explains that there are women who are suffering from severe vaginal and urinary infections due to the lack of hygiene and the impossibility of changing their clothes. “They come to see us because they feel sick and do not know what is happening to them,” she adds.

The U.N., in its periodic report on the situation in Gaza dated February 23, warned of the urgency of supplying more hygiene materials for the women in the territory. So far, some 9,000 menstrual hygiene kits and some 3,500 dignity kits, including soap, sanitary pads, and underwear, have been distributed, a derisory figure compared to the needs. The U.N. also reports that information is being distributed on how to protect oneself and report sexual assault, and that efforts are being made to create safe places for women and girls.

“The fears of these women are totally justified. These are women who don’t eat, don’t sleep, who have other children to take care of. They are exhausted, but their priority is to survive no matter what,” says Pomares. “It is clear that if a mother has to take her child to a neonatal ICU because of a problem, there is a chance the child will die because there are 60 babies in a space for 12. We are working on instilling some confidence and security in them, but the support we can give women in these circumstances is very limited.”

Asmaa Sendawi is nine months pregnant and lives in a tent in Rafah with her husband. The 27-year-old mother-to-be cannot hide her distress. “The truth is that I don’t know how I’m going to give birth. I am about to, but there is nothing for this newborn. My daughter could die, she will die for sure,” she sobs.

At the moment, the only maternity hospital in Gaza is the Emirati in Rafah, where MSF operates. There are 26 beds but all of them are permanently full and staff perform 80 deliveries a day in addition to those in other medical centers or clinics that are partially functioning, or in shelters. According to UNICEF data, some 20,000 babies were born in Gaza between October 2023 and the end of January.

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