What should have been a time of great joy and excitement has become a living nightmare for thousands of new and expectant mothers living under siege and constant Israeli bombardment in the Gaza Strip.

For Layla, 28, whose name has been changed for her safety, bringing a new life into the world at a time of so much death and destruction fills her with dread. “What worries me most is falling in love with life, amid all the death, once I hold my baby,” she told Arab News.

Like 5,500 other pregnant women in the Gaza Strip, Layla is due to give birth very soon amid a conflict between Israel and Palestinian militant group Hamas that has devastated healthcare infrastructure and deprived the population of access to nutritious food, clean water and public sanitation.

The closure of hospitals and clinics under the intense bombardment and chronic shortages of electricity, fuel and medicine are among the biggest challenges faced by the roughly 50,000 pregnant women in Gaza.

As of Nov. 10, some 18 hospitals and 51 primary care centers across the embattled enclave are no longer operational, meaning fewer than 60 percent of hospitals and 30 percent of public health centers are operating to some degree.

Fikr Shalltoot, Gaza director for Medical Aid for Palestinians, or MAP, a British charity operating in the Palestinian enclave, said that pregnant women in Gaza “face a dire reality, with limited access to essential health services amid a near-total humanitarian disaster.”

“With over 180 births daily and a staggering 235 attacks on healthcare infrastructure since Oct. 7, the situation is critical,” Shalltoot told Arab News. This leaves women deprived of emergency obstetric services and forces many to give birth in unsafe conditions.

“Closed hospitals force births in shelters, homes and streets amid rubble, raising infection risks,” she said. “Maternity hospitals, like Al-Hilo, face attacks.”

Hospitals in Gaza have been on the frontline of the conflict, overwhelmed by wounded civilians since the start of Israel’s military campaign, which came in retaliation for the Hamas attacks of Oct. 7, which killed 1,200 and saw more than 200 people, both Israelis and foreigners, taken hostage.

Some 135 health facilities across Gaza have been damaged or destroyed. Although these facilities are protected under international humanitarian law, Israel claims Hamas has been using hospitals, particularly Gaza’s largest, Al-Shifa, to host underground command centers.

Hamas and medical staff deny these facilities are being used to store weaponry, conceal hostages, or move fighters along a sophisticated network of tunnels. Israeli forces who took control of Al-Shifa on Wednesday are yet to provide evidence to support their claim.

There are at least 650 patients, including 22 in intensive care and 36 premature babies, at Al-Shifa, according to local media, in addition to some 400 medical staff. More than 2,000 Gazans have also taken refuge within the facility.

Amid the destruction and shortages, made worse by Israel’s restrictions on the entry of humanitarian aid into Gaza via the Rafah border crossing with Egypt, physicians have been forced to take extreme measures, such as performing cesareans without anesthetic or pain relief.

“Some women face complications while giving birth, and to stop the problem and because there are no (capabilities), tools, (or) time, (physicians) are faced with the extreme option to take out the uterus,” Soraida Hussein-Sabbah, gender and advocacy specialist at ActionAid Spain, told Arab News.

At Al-Awda Hospital, the only provider of maternity services in northern Gaza, doctors performed 16 cesarean C-sections last weekend under extremely challenging circumstances, according to local media.

Hussein-Sabbah said that although there are many trained and specialized obstetrics physicians and nurses in the Gaza Strip, as well as private and public maternity hospitals, “these cannot operate normally right now.”