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editor’s note:

in gaza, a land shrouded in haze, many newborns are still born every day. recently, al jazeera interviewed nour mwanis, a midwife in gaza, who talked about her experiences and what she has seen since the palestinian-israeli conflict.

under the gunfire, childbirth is no longer just the joy of welcoming a new life, but is accompanied by tears and pain. due to the extreme shortage of supplies, women in gaza cannot even get the most basic nutrition and health protection. midwives have also witnessed countless lives being saved from death. phoenix reference compiled this article to glimpse the real experiences and voices of ordinary people in the gaza strip during the israeli-palestinian conflict.

original title: a midwife in gaza: bringing life into the world during israel's war

compiled by song dongze and zhang xiaowen

a midwife in gaza

when the reporter arrived, 27-year-old midwife nour mwanis was still in the delivery room of the al-awda health center, delivering a woman who arrived early in the morning. the duty manager said that nour needed about half an hour to handle the delivery, clean and disinfect the room and equipment.

in the reception area, the grandfather, grandmother and uncles of a newborn baby were passing the baby back and forth in a festive atmosphere. the grandmother looked at the baby wrapped in a pink scarf with a smile on her face. their faces were filled with happiness, bringing warmth and joy to the people around them.this feeling of happiness has not appeared for a long time.when asked about the baby girl's name, they smiled softly and said: "she doesn't have a name yet."

a few minutes later, the mother, who had just given birth, was wheeled onto a gurney by two nurses and taken to the recovery area. the department director said noor was ready to meet, and she was almost ready, too.

standing in the quiet delivery room, she raised her head with a calm smile, put a tray of tools into the sterilizer, disinfected her hands, and then sat on the bed to talk about her career as a midwife during the conflict. suddenly, noor interrupted herself and walked to the reception desk to ask about the mother's condition and progress. the nurse at the service desk said, "they all need time. until the second shift or tomorrow morning."

"well, we should have some time to talk then," noor said as he returned to sit on the bed.

delivering on the floor

noor once dreamed of becoming a midwife, helping women give birth safely and bringing joy and smiles to new families. for three years, she had been holding on to this idea. however, the outbreak of the israeli-palestinian conflict in october 2023 destroyed her dream.

“i never thought i would see a day like this in my life."noor told al jazeera. large numbers of people have poured into the nusserat refugee camp in central gaza, trying to escape israeli bombs by migrating southwards.

“during the first three months of the conflict, we were delivering 60 to 70 babies a day, with only six midwives working around the clock."noor recalled. during those three months, the pressure of the hospital and the dangers of the outside world forced her to stay in the hospital and unable to go home.

"the delivery room can't accommodate so many people.we had to deliver babies on the floor or in unequipped antenatal rooms."after al-aqsa martyrs hospital in deir el-balah had to close its maternity ward to focus on treating the wounded, al-awda health centre became the only maternity facility in gaza central governorate, which put increasing pressure on the centre.

“it was chaos – there were bombings everywhere and women were giving birth in dire conditions,” noor said with a deep sigh. “many women had complications, such as hemorrhage or stillbirths, and they needed special care. but there was no such thing and their situation only got worse.”

as if to prove her point, a nurse came in and told noor that 28-year-old aya al-kafarna had been admitted with a stillbirth. aya was 31 weeks pregnant, but her baby died in her womb because she was too weak from being displaced to get enough food, clean water, medicine, supplies or medical care.

▎a nurse in the antenatal department takes aya’s blood pressure. source: al jazeera

aya's father, a 58-year-old medical worker, was killed in an israeli bombing. a day later, she found that her baby had stopped moving in her womb. noor explained that inducing labor was the only way to help aya. but inducing labor would cause further emotional and physical damage to aya because her body was not ready for a natural birth.

"i was completely shocked and cried a lot at first. but eventually, i tried to calm myself down and reflect on the situation i was in," aya said.maybe it was for the best, that the child didn't have to be born into such a miserable situation. maybe god spared him from such suffering.”

loss and tears in a land of joy

in december 2023, the third month of the conflict, noor received tragic news while delivering a baby - her brother had been seriously injured in an israeli bombing and was taken to her hospital.

"i almost broke down because i hadn't seen my family for months and i was worried that they had concealed his death," noor recalled. "i ran screaming through the hospital until i got to him. he was covered in wounds and tears welled up in my eyes."

fortunately, her brother survived and has recovered. he was injured when the house next door was bombed, which severely damaged the house they were taking shelter in. "like all families, my family - my parents and nine brothers and sisters - were forced to move from one place to another during the war," noor said.

she has been working hard to help women who are giving birth, many of whom arrive at the hospital alone, crying and despairing because they have lost a loved one.women would cry on their delivery beds and tell me they had lost a child, a husband, or a family member.this seriously affects the birthing process,” noor explains. “mental health is crucial for mothers who are giving birth. we try to provide some support, hug them or talk to them, try to comfort and reassure them. but there are many cases where this is not always possible, especially in the first few months [of the conflict].”

▎babies depend on their mothers' health, and many newborns require extra care. a premature baby lies in an incubator at al-aqsa martyrs hospital in deir el-balah on august 26, 2024. image source: al jazeera

noor recalled a woman who went into labor the same day her husband was killed. she cried throughout the labor because she was so frightened.because she is welcoming a new life into a world where the father of a child has just been killed."the situation was very complicated and we didn't know how to comfort her." eventually, the mother gave birth to a baby boy and named him after her husband. when she left the hospital, she was still worried about how to meet her child's future needs.

noor was interrupted during the interview when a nurse rushed in, holding a newborn baby in her arms, who was struggling to breathe. noor rushed to help, making sure the baby was stable and connected to oxygen. after the situation was under control, she returned to the ward, but occasionally got up to check on the baby.

noor said newborns whose mothers were injured in the blast, sometimes just pulled from the rubble, can be even more heartbreaking. "when the back of the woman's head is injured, the delivery becomes very complicated... we try to find a safe position for her to deliver," she said.

“these situations…did not appear in the training i received or in the books we studied.noor reflected.

rebirth in death

“childbirth is no longer the joy of welcoming a new life.” says noor as she tells the story of women’s efforts to bring life into this world.

on one occasion, an eight-month pregnant woman was injured while fleeing the explosion site and bleeding profusely. she was brought to the hospital by neighbors and passers-by. "the medical team tried their best to save her," noor said sadly, but neither the mother nor the child survived. she also witnessed five other cases where mothers died in explosions and doctors struggled to save their babies, but only two of them were successful.

the early months of the conflict were extremely difficult for noor, who lost contact with her family while in hospital. “there were times when communications were down, and every time i heard about an attack somewhere, i felt anxious,” noor said.all of us midwives had the same fears, so we tried to comfort each other…some of us would collapse from exhaustion and worry, and when they needed a break, we would take turns.”

but the profession of midwifery, which accompanies childbirth, also reminds noor that life goes on.

“war does not stop life. people still have children, still get married, and continue to live normally even under abnormal circumstances."i even got engaged during the conflict," noor said. noor met and fell in love with a young volunteer from the hospital's security team. she hopes the war will end soon so they can get married and start a new chapter in their lives.

"please...i don't want stitches."

according to noor, almost all the women who come to the hospital suffer from severe inflammation, which seriously hinders safe delivery. "no clean food, no clean water, not enough hygiene products... all these factors increase the risk of inflammation," noor explained.when the women gave birth, they had not bathed for several days, their hair was full of lice, and they had to give birth in an unsterile delivery area.”

hospital staff managed to clear a bathroom for the women who were about to give birth and provided them with basic hygiene kits, including razors, soap and shampoo, so they could wash themselves, but once they were done giving birth, they had to return to their makeshift tents.

noor added: "many women even begged us not to stitch their wounds after giving birth. they said: 'please, i live in a tent and there is no toilet. i don't want stitches.'" almost all displaced women have no clean water or gas to heat water for disinfection. "many women return with infected stitches because of the poor living conditions," noor said.

it’s not just water that these new mothers lack. the sanitary pads they need after giving birth are hard to find and expensive, if available. “women also say they don’t have the privacy to breastfeed their babies because the tents are so crowded…” noor noted.these are the most basic needs of women who have just given birth. yet, women in gaza cannot get them.”

disease, malnutrition and newborns

newborns in gaza were not immune to what happened to their mothers, with their average birth weight dropping by around 30 per cent and their overall health also suffering.

in the crowded camps, infectious diseases such as hepatitis a are also spreading, increasing the risk for pregnant women. according to data from the gaza health department, 45,000 cases of hepatitis have been recorded during the conflict, a significant increase from 85 cases in the year before the conflict. "we have admitted several pregnant women infected with hepatitis b," noor explained, saying that infected pregnant women are more likely to suffer from postpartum hemorrhage.

"one woman was infected with hepatitis... we tried to save her, but she died. we had no intensive care facilities and no established protocols for such cases," she added.

as the conflict continues, the number of births at the hospital has dropped to around 15 a day.palestinians are known for their love of family and children, and they celebrate the arrival of newborns with great fanfare, but now they are having far fewer children.noor concluded sadly.