A Palestinian child injured in Israeli shelling in the Gaza Strip is taken to a hospital in Rafah on Tuesday, December 12, 2023. AP

DEIR AL-BALAH, Gaza Strip – The birth of their daughter should have marked the beginning of a joyful chapter for the young Palestinian couple.

Instead, the devastating war in Gaza, now in its third month, has turned childbirth and parenthood into a time of worry and fear for Salim and Israa al-Jamala.

First, they faced a dangerous journey, avoiding missile fire, to reach the maternity ward. And now, the couple is sheltering with their newborn in the partially tented courtyard of another hospital, where they cannot properly care for their 3-week-old daughter, her mother's namesake.

His wife's breast milk is not enough because she cannot eat enough due to widespread food shortages, said Salim, 29, who cradles baby Israa, swaddled in blankets in a cot cobbled together from scrap wood. Baby formulas and medicines for persistent baby cough are not available and in any case are not affordable.

The war, sparked by a deadly Hamas attack in southern Israel on October 7, has unleashed unimaginable destruction, with more than 18,000 Palestinians killed and nearly 50,000 injured in Israel's offensive, according to health officials in controlled Gaza. by Hamas. Hamas' initial attack killed about 1,200 people in Israel, most of them civilians.

Amid the devastation, around 5,500 births are expected next month from an estimated 50,000 women in Gaza who are currently pregnant, according to the World Health Organization.

However, the health sector is on the brink of collapse, with two-thirds of Gaza's 36 hospitals out of service. The remaining 12 health facilities are only partially operational. Even in functioning hospitals, doctors report a lack of basic medicines and the type of equipment needed to treat newborns, including ventilators, powdered milk and disinfectants.

Severe fuel shortages are another major concern for hospitals that have run exclusively on generators since the early days of the war, when Israel cut off electricity supplies to Gaza.

“Sometimes the electricity is turned on for a few minutes” before going out, said Wisam Shaltout, head of the neonatal intensive care unit at Al-Aqsa Hospital in Deir al-Balah in central Gaza.

Salim and Israa's odyssey began in mid-October. During this period, the Israeli military issued daily warnings to residents of northern Gaza, including Gaza City, to head to the southern half of the territory ahead of an imminent Israeli ground offensive in the north.

Heeding the warnings, Salim, a pregnant Israa and her 5-year-old son fled their home in the Sheikh Radwan neighborhood of Gaza City and headed south on foot. The family of three arrived shortly after at Shifa Hospital in Gaza City, before getting a taxi later that day to take them to Al-Aqsa Hospital, where they found shelter.

When 26-year-old Israa went into labor on November 23, the pair were told to go to Al-Awda Hospital, near the Nuseirat refugee camp, as there was still a maternity ward.

The couple managed to find a Red Crescent ambulance to take them to Al-Awda, just 6 kilometers away. But it was a frightening journey that lasted more than an hour because three airstrikes took place close to the road.

Most who arrive at the Al-Awda maternity ward do not have a vehicle to help. Some pregnant women are too afraid to go, fearing airstrikes that in some cases have also hit ambulances, said Dr. Yasmin Kafarneh, who heads the obstetrics department in Al-Awda.

She said she believes her department is the only operating maternity hospital in southern Gaza. Before the war, the department handled around six births a day. Now, pregnant women arrive from everywhere and more than 70 babies are born every day.

Under current conditions, first-time mothers can stay and receive treatment in hospital for around four hours after giving birth, while those who have given birth before can only stay for half that time.

Israa gave birth at 2am on November 24th, but the joy was short-lived. Shortly after dawn, the family was informed by the medical team that they needed to leave to make room for other people.

They got a donkey cart to take them back to the shelter at Al-Aqsa Hospital. They have little to eat, some days just onions.

Their neighbors build fires to stay warm, sometimes burning plastic that releases toxic fumes. “The atmosphere here is just smoke, just dust,” said Salim. “It’s not an appropriate environment for a newborn girl!”

The baby's health worsened, said Salim, worried about the persistent cough.

Israel was born just hours before a week-long ceasefire came into effect. After the resumption of fighting and the advance of ground forces in the center and south of Gaza, their shelters became even more crowded.

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Given the circumstances, Salim said he did the best he could. But he is scared for his daughter. “I don’t know if she’ll be alive tomorrow,” he said.