The perils of giving birth in war-torn Gaza

LONDON and GAZA -- Amid the chaos, destruction and uncertainty of Israel's siege on the neighboring Gaza Strip, one group stands out among the most vulnerable -- mothers with their newborn babies. Aid agencies are growing increasingly concerned for their wellbeing.

"Women face elevated risks during pregnancy and post-delivery, placing their newborns in jeopardy due to the dire humanitarian situation and the absence or limited access to nutrition, hygiene and basic health services," Ammar M. Ammar, regional chief of advocacy and communication for the United Nations International Children's Emergency Fund, told ABC News.

"Pregnancy during conflict is linked to an increase in miscarriages, congenital abnormalities, stillbirths, preterm labor, maternal mortality and mental health," he added. "And the trauma of war can also directly affect newborns."

An estimated 180 mothers a day are giving birth in war-torn Gaza each day, according to UNICEF.

"These women are unable to access the emergency obstetric services they need to give birth safely and care for their newborns,” Ammar said. “Women are having to give birth in shelters, in their homes, in the streets amid rubble, or in overwhelmed health care facilities, where sanitation is worsening, and the risk of infection and medical complications is on the rise."

Fatima Suleiman, 35, from Gaza City, said she gave birth during the first month of the war.

"I became pregnant with my daughter after long attempts to have a baby," Suleiman told ABC News. "Every day, I dreamed of the moment of the birth of that baby girl. I felt happy."

The war broke out after Gaza’s militant rulers, Hamas, launched a surprise invasion into southern Israel on Oct. 7, which killed more than 1,200 people, according to the Israel Defense Forces, marking the deadliest one-day attack in Israeli history. Israel has since retaliated with a military campaign in Gaza, attacking the tiny coastal enclave by air, land and sea amid its determination to obliterate Hamas. More than 25,700 Palestinians have been killed and over 63,000 have been injured, according to Gaza’s Hamas-controlled Ministry of Health.

"When the war began, the feeling of anxiety increased,” Suleima said, “and I prayed daily that the war would end before the time of the birth."

"I was very afraid at that moment. How would I go to the hospital, and how would I survive the constant bombing?” she continued. “We went to Al-Shifa Hospital before it was stormed in mid-October and it was a very difficult night. We got there with difficulty. Very carefully, by cesarean section, I gave birth to my baby girl, Nabila."

After giving birth, the Israeli military began asking residents of Gaza City to move south, which Suleima said “was very difficult” because she had not yet recovered from the cesarean section and “could not walk long distances.” Once she was mobile, Suleiman and her family headed to the southern city of Khan Younis, where they took shelter in a bombed-out house belonging to her husband’s relative. Suleiman said she now only eats one meal a day and is forced to drink salty water due to a lack of resources in war-ravaged Gaza.

"This is the suffering of displacement and movement, and I am in a bad condition from childbirth," she told ABC News. "I have had a cesarean section and I am breastfeeding my daughter, and I need healthy food in order to provide milk in my breasts for breastfeeding. But unfortunately there is no food in the market, and we cannot buy much of it due to the high cost, which requires a lot of money."

"I felt that I could not breastfeed my child when I put the breast in her mouth. She screams and cries because there is no milk because she is not nourished," she added. "The child needs food for her health and immunity, otherwise she will contract many diseases. We are forced to buy formula milk from pharmacies in order to breastfeed the child. I do not want to lose her during this painful war."

Suleiman said she’s far less concerned about feeding herself than feeding her baby.

"I no longer care about eating, even if it is one meal," she said. "The most important thing is to save money to buy milk for my daughter so that she can get a little full."

UNICEF warned that Suleiman's situation is being repeated across Gaza.

"The deteriorating situation is raising concerns about acute malnutrition and mortality breaching famine thresholds," Ammar told ABC News. "UNICEF is particularly worried about the nutrition of the over 155,000 pregnant women and breastfeeding mothers, as well as more than 135,000 children under 2, given their specific nutrition needs and vulnerability."

Navin Al-Barbari, 33, from Gaza City, said she has been having a similarly traumatic experience of motherhood.

"I certainly had a great fear of giving birth because the nonstop bombing of Gaza City was so worrying and the large number of injuries and the Ministry of Health's appeals to save the health system made me feel that I would not find a hospital to receive me to give birth," Al-Barbari told ABC News.

"In mid-October, on a night when the bombing was intense, I went to Al-Shifa Hospital to give birth there," she continued. "I could not bear the mothers screaming for their martyred children. The hospital was very crowded with people. The number of displaced people there was large. I was very afraid of losing my baby, but I survived the birth."

Al-Barbari said she gave birth via cesarean section as she was in a state of anxiety and the doctors wanted to deliver the baby quickly. She said she returned home with her newborn but could not stay there for long as Israeli tanks were approaching her neighborhood of Al Zaytoun in Gaza City.

"We were thinking of moving to the south, but it was not easy because I gave birth by cesarean section and I could not bear long walks," she said. "We did not find food in Gaza, and my daughter was screaming day and night because she was hungry."

Al-Barbari eventually evacuated to Gaza’s southernmost city, Rafah, with most of her family.

"The crowding in the city of Rafah has made prices very high due to the lack of supplies and food," she said. "I do not eat, but my child needs to eat because she is very small, and I was forced to buy artificial milk for her.”

"I was afraid of war because I was pregnant with my child, but the fear doubled even more when she became alive,” she added. "I do not know how to protect her from this -- the bombing. And I don't know how we will be able to buy milk on an ongoing basis for her, as it is very expensive and we have no financial income."

Al-Barbari also expressed concerned about her own mental and physical health.

"I still feel the pains of childbirth, and I still feel great psychological fatigue and distress. This war did not give me the opportunity to be happy with my daughter," she said.

But Al-Barbari and Suleiman are among the lucky ones -- because their children are still alive. Pascale Coissard, emergency coordinator in Gaza for international medical charity Doctors Without Borders, shared the story of one mother who lost her baby.

"She went to a hospital when she felt labor was starting, but she couldn't be treated,” Coissard told ABC News. “All the delivery rooms were full. She knew something wasn't right, that she needed to be admitted -- she had had a C-section before. But with no other option, she had to go back to her tent."

"Her son died. She gave birth to him in the latrines closest to her tent," she added. "Without this war, she would not have lost her son."

ABC News' Dragana Jovanovic contributed to this report.