Cesarean Sections Rise in Gaza Amid Infection Risks for New Mothers

Gaza City, Gaza Strip – On a mattress on the floor of a half-destroyed apartment, Duha Abu Yousef cradles her newborn with difficulty after an emergency cesarean section at a hospital the night before.

Abu Yousef, 24, was in her ninth month of pregnancy and hoped for a natural birth for her first child. However, due to severe anemia, doctors decided on a C-section to protect the baby.

Throughout her pregnancy, she endured physical and emotional pain because of Israel's genocidal war on Gaza. Most impactful was the famine and prolonged food shortage, which severely weakened her body.

“All through my pregnancy, I didn't eat meat, chicken, or eggs… only in the last three months things got slightly better,” Abu Yousef, who is displaced, told Al Jazeera from her shelter. “Even dietary supplements were unavailable. I constantly couldn't move, had headaches, and felt nauseous due to lack of food.”

Famine also caused her to be anemic throughout the pregnancy. “Any pregnant woman is usually anemic, but food helps improve it. In Gaza, there is famine, a lack of iron, and everything else.”

Added to that was the psychological trauma from the death of her brother and his wife from Israeli tank shelling. “I cried nonstop, completely lost and deeply grieving.”

The Rise in Cesarean Sections

April is Cesarean Awareness Month, established to raise awareness about the procedure and support mothers. In Gaza, the dangers accompanying C-sections are amplified by the collapse of the healthcare system.

Dr. Fathi al-Dahdouh, head of obstetrics at Al Helou International Hospital in Gaza City, said the number of cesarean sections has increased by about 2% compared to before the war, now accounting for a quarter of all births.

Al-Dahdouh explained that wartime movement difficulties cause many pregnant women to arrive at hospitals late, reducing the chance of natural birth and increasing emergency C-sections. He also noted a trend of pregnancy as a form of “compensation for loss,” especially among women who lost children or relatives. “We see women in their late 30s, even over 40, deciding to get pregnant despite risks because they lost a child in the war.”

Dr. Ruba al-Madhoun, an obstetrician-gynecologist at the International Medical Corps field hospital in Gaza, said many pregnant women arrive in critical condition with injuries from bombings. They may have placental abruption, directly threatening mother and fetus, requiring immediate surgery. She added that shortages of equipment and medical supplies, including continuous fetal monitors and induction drugs, have increased reliance on C-sections. Heavy pressure on hospital wards and staff shortages also make C-sections sometimes the fastest and safest option.

Infection Risks

The danger from C-sections in Gaza often comes after surgery, especially the risk of infection. Displacement due to Israel's destruction of homes, malnutrition, and deficiencies in essential nutrients like protein and iron directly affect wound healing, while overcrowded tents and contaminated water significantly increase infection risks.

“This is compounded by severe overcrowding in hospital areas, where many patients often share a room,” al-Madhoun said. She added that the number of surgical site infections is rising while hospitals lack appropriate antibiotics and the capacity for lab tests to identify bacteria.

Sanaa al-Shukri, 35, returned to the hospital 10 days after giving birth due to a recurrent infection in her C-section wound. From her hospital bed, she described intense pain when doctors reopened the wound without anesthesia and cleaned accumulated pus. “I felt like my soul left my body.” Doctors attributed the infection to a lack of a suitable wound-healing environment, despite her efforts to care for it.

Al-Shukri lives in a tent in Gaza City's Tuffah neighborhood, where she faces major postpartum challenges. “The bathroom was terrible and not clean… It's a hole in the sand, full of flies and insects, far away. There are no walls in the tent to lean on, no bed… I sleep on the ground. I tried to clean the wound and change the bandage, but it got infected. The tent is very hot nearby, and the doctor said the water is not clean.”

Her husband, Mohammed, 50, lost his entire family—his wife and seven children—in a bombing of their home in Jabalia at the start of the war. He tried to rebuild his life with Sanaa. The couple named their newborn son Ahmed, after Mohammed's eldest son.

Despite the joy of childbirth, recovering in a tent has become a daily battle against harsh environmental conditions. “I started saying that giving birth in these tents was a mistake… Heat, mosquitoes, flies, rats, dogs… everything is here. All night I hear rats on the canvas. I can't move. I wake up and wake my mother because I worry about the baby. I will never give birth in a tent again… It is suffering.”