Pregnant Women in Gaza Are Undergoing C-Sections Without Anesthesia as Humanitarian Crisis Worsens

In southern Gaza, a woman named Raneem Hejazi was 32 weeks pregnant when she was nearly killed by an Israeli airstrike on October 25, NPR reported last week. Shortly after being rescued from under the rubble, doctors at Nasser Hospital performed an emergency C-section guided by cell phone flashlights in order to save her unborn child. Dr. Mohammad Qandeel, who performed the procedure, didn’t have clean water to wash his hands nor antibiotics to prevent infections. The baby was safely delivered and named after a family member who had been killed by a recent Israeli airstrike.

Hejazi, whose arm was crushed—and later amputated—and whose legs were broken by the attack, was just one of two emergency C-sections that Nasser Hospital performed on that day alone. At a different hospital in Gaza, another baby was delivered at 32 weeks via C-section from a dying pregnant woman who had been hit by an Israeli airstrike. The baby, the Gaza director of Medical Aid for Palestinians (MAP) told Jezebel last week, is the last surviving member of his entire family.

According to the international humanitarian organization CARE, these emergency C-sections are increasingly being performed without anesthetics amid the collapse of the Gazan health system, under both bombardment and an ongoing blockade preventing medical supplies, food, water, and fuel from entering. CARE International shared with Jezebel on Wednesday that the organization “now has confirmation” from medical personnel across Gaza that more and more pregnant Gazan women are undergoing C-sections sans anesthetic.

“If at some point during the day or days the hospital has run out of anesthetic, then surgeries will take place without, until doctors manage to get another supply—if they do,” Hiba Tibi, CARE’s West Bank and Gaza director, told Jezebel. Because it’s “not only C-sections,” all surgeries are increasingly “taking place without anesthetic,” which is offered “on a first arrived first served basis,” Tibi explained. And after someone gives birth, if they “don’t require critical care,” they’re “discharged as soon as possible, usually within one day.” Then, once discharged, “they won’t be going back home but back to the overcrowded and unsanitary shelter.”

CARE couldn’t speak to how many C-sections have been performed without anesthetics—only that anesthetic is in critically low supply and more emergency C-sections are happening to try and save babies as pregnant women are struck by Israeli bombardment. Ammal Awadallah, executive director of the Palestinian Family Planning and Protection Association (PFPPA), told Jezebel that her organization is looking into the issue of C-sections without anesthesia, but it’s “become extremely difficult to hear from our staff in Gaza, particularly in these past few days,” since, as of last Friday, Israel’s cut off telecommunications and internet services across Gaza at varying points. PFPPA’s health center in Gaza was destroyed by Israeli bombardment on Oct. 8.

“Still, we are aware that with the prevention of medical supplies and drugs entering Gaza, the availability of anesthesia is depleting,” Awadallah said. “The health workers in Gaza are now forced to make decisions of which procedures are prioritized for the utilization of the limited quantity of anesthesia they have left—be it a C-section or not.”

Speaking to Al Jazeera on Wednesday, Laila Baker, regional director of Arab states at the United Nations Population Fund (UNFPA), also confirmed that C-sections are taking place not just in the dark but without anesthesia and in “overcrowded, unhygienic” health facilities. She added that after these procedures, “Women have to walk home, including downstairs, and also face unsafe conditions as they return to the overcrowded shelters.”

Since a Hamas attack on Israel killed 1,300 on Oct. 7, Israel has waged war on Gaza, killing at least 9,061 Gazans including 3,760 children as of Oct. 31. Over the last couple of weeks, hospitals across Gaza have reported running out of crucial supplies as Israel maintains its blockade. On Wednesday, the World Health Organization reported that Gaza’s only cancer treatment hospital was forced to shut down upon running out of fuel. Doctors Without Borders warned of “alarming” infection rates in the region as wounds are routinely getting disinfected with vinegar. The United Nations also reported Wednesday that more than a third of Gaza’s hospitals and about two-thirds of its primary healthcare centers have shut down. Biden announced this week that “the largest delivery of life-saving humanitarian assistance so far” has been delivered to Gaza. But this comes after three weeks of a blockade that’s been fatally starving the region of basic needs. Previous aid deliveries have been likened by the WHO to “a drop in the ocean of need.”

In addition to the severe pain of undergoing C-sections without anesthesia, Awadallah notes that without water and medical supplies, pregnant and birthing Gazans could see “an increase in infection rates,” further threatening their safety and lives. This comes as humanitarian and medical groups have been raising alarms that there are no safe places to give birth under bombardment, and pregnant Gazans are reportedly experiencing miscarriage and premature labor as a result of shock and extreme stress. If pregnancies are carried to term and babies are delivered, the conditions remain grave: Hospitals and humanitarian groups warn that preterm babies who can’t survive without ventilators face the risk of imminent death as hospitals run out of fuel.

“I can only imagine how afraid these women are, for themselves and their babies,” Tibi said. “All while suffering in unbearable pain.”