Shima Younes, 35, reluctantly takes the pills that will delay her menstruation.
The woman, already a mother of four, lives in a tent in Rafah, at the southern end of the Gaza Strip, and feels she has no other option, due to the lack of running water, hygiene products and the slightest privacy.
“I have a hard time taking these pills, but it is the only solution, although they give me back pain and cause me very great episodes of sadness,” she explains.
Since October, the simplest gestures of daily care, such as going to the bathroom and washing with a minimum of privacy, especially during menstruation, become a true feat for the Gazans displaced in the immense improvised camps in the south of this territory, where tens of thousands of people are miserably crowded.
These women must in many cases opt for alternative and sometimes risky solutions for their health, such as taking these medications.
“The shortage of pads and tampons aggravates this situation and many women turn to norethisterone pills, as is the case with Shima,” explains Walid Abu Hatab, a medical consultant in Gaza specializing in obstetrics and gynecology.
This medication is a hormonal treatment that helps raise progesterone levels to delay menstruation.
But it is a double-edged sword: it offers temporary relief in this emergency situation, but can cause several adverse side effects, such as irregular vaginal bleeding, nausea, dizziness, and mood disturbances.
“They are additional risks to the health of those who already endure the incessant bombings,” adds the expert.
According to UN figures, 1.7 million Gazans, out of a population of 2.2 million, have been displaced since October 7, when the Islamist movement Hamas carried out bloody attacks in Israel, which, according to official sources, resulted in the death of 1,200 people and the kidnapping of more than 200. The Israeli military response, which continues to this day, has caused the death of at least 30,000 Palestinians and has injured some 70,000 people, according to figures from the Gaza Ministry of Health, controlled by Hamas.
The shortage of accessible toilets, washing facilities and laundry services profoundly affects women's mental balance.
Nivín Adnan, Palestinian psychologist
“We know that births are being performed, including by cesarean section, without anesthesia.
There is a near-total collapse of the education system and a serious risk that girls still alive will miss the entire school year, with associated increased risks such as child marriage, family separation or human trafficking.
There are also reports of gender violence, including sexual abuse and threats of rape against detained women by Israeli forces, both in Gaza and the West Bank," Dorothy Estrada Tanck, president of the UN Working Group on discrimination against women and girls.
The flutter of life
“The cost of the conflict on women's well-being has a thousand faces,” corroborates Nivín Adnan, a psychologist and social worker from Gaza, also displaced, detailing that the physical discomfort and psychological alterations that accompany menses are exacerbated in this context of death, fear, misery and displacement.
“The shortage of accessible toilets, washing facilities and laundry services deeply affects women's mental balance.
Added to this is that the shelters are meager and there are no amenities or the slightest privacy in them,” she details.
The expert also warns that for “girls who experience their first menstruation in such circumstances, resorting to medications that delay the period entails enormous health risks.”
Displaced Gaza women cook at a UN school in the south of the Strip, on February 24, 2024.MOHAMMED SABER (EFE)
And for mothers-to-be, the journey to motherhood is fraught with danger.
In makeshift and overcrowded shelters, in ruined schools and in semi-destroyed houses, these women fight to defend the life they carry inside in the midst of chaos.
Some don't make it.
“I no longer feel the flutter of life within me.
My unborn son, already stripped of his innocence and condemned to ruins,” sobs Aya Ahmad, who believes she has lost the baby she was expecting, but has not yet been able to confirm it, because she does not have access to a hospital or an ultrasound.
Marina Pomares, coordinator of the Doctors Without Borders (MSF) project in Gaza, has just returned from a month-long mission in the Strip, and confirms to this newspaper that there are many women who have not been able to attend pregnancy check-ups and They don't know how their baby is.
The head of MSF also explains that there are “complications in pregnancies, abortions and births in shelters and tents” because Gazans cannot access the few hospitals that still function or are afraid to go and not be able to receive care. what do you need.
“And once they have their baby, they must live with him in a tent, in precarious conditions.
They fear that breastfeeding will not work, due to stress, and that they will not find formula milk, or that he will get sick and they will not be able to take him to see a doctor,” she summarizes.
This is the case of Noor Zakari, 24, who gave birth to her second baby while living in a camp for displaced people in Rafah.
“I am surrounded by many displaced people.
It is unbearable to be in a tent during the harsh winter and I am worried about my baby's health as she is too cold at night and there are not enough clothes or blankets,” she explains.
Survive no matter what
“Women need pads, for example, and we can't even find them in stores.
They also do not have a decent and safe place to shower or a proper latrine in which to relieve themselves.
Going to the bathroom is a feat, because either they are practically in the middle of the street, or they have to move away and then they have to be accompanied,” says Pomares.
These women's fears are completely justified.
They are women who don't eat, don't sleep, who have other children to take care of.
They are exhausted, but their priority is to survive no matter what.
Marina Pomares, MSF
The MSF coordinator also explains that there are women who are suffering severe vaginal and urinary infections due to lack of hygiene and the inability to change their clothes.
“They have never had them in their lives, they come to see us because they feel bad and they don't know what is happening to them,” she details.
The UN, in its periodic report on the situation in Gaza dated February 23, warned of the urgency of providing more hygiene materials for women in the Strip.
So far, around 9,000 menstrual hygiene kits and around 3,500
dignity kits
have been distributed , which include soap, sanitary pads and underwear, a ridiculous figure compared to the needs.
The UN also reports that information on how to protect yourself and report sexual assault is being distributed and that efforts are being made to create safe places for women and girls.
“These women's fears are completely justified.
They are women who don't eat, don't sleep, who have other children to take care of.
They are exhausted, but their priority is to survive no matter what,” says Pomares.
“It is clear that if a mother has to take her child to a neonatal ICU due to a problem, there is a chance that she will die because in a space for 12 there are 60 babies.
“We are working on instilling some confidence and security in them, but the support we can give women in these circumstances is very limited,” she adds.
Asmaa Sendawi is nine months pregnant and also lives in a tent in Rafah with her husband.
This 27-year-old first-time mother does not hide her anguish.
“The truth is that I don't know how I'm going to give birth.
I'm ready, but there's nothing for this newborn.
My daughter could die, she sure will die,” she sobs.
At the moment, the only maternity hospital in Gaza is the Emirati hospital in Rafah, where MSF operates.
There are 26 beds in this maternity hospital, but all of them are permanently full and 80 births are attended to each day, in addition to those registered in other partially functioning medical centers or clinics or in shelters.
According to Unicef data, from October to the end of January, some 20,000 babies had been born in Gaza.
Gazan journalist Eman Alhaj Ali poses with her brother, Yusef, in Rafah, next to the displaced persons camp where they had to take refuge in January 2024.Courted by Eman Alhaj Ali
My name is Eman
My name is Eman, I am a journalist and I am 22 years old. I am the author of this report and I suffer the same difficulties as some of its protagonists. I live with my parents and seven siblings in a tent in Rafah. We arrived a month ago, but it seems like years. I have lost track of time. I miss my past life, my independent and warm bedroom. All that is very far away. We don't have mattresses for everyone and I have been sleeping on the floor for many days. My whole body hurts, I don't rest and I'm constantly cold, especially at night, when I spend hours shivering.
The arrival of the tanker is a respite in the midst of this despair, but the water it contains, often contaminated and dirty, reminds us of our extreme situation. My father leaves the house every day to look for food, but, despite his valiant efforts, we eat the same thing every day: some preserves, peas and, in the best case, a little cheese. As the days go by, the tent seems smaller and makes me feel claustrophobic. The rain, at times heavy, has threatened to bring it down on several occasions. We have all been sick and had trouble breathing due to these living conditions.
These days I hear talk of a long truce, before the arrival of the holy month of Ramadan. I don't have confidence. In a normal period, we would already be shopping, preparing food and the house for this date so dear to us. But this Ramadan will undoubtedly be terrible for Gaza.
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