Written by Sandeep Kumar
Research Intern,
Jindal Centre for the Global South,
O.P. Jindal Global University, India
Email: iamsandeep957@gmail.com
A gruesome conflict impinges on different genders unequally reflecting sexist social norms; Men are expected to wage until they exhaust their wherewithal and will, and Women are forced to suffer and flee (5 Ways Conflict Prevents Girls and Women From Being Equal Everywhere, 2022).
On October 7th, 2023 Israel and its longstanding nemesis Hamas entered a sanguinary strife that would be one of the atrocious humanitarian crises of the 21st century. The United Nations Secretary-General Antonio Guterres has decried the war urging the UNSC ‘the terrible war must end’ (‘This Terrible War Must End’, Secretary-General’s Chef de Cabinet Urges Security Council, 2024).
War and protracted conflicts, conflicts persisting over an extended period with intermittent escalations (Debarre, 2023), discriminate against none, it percolates to every nook and corner transcending the socially constructed boundaries. However, a gendered lens is important to scrutinize the popular veracities and bring the innumerable implications of conflict on women and girls to the fore. According to Unaiza Niaz (2020), women usually do not pledge wars, but they do suffer from their pernicious aftermaths.
This article examines the gendered impacts of healthcare crises in conflict zones, specifically in Gaza, by exploring the breakdown of healthcare infrastructure, the exacerbated vulnerabilities of women, and the role of international organizations in addressing these challenges.
Conflicts severely disrupt healthcare facilities and adversely impact citizens, disproportionately affecting women due to systemic gender inequalities and prioritization gaps in health resource allocation (Chi & Urdal, 2023). These inequalities are exacerbated in protracted conflicts where resources are limited, reflecting patriarchal biases in both local and international response mechanisms. Rostomian (2023) contends that mothers, wives, and sisters have to bear the brunt disproportionately because their health is directly predicated on regular access to well-functioning healthcare systems.
In a protracted conflict such as Israel-Hamas since October 7th, healthcare facilities in Gaza have been reduced to rubbles or stranded inoperational due to health personnel fleeing the precincts to save their lives from the impending airstrikes (Requejo et al. 2022).
Historically, protracted conflicts in countries such as Sudan and Yemen have resulted in demoting them to the weakest healthcare systems worldwide (Debarre, 2023). Thus, it engenders concomitant crises including physical abuse, violence, forced labour, human trafficking, and kidnapping (OHCHR, 2023). Against this backdrop, Duff-Brwon and Masset posit that the effect of the healthcare crisis on women in a conflict ‘far exceeds’ the impact on those who are directly hurt or killed (Brown & Masset, 2023).
The Grim Reality
Although conflagration and skirmishes are not new to Gaza, the current war is believed to be of an unprecedented scale- unprecedented in the scale of deaths, agony it has entailed, and destruction of healthcare and properties. According to the Ministry of Health (MoH), 34,568 Palestinians were killed in Gaza (72% women and children) whereas 77,765 were severely injured between 7th October 2023 and 30th April 2024 (MoH Palestine, 2024). Nearly 10,000 people are estimated to be missing under the rubble in Gaza, according to the figures published by Palestinian Civil Defense (OCHA, 2024).
During the period from October 7th, 2023, to April 23rd, 2024, healthcare facilities in Gaza were severely impacted by violence, with a total of 443 attacks reported (WHO, 2024). This violence resulted in devastating consequences, with 723 people killed and 924 injured. Notably, 353 attacks targeted healthcare facilities themselves, while 82 attacks disrupted medical transport services (ibid).
The situation in the West Bank, while less severe, is still concerning. Over the same period, 447 attacks against healthcare were documented, leading to 12 deaths and 95 injuries. Here, 52 attacks impacted health facilities and 286 attacks targeted medical transport (WHO, 1 May 2024).
A Public Health Needs Assessment conducted on May 1st, 2024, revealed a critical situation in the healthcare system. Only one-third (12 out of 36) of hospitals remained operational, and their functionality was significantly compromised (OCHA, 1 May 2024). These facilities faced overwhelming patient loads and critical shortages of essential resources, including fuel, medicine, medical supplies, and qualified personnel ((OCHA, 1 May 2024).
Previously, the 36 primary hospitals served a population exceeding 2 million Gazans (WHO, 2023). The situation with primary healthcare centers was even more dire, with 70% of primary healthcare centers non-functional, access to prenatal and postnatal care becomes severely limited. Pregnant women and new mothers face increased health risks, from unsafe birthing practices to the spread of infectious diseases in unsanitary conditions, intensifying the healthcare crisis for women in Gaza (OCHA, 2024).
The United Nations Relief and Works Agency (UNRWA) healthcare system, which previously operated 24 centres, was also severely impacted. Only eight centres remained operational, with two of those being temporary facilities established to address the needs of growing displaced populations (UNRWA, 9 April 2024).
In northern Gaza, an alarming 81% of households lack safe drinking water, as per the World Health Organisation (WHO). The WHO has confirmed outbreaks directly linked to this lack of clean water and proper sanitation egregiously affecting women and children (ACAPS, 13 December 2023).
UNFPA’s assessment paints a grim picture of sanitation in Gaza. With only one functioning toilet for every 341 people and a staggering 80% unusable in displacement camps, access to basic sanitation is severely limited. Less than 25% of locations offer safe and private facilities, and sanitary pads remain out of stock for over two-thirds of women and girls, reaching nearly 90% in makeshift shelters (UNFPA, 8th May 2024).
In Gaza, almost 700,000 women and adolescent girls who menstruate face severe difficulties due to a lack of sanitary products and limited access to clean water and sanitation facilities. Many are forced to use rags as makeshift pads because sanitary pads are unavailable, and clean water for basic hygiene is scarce. An alarming proportion, nearly three-quarters, lack privacy for washing, and a similar number have no access to clean water for hygiene (UNFPA, 6 April 2024).
In conflict zones like Gaza, societal expectations and cultural norms regarding gender roles compound the healthcare crisis for women. Women are often caregivers for children and the elderly, which not only exposes them to additional health risks but also limits their ability to access medical facilities during crises (Rostomian, 2023)
The high rate of maternal deaths, where approximately 37 mothers lose their lives daily, not only underscores the scarcity of maternal healthcare but also destabilizes family structures, leaving children vulnerable in a society already facing systemic trauma (Protection Cluster, Dec 2023). The targeting of healthcare services particularly harms around 50,000 pregnant women and girls currently, as well as the over 5,500 expected to give birth in the coming month. Consequently, pregnant women are at increased risk of complications, potentially leading to fatalities (Protection Cluster, Jan 2024).
On the other hand, women make up about 45% of the population with disabilities (OCHA, 2024). Among the older people in the Occupied Palestinian Territory (OPT), the physical and mental health of women is acutely impacted due to the unavailability of essential medication (Albelbeisi et al., 2023). In the OPT region, the primary reasons for neonatal deaths are prematurity, respiratory infections, and congenital abnormalities, making up 61 per cent of all neonatal mortality cases (WHO, 2024).
The Unwavering Efforts of International Bodies and their Inevitable Challenges
More than three-quarters of Gaza’s 1.2 million women have been displaced within the region. UNRWA shelters, government schools, public facilities, newly erected tented settlements, and existing rented spaces accommodating displaced individuals are overcrowded and insufficiently equipped to provide adequate water, sanitation, and hygiene (WASH) services for the population. In Khan Yunis, shelters intended for 2,000 people now accommodate 20,000, with nearly 650 individuals relying on a single latrine facility (OCHA, 2024).
UNRWA facilities, greatly surpassing their intended capacity, have been subjected to bombings: the agency reports over 60 direct strikes on its installations, resulting in at least 319 displaced individuals killed and over 1,135 injured in their shelters (UNRWA, 2024).
Since October, UN’s ‘High-Risk Mission’ teams have undertaken dangerous missions to deliver aid, visiting severely damaged health facilities overwhelmed with patients and facing severe resource shortages (ibid). In Gaza City, all hospitals are now non-functional. On January 10, Tedros Ghebreyesus announced that 6 scheduled trips to northern Gaza had been cancelled since December 26 (How the UN is helping civilians in Gaza, 2024).
The United Nations Population Fund (UNFPA) is the exclusive provider of family planning services in Gaza, facilitating coordination among service providers to streamline these services. A four-day ceasefire in late November 2023 enabled essential reproductive health kits from UNFPA to reach Gaza, saving lives. Despite severely restricted aid deliveries since then, UNFPA remains involved in risky missions with other agencies and remains committed to delivering crucial aid to the occupied territory (How the UN is helping civilians in Gaza, 2024).
Inter alia local NGOs and UN Women are persistent in their efforts to assuage the crisis, especially for women by supporting SDGs 3, 5, 6, & 10 in tandem.
Plausible ways of modus-vivendi in ending the healthcare crisis and conflict at large
In the year 2000, the United Nations Security Council (UNSC) adopted resolution 1325, launching the Women, Peace, and Security agenda. This resolution called for women’s involvement in peace efforts, safeguarding their human rights, and preventing conflicts. Subsequently, eight additional resolutions have expanded the agenda’s scope, increasing its ambition (Oxfam, 2019). The resolution was a watershed milestone in recognising that women and girls suffer differently during a conflict.
In this spirit, the UNSC must ensure that Israel-Hamas abide by the adopted resolution on June 10th, 2024. The US Secretary of State Antony Blinken visited Israel on June 10 to bring Benjamin Netanhayu around the deal. However, Netanhayu, being skeptical, said that he is still committed to eradicating Hamas from its roots (Al Jazeera 2024). At the same time, Hamas welcomed the deal with a caveat that they would not cease their effort against illegal Israeli occupation (U.N. Security Council adopts a ceasefire resolution aimed at ending the Israel-Hamas war in Gaza, 2024).
However, a more concrete decision in the form of a ‘two-state solution’ must be reached if further wars are to be prevented. Apropos the immediate recommendations that the working international bodies can adopt to expedite the process are:
UN Women must join the United Nations Security Council’s call on March 25 (Resolution 2527(2024)) for an immediate and lasting ceasefire. They also should advocate for the delivery of safe, unhindered, and comprehensive humanitarian aid throughout the Gaza Strip, including northern Gaza, to address urgent humanitarian and WASH needs effectively with the help of funds being provided by the EU and the US.
By enhancing access for women and girls to food, safe drinking water, sanitation facilities, and menstrual hygiene products that respect their privacy and dignity, ensuring they are suitable for their age during emergency WASH interventions and assistance. Bear in mind that WASH coordination and response efforts comprehensively address the specific needs of women and girls. This includes conducting gender analysis and systematically collecting sex, age, and disability disaggregated data (SADDD) to inform WASH planning and response strategies. And further, assist organizations led by women by providing direct and adaptable funding. These organizations are instrumental in guiding and improving healthcare sector initiatives and can enhance the delivery of inclusive and gender-sensitive services to women and girls impacted by the crisis.
With the catastrophe witnessing a domino effect impacting women and girls every day, endangering their lives and health; the world community must come together despite its alliances and favouritism, to save women.
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The opinions expressed in this article are those of the author (s). They do not purport to reflect the opinions or views of the Jindal Centre for the Global South or its members.
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