Women, children, and newborns in Gaza are disproportionately bearing the burden of the escalation of hostilities in the occupied Palestinian territory, both as casualties and in reduced access to health services, warn the United Nations Children’s Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), the United Nations sexual and reproductive health agency (UNFPA), and the World Health Organization (WHO).

As of 3 November, according to Ministry of Health data, 2326 women and 3760 children have been killed in the Gaza strip, representing 67% of all casualties, while thousands more have been injured. This means that 420 children are killed or injured every day, some of them only a few months old.

The bombardments, damaged or non-functioning health facilities, massive levels of displacement, collapsing water and electricity supplies as well as restricted access to food and medicines, are severely disrupting maternal, newborn, and child health services. There are an estimated 50,000 pregnant women in Gaza, with more than 180 giving birth every day. Fifteen percent of them are likely to experience pregnancy or birth-related complications and need additional medical care.

These women are unable to access the emergency obstetric services they need to give birth safely and care for their newborns. With 14 hospitals and 45 primary healthcare centres closed, some women are having to give birth in shelters, in their homes, in the streets amid the rubble, or in overwhelmed healthcare facilities, where sanitation is worsening, and the risk of infection and medical complications is on the rise. Health facilities are also coming under fire – on 1 November Al Hilo Hospital, a crucial maternity hospital, was shelled.

Maternal deaths are expected to increase given the lack of access to adequate care. The psychological toll of the hostilities also has direct – and sometimes deadly – consequences on reproductive health, including a rise in stress-induced miscarriages, stillbirths, and premature births.

Prior to the escalation, malnutrition was already high among pregnant women, with impacts on childhood survival and development. As access to food and water worsens, mothers are struggling to feed and care for their families, increasing risks of malnutrition, disease, and death.

The lives of newborns also hang by a thread. If hospitals run out of fuel, the lives of an estimated 130 premature babies who rely on neonatal and intensive care services will be threatened, as incubators and other medical equipment will no longer function.

Over half of the population of Gaza is now sheltering in UNRWA facilities in dire conditions, with inadequate water and food supplies, which is causing hunger and malnutrition, dehydration, and the spread of waterborne diseases. According to initial assessments by UNRWA, 4600 displaced pregnant women and about 380 newborns living in these facilities require medical attention. Already more than 22 500 cases of acute respiratory infections have been reported along with 12,000 cases of diarrhoea, which are particularly concerning given the high rates of malnutrition.

Despite the lack of sustained and safe access, UN agencies have dispatched life-saving medicines and equipment to Gaza, including supplies for newborns and reproductive health care. But much more is needed to meet the immense needs of civilians, including pregnant women, children, and newborns. Humanitarian agencies urgently need sustained and safe access to bring more medicines, food, water, and fuel into Gaza. No fuel has come into the Gaza Strip since 7 October. Aid agencies must receive fuel immediately to be able to continue supporting hospitals, water plants, and bakeries.

An immediate humanitarian pause is needed to alleviate the suffering and prevent a desperate situation from becoming catastrophic.

All parties to the conflict must abide by their obligations under international humanitarian law to protect civilians and civilian infrastructure including health care. All civilians, including the hostages currently held in Gaza, have the right to health care. All hostages must be released without delay or conditions.

In particular, all parties must protect children from harm and afford them the special protection to which they are entitled under international humanitarian and human rights laws.