Global Health Problem: How does the destruction of hospital infrastructure impact healthcare
access for mothers giving birth and their newborn children in Gaza?
*intro music*
[Narration]
Many women in Gaza go into labor with no hospitals or doctors nearby to safely deliver their
baby. Without any access to proper prenatal care, their baby is at risk of being born prematurely.
[Shatha Elnakib]
These women are just under unimaginable, unfathomable stress because of the, you know, the
impossible conditions they're living under.
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[Narration]
To understand why Gaza’s healthcare system is in ruins we need to go back seven decades.
The roots of this problem date back to 1948, when hundreds of thousands of Palestinians were
displaced from their homes during the Nakba with many seeking refuge in what is now known
as the Gaza Strip. This mass displacement was recognized by the United Nations, which in its
Resolution 194, called for the right of return for Palestinian refugees displaced during that time.
The displacement of the Palestinians continued, along with continuous airstrikes over the next
seven decades, leaving Gaza’s healthcare system in shambles. In 2007, Israel and Egypt
imposed a blockade on Gaza which severely restricted the movement of the people, goods and
supplies which included medical supplies. This blockade has made it nearly impossible for
hospitals to continue functioning as usual. This blockade on Gaza is still in place meaning
limited medical supplies and other resources.
[Shatha Elnakib]
Israel decided to stop aid in Gaza with the end of the ceasefire. And so this is what we call
weaponization of humanitarian aid using humanitarian aid, which is not supposed to be a
weapon, but using it as a weapon against people. Telling people you have to acquiesce to our
political demands in order for you to get your humanitarian aid. So this–we're seeing this play
out. And of course this is not normal. It is not legal. It is very much a war crime to prevent
civilians from having access to humanitarian aid.
[Narration]
That’s how Dr. Shatha Elnakib, an Assistant Scientist at Johns Hopkins Bloomberg School of
Public Health, describes the situation with regards to aid in Gaza. Dr. Elnakib has researched
the crisis in Gaza specifically how it affects pregnant women. In an article for The Lancet, she
writes about the harsh conditions for pregnant women in Gaza and her research reveals the
severe lack of maternal healthcare.
*music*
[Narration]
With hospitals already struggling under years of blockade and bombardment, this weaponization
of humanitarian aid only worsens the crisis. Medical facilities that once provided essential care
are now barely functioning and nearly two thirds of them have shut down completely. Only 39%
of hospitals in Gaza are still partially functioning.
[Shatha Elnakib]
Once they get to the facility, facilities tend to be overcrowded. They tend to also be understaffed
because healthcare workers are unable to get to the facility the same way that these women
can't get to the facilities because of, you know, the destroyed roads...And so the priority
becomes to dealing with these mass casualties, these trauma injuries. Just you know, so you
know, according to the latest estimates we have around 112,000 people who have reported
injuries according to the WHO’s most recent situation or SitRep. And as you can imagine, these
are people who have burns who have complex trauma injuries. These are not simple injuries.
Right, because, you know, because of the nature of the war, because of the relentless
bombardment, the use of weapons that are, you know, quite cruel, white phosphorus included.
And so these people's needs are often so acute that they will take precedence over other things
like routine pregnancy care, for example, or antenatal care. And so the needs of women,
particularly pregnant women, then become deprioritized.
[Narration]
For pregnant women, this means barely any prenatal care, leading to more premature births,
low birth weights, and higher risks of infant mortality. In overcrowded and makeshift maternity
wards, doctors are forced to work with minimal resources. There are shortages in some of the
most basic medical supplies like gloves, gauze, and disinfectants which leads to many births
taking place in unsanitary conditions risking infections for both the mother and the newborn.
[Shatha Elnakib]
There's, you know, scarcity in oxygen. And statements from health providers themselves have
indicated that certain surgical procedures, including C-section, which is a very serious surgical
procedure, are now being conducted without anesthesia or women are being cut open without
any anesthetic. And at times, without even electricity, you must have read in the news how
doctors were using their telephone flashlights because there was no electricity in hospitals and
they were conducting these very advanced surgical procedures in the absence of electricity.
*music*
[Narration]
But the crisis in Gaza’s hospitals doesn’t end after the mothers give birth. Even when babies
survive birth, they face yet another challenge: a lack of electricity. Gaza has been in an ongoing
electricity crisis since October of 2023. According to the World Health Organization, as of 2023,
130 premature infants in Gaza rely on incubators and 61% of those incubators need electricity
to function. Without reliable electricity, life-saving equipment like these incubators are shut down
and so according to the United Nations, during this past winter alone eight newborns have died
of hypothermia. Infant mortality rates are one of the biggest indicators of a population’s overall
health. They reflect not only access to medical care, but the stability of infrastructure, and
access to other essential resources. But in Gaza, where hospitals are barely functioning, these
numbers don’t just signal a health crisis, they represent lives lost to conditions that should be
preventable.
*music*
[Narration]
At first, it might seem like this is an issue happening far away, with no direct connection to the
people in the United States. But in reality, U.S. taxpayer dollars directly fund the Israeli
military–its weapons, its airstrikes, and the destruction of infrastructure including hospitals in
Gaza. According to the U.S. Department of State, through the U.S. Foreign Military Financing
program, Israel has received some of the most advanced military equipment in the world.
According to USA Spending, a website run by the U.S. Department of Treasury, this program is
funded by U.S. federal revenue which is primarily taxpayer dollars meaning American citizens
are directly financing the military operations in Gaza. The Department of State also reports that
since Israel’s founding in 1948, the United States has provided Israel with over $130 billion in
direct aid. This financial and military support makes the U.S. more than just a bystander.
[Shatha Elnakib]
I think international pressure is very important and we have just, we have seen big hegemons,
big countries in the West failing to exert international pressure, you know, not just turning a blind
eye to what's happening, but rather, you know, they're very much complicit materially. So they
give the money, they give the weapons.
[Narration]
While there has been a lot of material support for Israel, efforts to aid Gaza have also been
made, though they face more obstacles that make the aid delivery process more difficult.
Humanitarian convoys, organized by international agencies like the United Nations and the Red
Cross, have managed to deliver resources, such as food, medical supplies and other essential
supplies despite the blockades and ongoing airstrikes. Temporary ceasefires including the most
recent one have allowed for the aid from these convoys to reach Gaza safely. The United
Nations Relief and Works Agency has set up field hospitals to provide medical care on the Gaza
Strip. In addition, organizations like Doctors Without Borders and Oxfam have also played a key
role in providing emergency medical care and essential services to the people in Gaza by also
setting up field hospitals, supporting the few functioning hospitals remaining in Gaza, and
operating mobile clinics. But beyond these humanitarian efforts, local governments and
individual countries are also taking action to address the conflict. The Oxford City Council has
recently voted to divest from Israel in support of the Boycott, Divestment and Sanctions
movement against Israel. South Africa has also been vocal in its support for Gaza, even taking
legal steps against Israel by bringing a case to the International Court of Justice, accusing Israel
of committing acts of genocide in Gaza. While these actions are different in terms of approach,
they both reflect a growing global movement pushing for accountability and consequences.
[Shatha Elnakib]
Beyond rebuilding hospitals, we need to make sure we have long term strategies that ensure
that healthcare remains protected and accessible. And we're not just talking about, you know,
let's rebuild and reconstruct, but how do we prevent this from happening?
[Narration]
Despite the growing global movement for accountability and the humanitarian aid efforts, these
alone cannot truly address the devastation in Gaza. International organizations such as UNICEF
and the WHO must not only fund the rebuilding of hospitals and ensure people have access to
medical supplies, but they must also support the training of local healthcare workers and equip
them so that they can continue operating hospitals effectively in Gaza. Long-term unrestricted
aid is crucial for rebuilding Gaza’s healthcare system, but true recovery won’t happen until a
permanent ceasefire is reached. Many ceasefires in the past have been fragile. For example,
the most recent ceasefire which took effect on January 19th of this year, was violated when
Israel resumed its attacks on Gaza. According to Amnesty International, this was a “unilateral
resumption” of the war meaning the attacks were one sided, and they resulted in the deaths of
at least 414 Palestinans including 174 children. This was a clear violation of the ceasefire
agreement and this is only one example of many where Israel has failed to honor such
agreements. Achieving a permanent ceasefire requires more than just a temporary pause in
violence; it requires strong diplomatic efforts that address the root causes of the conflict. This
includes pressing the international community to hold Israel accountable by ensuring that they
honor the terms of a permanent ceasefire. A first step would be the lifting of the blockades on
Gaza. Lifting the blockades would let aid reach Gaza without any obstacles. But for any peace
agreement to hold, the international community also has to ensure accountability for war crimes
and violations of the international law. While these are important steps towards a permanent
ceasefire, they would only be the beginning of a very long process.
[Shatha Elnakib]
We need better humanitarian diplomacy. We need international pressure to prevent attacks on
medical facilities everywhere, not just in Gaza. I mean we've seen in Syria, we've seen in
Ukraine how health facilities, health infrastructure is very much targeted as part of war tactics,
right? It’s part of the strategy of war. And that needs to stop...And it's not just obviously about,
you know. Rules of war around healthcare, but also rules of war against, you know, not
weaponizing food, not weaponizing water, not weaponizing aid. These are basic fundamentals.
Like I said, that are part of a rules based order that we have been living under for the last how
many years, 60 years more. And so we need to make sure that the rules based order, you know,
is back. And it's not just an anarchy and a jungle.
*music*
[Narration]
Gaza’s healthcare crisis is not just a humanitarian issue but also a moral and ethical one.
Hospitals shouldn’t be battlegrounds or places for airstrikes. The lives of pregnant women and
newborns shouldn’t be collateral damage during a so-called “war.” None of us choose the place
of our birth, yet for many, the circumstances of where they're born dictate whether they will
survive past their first year of life. As we continue to witness this ongoing crisis, we must ask
ourselves: What steps are we, as the global community, willing to take to ensure a future where
every life, regardless of the place of birth, has the opportunity to live without the constant threat
of violence and destruction to their healthcare and basic human rights?
*music*
[Narration]
This podcast was produced by Sarah Zaraf for the Spring 2025 Global Health Course at
Guilford College.