Universally inadequate antenatal coverage and the paradox of facility-based delivery in conflict-affected Gaza: a cross-sectional study
This cross-sectional study of 95 women in conflict-affected Gaza reveals that despite high rates of facility-based delivery, access to essential antenatal care was universally inadequate, resulting in severe maternal complications, high neonatal mortality, and widespread malnutrition, thereby demonstrating that facility delivery alone no longer guarantees safe pregnancy outcomes in such extreme humanitarian crises.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the quiet corners of public health, there is a simple, enduring belief: if a mother gives birth inside a hospital, she and her baby are likely safe. For decades, health workers have used the location of a birth as a quick, reliable shortcut to measure how well a society cares for its families. This idea rests on the assumption that a hospital is not just a building with a bed, but a hub connected to a larger web of care. Before a baby arrives, a mother should have regular checkups, blood tests, and vaccines. Afterward, she and the newborn need immediate follow-up, medicine, and clean water. When these pieces work together, they form a safety net known as the continuum of care. But what happens when that web is torn apart? In places torn by war, where hospitals might still have walls and a roof but no electricity, no medicine, and no staff, the old rules no longer apply. Understanding how conflict breaks this chain of survival is vital, because without that knowledge, aid efforts might focus on the wrong things, leaving mothers and babies vulnerable even when they appear to be in a safe place.
A new study from the Gaza Strip, conducted during the intense and prolonged fighting between late 2023 and mid-2025, reveals a stark reality that challenges this old assumption. Researchers from Médecins du Monde France and the University of Rome worked directly in primary healthcare clinics across the five main regions of Gaza. They spoke with 95 women who had become pregnant and given birth during the war. These women were not a random group; they were the ones who had managed to reach a functioning clinic despite the chaos of displacement, roadblocks, and active hostilities. The team asked them detailed questions about their entire journey: Did they see a doctor before the baby was born? Did they get blood tests or ultrasounds? Did they have clean water? What happened to the baby in the first month of life? The goal was to see if the safety net still existed for those who could still reach it.
The findings paint a picture of a system that has completely collapsed. Every single woman in the study who could be fully evaluated had missed essential parts of the care she needed before her baby was born. None of them had received the full package of checkups, supplements, blood tests, scans, and vaccines that health experts consider the standard for a safe pregnancy. It was not just that some women missed a visit; the entire structure was gone. While nearly 87 percent of the women still managed to give birth inside a hospital, that fact no longer meant safety. Inside those hospitals, the support systems that usually make a birth safe were missing. Only about 62 percent of the mothers saw a health worker within 48 hours after giving birth, and fewer than 7 percent of the newborns had access to essential medicines in their first month. The hospital building remained, but the care that should happen inside and around it had vanished.
The consequences of this broken chain were severe and measurable. In the first 30 days of life, nearly 10 percent of the babies in this group died. This is a devastatingly high number for a group of women who had managed to reach a medical facility. Furthermore, more than two-thirds of the surviving newborns showed signs of moderate to severe malnutrition, a condition where the body does not get enough food to grow and stay healthy. The mothers themselves were not spared; more than 80 percent reported at least one serious complication during their pregnancy, such as severe anemia or bleeding. The environment outside the clinic walls played a direct role in this suffering. Almost all the women reported having little to no access to clean water during their pregnancy, and about half faced severe exposure to unhygienic conditions or the physical trauma of bombing. These were not just background details; they were the forces driving the illness and death the researchers observed.
The study forces a rethinking of how we measure safety in war zones. The researchers found that the old marker—giving birth in a hospital—is no longer enough to tell us if a mother and baby are safe. In a stable world, a hospital birth implies a full system of care. In Gaza, it has become a hollow sign. A woman could be inside a hospital building, yet still lack the clean water, the medicine, the follow-up visits, and the nutrition that keep a newborn alive. The study suggests that to truly help, aid organizations must stop looking only at whether a baby was born in a building. Instead, they must look at the entire journey, from the first checkup to the first month of life, and rebuild the missing links of that chain. The data shows that even for the women who could still reach a clinic, the path to a healthy baby was blocked at every turn, proving that in the face of total system collapse, the location of a birth tells us very little about the fate of the family.
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