The consequences of war are often measured in the number of people killed, the scale of destruction, and the hospitals forced out of service. But in Gaza, another crisis is unfolding quietly – one whose consequences may extend for decades: a reproductive health crisis.
Beyond the immediate injuries of war, thousands are living through conditions that may affect their ability to conceive and build families. Yet this issue receives little attention compared with the other dimensions of Gaza’s humanitarian catastrophe.
Uncertain futures
For Palestinians, having children has long represented continuity, hope, and life. But war does not only kill people; it can also threaten the ability to bring the next generation into the world.
There is no single cause. Instead, multiple factors converge: prolonged psychological trauma, malnutrition, repeated displacement, the near-collapse of the healthcare system, and exposure to harsh environmental conditions. Together, these circumstances create an environment profoundly hostile to reproductive health.
Severe psychological stress alone does not cause infertility. However, prolonged and extreme stress can disrupt the hormonal pathways that regulate ovulation and the menstrual cycle. Studies from settings affected by famine and armed conflict have documented menstrual disturbances among women exposed to extreme conditions. In Gaza, these pressures are occurring simultaneously and on an unprecedented scale.
Clinical cases
In my own clinical work with women from Gaza, I have encountered cases that highlight the depth of this emerging concern.
One woman I followed was only 29 years old. She had not menstruated for six months. What began as an absence of her period eventually led to investigations that revealed severely diminished ovarian function, consistent with premature ovarian insufficiency. The findings were deeply distressing for her.
She had spent years imagining a future in which she would marry and build a family. Instead, at 29, before she had even begun that chapter of her life, she was confronted with the possibility that her reproductive potential may have been significantly compromised.
Her case cannot establish a direct causal link between stress and ovarian failure. However, it raises an urgent scientific question: how do prolonged exposure to fear, displacement, malnutrition, and extreme psychological stress affect reproductive function in young women?
Malnutrition
Malnutrition is another major concern. Pregnancy requires more than fertilization; it depends on a body capable of sustaining complex biological processes. Inadequate intake of calories, protein, and essential micronutrients can disrupt ovulation and reproductive function and may increase the risk of miscarriage and pregnancy complications.
Gaza was already facing food insecurity before the war. Today, many families are surviving on severely limited diets, making nutritional recovery extremely difficult.
The impact is not limited to women. Male reproductive health may also be affected, although it is often under-recognized. Chronic stress, malnutrition, illness, and environmental exposures may influence sperm quality and production. In Gaza, however, the long-term reproductive effects of these combined factors remain insufficiently studied.
Another woman I followed described a different aspect of this crisis. Her husband had previously been diagnosed with a low sperm count, and follow-up testing during the war showed further deterioration in sperm parameters. Their treatment became increasingly difficult as specialists in male reproductive health left Gaza, while medications and supplements became scarce or unaffordable.
For this couple, the challenge was no longer only medical. Even when a treatment plan existed, the system required to deliver it was steadily disappearing.
Gaza’s fertility centers
The crisis becomes even more visible among couples who depend on assisted reproductive technologies.
Before the war, Gaza had fertility centers offering treatments such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). For many couples, these services represented a vital source of hope. Today, however, most of these services have been severely disrupted due to damage to healthcare infrastructure.
I also followed the case of a 39-year-old woman who was approaching 40 and deeply concerned about preserving her chance of becoming a mother. She had previously undergone fertility treatment, and embryos had been stored at Al-Basma Medical Center in central Gaza. Those embryos were lost when the center was destroyed during the war.
Now, she has no embryos remaining.
At her age, time is particularly critical, as female fertility naturally declines, especially in the late thirties. Yet access to fertility services in Gaza is no longer reliable. She has been asking about restarting IVF and ICSI, but uncertainty surrounding the availability of services has left her in a prolonged state of distress.
Financial barriers to treatment
In some cases, patients are even asked to pay in advance simply to secure a place on a waiting list, with no guarantee that treatment will eventually be available.
For individuals already living through war, displacement, and loss, this adds another layer of psychological burden.
Fertility centers have been damaged or forced out of service. Laboratories have been disrupted, and essential medications and specialized supplies required for assisted reproduction are extremely difficult to obtain.
The specialized medical workforce has also been severely affected. Some doctors and specialists have been killed, while others have been displaced. Those who remain are unable to fully replace the expertise required to sustain complex reproductive programs.
As a result, Gaza has lost not only infrastructure, but also accumulated medical expertise in reproductive medicine.
Financial barriers further compound the crisis. Fertility treatment was already expensive before the war, and now, with widespread economic collapse and unemployment, it has become inaccessible for most families.
Even when treatment might be available elsewhere, movement restrictions make travel for medical care extremely difficult.
Time is running out
For many patients, fertility treatment cannot be postponed indefinitely. Female fertility declines with age, and certain conditions require timely intervention. Each passing month may reduce the likelihood of successful treatment.
The cost is not only physical or medical – it is deeply psychological.
Couples who have already lost homes, loved ones, and stability now face another fear: the possibility that their chance to have children may disappear with time.
Yet fertility is rarely prioritized in humanitarian responses.
While emergency care, trauma surgery, maternal health, and nutrition are essential priorities, reproductive health also includes preserving future fertility, providing counseling, and maintaining access to reproductive medicine whenever possible.
Ignoring this dimension does not eliminate its consequences. It only delays them—potentially affecting long-term mental health, family stability, and post-war recovery.
Reconstruction of reproductive health facilities is essential
Reconstruction efforts in Gaza must therefore include reproductive health as part of long-term planning. This includes documenting changes in fertility patterns, supporting reproductive health monitoring, and integrating fertility preservation and infertility care into future healthcare systems.
Wars leave wounds that are not always visible. Some are carried quietly within families waiting for a child who may never come, within a young woman confronting unexpected ovarian failure, within couples struggling with declining fertility in the absence of care, or within a woman who lost her embryos along with the clinic where they were stored.
These are not only medical stories. They are stories about time, hope, and the right to imagine a future.
The human cost of war should not be measured only in lives lost, but also in lives that may never have the chance to begin.
Featured image via UNICEF
By Haya Hijazi
From Canary via This RSS Feed.