May 5, 2025 – Israel’s assault on Gaza has escalated further into catastrophe.

On 5 May 2025, Israeli Prime Minister Benjamin Netanyahu announced an “intensified” military offensive “Operation Gideon’s Chariots” that includes not only continued bombardments, but also the establishment of a permanent Israeli military presence in Gaza and the forcible displacement of the population.

Publicly described by Israeli officials as seeking to “conquer” Gaza, this planned mass displacement of civilians in tandem with sustained airstrikes and destruction of infrastructure further erodes the possibility of safety, autonomy, and survival for Palestinians.

Among the gravest consequences of this violence is the systematic targeting of reproductive autonomy—a dimension of the conflict that remains critically under-addressed. The assault on reproductive autonomy in Gaza is not incidental—it is systemic, strategic, and devastating. From the bombing of maternity hospitals and fertility clinics to the forced births in tents and surgeries without anaesthesia, the evidence is overwhelming: reproductive violence is being used as a weapon of domination and erasure. Yet, despite this reality, the International Criminal Court (ICC) has so far not included reproductive violence in its accountability efforts for Palestine.

This article argues that reproductive violence in Gaza must be recognized for what it is: a central pillar of the broader strategy to destroy the capacity for Palestinian survival. We call on the ICC Office of the Prosecutor (ICC-OTP) to explicitly and systematically charge all forms of reproductive violence, including as crimes of genocide.

The Systematic Collapse of Reproductive Health in Gaza

Israel’s military expansion comes on the heels of a series of calculated and devastating policies. Even before the cessation of a temporary ceasefire on 18 March 2025, Israeli authorities have systematically dismantled what remains of Gaza’s already fragile infrastructure. The blocking of all humanitarian aid on 2 March 2025,^[1] followed by the total shutdown of electricity on 9 March 2025 has critically impacted access to drinking water and health services, including reproductive healthcare.^[2]

These acts reflect a broader and well-documented pattern in the conduct of Israeli forces over the past 18 months, characterized not only by disregard for civilian harm but also the deliberate targeting of civilians and essential infrastructure. Palestinian activists and human rights organizations have documented this reality, including evidence of sexual and reproductive violence.

In Al Mezan’s January 2025 report, Reproductive Health under Genocide: The Struggle of Palestinian Women in Gaza, Palestinian women described being forced to give birth in tents, schools, or bombed-out buildings without medical assistance, surrounded by fear and displacement.^[3] Health services have collapsed under siege, with emergency surgeries including C-sections performed without anaesthesia and newborns dying for lack of incubators or proper medical care.^[4] The report also highlighted dangerously unsanitary conditions from contaminated water, waste accumulation, and sewage flooding^[5]—worsened by Israel’s recent attacks on one of Gaza’s few functioning desalination plants.

In a testimony provided to the Palestinian Centre for Human Rights, Warda Ward, who gave birth while fleeing from bombs and surviving only on chili peppers, recounted her experience^[6]:

“When the surgeon saw me, he told me I wouldn’t be giving birth naturally: it must be a C-section. I was in excruciating pain, like nothing I’d felt before, until they performed the surgery. […] When I came out of the surgery, I was conscious because they used local anaesthesia. All I wanted was to see my baby. I was so excited to meet him, having already bought him clothes, diapers and so many things. The next day, my brother from northern Gaza called me to offer condolences. I didn’t know—but that’s how I found out. They told me the baby had severe breathing difficulties and severe infections. They said it was from the peppers I ate, and the phosphorus I breathed.”

Al-Mezan’s report also documents the intentional destruction of hospitals, clinics, and pharmacies in the form of targeted sieges and attacks, leading to the near-total collapse of maternal healthcare and the erosion of reproductive autonomy.^[7] Most recently, on 13 April 2025, Israeli forces bombed al-Ahli Arab Hospital—the largest remaining operational hospital in northern Gaza, bringing the total number of hospitals targeted since October 2023 to 36.^[8] This pattern was also documented in the March 2025 report of the United Nations Independent International Commission of Inquiry on the Occupied Palestinian Territory (‘Commission of Inquiry’). The report examines gender-based violence perpetrated by the Israeli Occupation Forces and settlers across the Occupied Palestinian Territory, including how the deliberate destruction of healthcare facilities, denial of essential supplies, and environmental hazards contribute to pregnancy-related deaths and severe pregnancy complications^{[9] [10]}

“Giving birth in Gaza is like giving birth in the Middle Ages. There is no access to neonatal, prenatal or post-partum care. Basic equipment for childbirth, such as forceps, is not available, nor are crucial drugs such as hypertension medication to treat common and serious conditions such as preeclampsia. As a result, maternal morbidity, stillbirths, and miscarriages have increased.”

Reproductive Violence as Genocidal Violence

In its report, the Commission of Inquiry concluded that Israel’s actions related to reproductive violence amount to genocidal violence under international law.^[11]  Specifically, it identified two genocidal acts under the Rome Statute^[12]:

1. Imposing measures intended to prevent births within the group (Article 6 (d), and
2. Deliberately inflicting conditions of life calculated to bring about the group’s destruction (Article 6(c)).

These findings were based on evidence such as the destruction of the Basma IVF clinic, which eliminated over 5,000 embryos and reproductive specimens,^[13] and the systematic targeting of maternity hospitals and reproductive health facilities across Gaza.^[14] The Commission also found that Israel restricted essential humanitarian aid—including items for ^[15]pregnant and postpartum women—contributing to conditions of life that deprived civilians of care necessary for survival.^[16]

There is no shortage of similar findings.

The United Nations Special Rapporteur on Violence Against Women and Girls state[17]: “[T]he reproductive violence inflicted by Israel on Palestinian women, newborn babies, infants, and children could be qualified as… acts of genocide under Article 2 of the Convention on the Prevention of Genocide, including ‘imposing measures intended to prevent births within a group.’”

The ICJ has similarly recognized in its January 2024 Provisional Measures Order that there are indications that Israel’s actions—such as attacks on medical infrastructure and the deprivation of essential resources—may fall within the scope of Article II of the Convention as acts of genocide.^[18]

While these international findings have provided crucial leverage for accountability efforts, it must be noted that Palestinian civil society organizations have long identified these attacks as genocidal in nature. Indeed, the Palestinian Feminist Collective has termed this violence as reproductive genocide—a framework that captures the policies, practices, and discourses that restrict, target, or diminish the life-giving capacities, choices, and health of communities rendered vulnerable by systemic military violence.[19] Palestinian voices are essential to shaping how international justice understands and responds to these crimes, and must remain central to any accountability efforts.

Transgenerational Harm of Reproductive Violence

Reproductive violence does not end with physical acts. Scholars have documented how such trauma embeds psychological and social scars that affect subsequent generations.^[20] As noted in the Commission’s report, a Gaza health agency director warned^[21]:

“The measures imposed by Israel, coupled with repeated bombardment since October 2023, will have long-term effects on Gazan women’s fertility. We do not know the extent of these women’s trauma or the extent of the impact on their unborn babies, nor the long-term effect on the Palestinian people.”

Studies show that children in Gaza exposed to long-term occupation and war exhibit trauma from their parents’ experiences, including depression, behavioural disorders, and deep psychological distress.^[22]

Emerging trauma and epigenetics research suggests that extreme maternal stress, malnutrition, and violence exposure may alter gene expression in children—potentially affecting emotional regulation, immunity, and health outcomes.^[23] In Gaza’s context of cyclical violence and deprivation, these findings underscore that reproductive violence is not just an immediate harm but an intergenerational threat to the continuity and survival of the Palestinian people.

Considering this evidence, we urge the ICC-OTP to consider charges of genocide under Article 6 of the Rome Statute.

Filling in the Blanks: Missing Charges on Gender Based Crimes

In addition to reproductive violence as genocidal acts, the Rome Statute explicitly criminalizes forced pregnancy^[24] and enforced sterilization^[25] as both war crimes and crimes against humanity.

Yet, the ICC-OTP has not included gender-based crimes, including reproductive violence, in the 2024 arrest warrants for Israeli leaders Benjamin Netanyahu and Yoav Gallant. This omission is troubling, particularly given the Commission of Inquiry’s subsequent findings of Israel’s responsibility for these crimes under the Rome Statute.

This disparity underscores the ICC-OTP’s inconsistent application of its gender justice commitments, evident not only in the Situation in Palestine but also in the pursuit of gender persecution charges in the Afghanistan investigation, alongside the decision to drop appeals on gender-based crimes in the Al Hassan case. Such selective enforcement risks ennforcing hierarchies of victimhood and undermines the Court’s legitimacy.

These concerns are particularly pressing given the commitment made in the ICC-OTP 2023 Gender-Based Crimes Policy (GBC Policy)^.[26]  The GBC policy mandates the ICC-OTP to actively integrate gender-based crimes into case hypotheses, recognize ‘red flags’ that could indicate gender-based violence (e.g., torture, detention, displacement, hate speech), and pursue diverse sources of information.^[27] Crucially, the Policy calls for going beyond the “most obvious” gender-based crimes, using broader charges where appropriate, to capture the full scope of harm.^[28]

In our report Reproductive Violence in Gaza: A Gendered Atrocity Under International Law, we argue that even forms of reproductive violence not explicitly listed in the Rome Statute can be prosecuted through broader interpretations of statutory provisions, as affirmed by the GBC policy.

The Policy also emphasizes the need to reflect the underlying harms and protected values of crimes, including those shaped by non-Western experiences of stigma, deprivation, and gendered social impact.^[29] Additionally, the Policy commits the ICC-OTP to staying alert to opportunities to revisit charges before trial and to modify their legal characterisation for a full and accurate representation of criminal conduct.^[30]

For example, should the ICC-OTP pursue charges for attacks against protected buildings under Article 8(2)(b)(ix) of the Rome Statute, the reproductive and gendered impacts, such as the destruction of maternity hospitals or fertility clinics, should be clearly articulated, so that this crucial aspect of harm is not overlooked.

In addition to issuing new arrest warrants, existing charges should also be modified to reflect gendered harm. The war crime of starvation, for instance, has disproportionate impacts on pregnant and lactating women, infants, and newborns. In line with Paragraph 120 of the GBC Policy, the ICC-OTP should seek a modification of legal characterisation to reflect these specific gendered consequences.

In carrying out these responsibilities, the ICC-OTP can and should rely on Palestinian women’s rights defenders, human rights organizations, and medical professionals who are documenting these crimes and supporting survivors. Their knowledge and experience are indispensable to any intersectional, survivor-centered, and evidence-based investigation.

Reproductive Violence Must Be Charged Fully and Explicitly

As Israel expands military operations in Gaza, the ICC’s role in delivering justice for core international crimes is more urgent than ever. What is unfolding is not just intensified violence but a strategy aimed at dismantling futures, identities, and generational survival.

The ICC-OTP must explicitly and systematically address reproductive and other gender-based crimes in its Palestine investigation, recognizing violations by all parties, including Israeli forces. This is essential to ensure arrest warrants include charges of gender-based violence or reflect its gendered impacts.

Targeting reproductive health infrastructure and obstructing care undermines Palestinian survival itself. These patterns must be charged as acts of genocidal reproductive violence.

Justice that fails to confront gendered harm is partial.

Justice that ignores reproductive dimensions of atrocity is blind.

Justice that excludes the full Palestinian suffering is unjust.

We count on the ICC for a principled, gender-informed accountability that listens to survivors, engages with Palestinian expertise, and acts on the evidence. The integrity of international justice, and the lives of generations to come, depend on it.

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We would like to acknowledge and thank Prachiti Venkatraman and Julia Tétrault of Global Rights Compliance for their thoughtful comments and input in the development of this work. Their expertise meaningfully shaped and strengthened the analysis presented in this piece.

This article forms part of our series on Sexual and Reproductive Violence in Gaza.

For more information regarding reproductive violence, please visit our resource webpage on reproductive violence in international criminal law.

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Footnotes

^[1]Associated Press. “Israel cuts off all supplies to Gaza. Here’s what that means.” 2 March 2025. Accessed March 2025. https://apnews.com/article/gaza-israel-hamas-palestinians-aid-explainer-ecc0e70d5ff1120a04bf36626dfd96f4.

^[2] The Jordan Times. “Palestinian Authority Says Israel’s Gaza Electricity Cut an ‘Escalation of Genocide’.” 10 March 2025. Accessed March 2025. https://www.jordantimes.com/news/region/palestinian-authority-says-israels-gaza-electricity-cut-escalation-genocide.

^[3] Al Mezan Center for Human Rights. Reproductive Health Under Genocide: The Struggle of Palestinian Women in Gaza. p. 3-4. January 2025. Accessed April 2025. https://www.mezan.org/uploads/files/2025/1/1736679219Reproductive%20Health%20Under%20Genocide_%20The%20Struggle%20of%20Palestinian%20Women%20in%20Gaza.pdf.

^[4] Ibid, p. 2-4.

^[5] Ibid, p. 4.

^[6] Palestinian Centre for Human Rights. “Israeli occupation imposes measures to prevent birth in Gaza.” 5 February 2025. Accessed March 2025. https://www.youtube.com/watch?v=ocx74ppzDyE&t=7s.

^[7] Al Mezan Center for Human Rights. Reproductive Health Under Genocide: The Struggle of Palestinian Women in Gaza. p. 2.

^[8] Al Jazeera, “Israeli forces bomb Al -Ahli Hospital in Gaza, forcing patients to flee.” 13 April 2025. Accessed May 2025: https://www.aljazeera.com/news/2025/4/13/israeli-forces-bomb-al-ahli-hospital-in-gaza-forcing-patients-to-flee

^[9] Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel. “More than a human can bear”: Israel’s systematic use of sexual, reproductive and other forms of gender-based violence since 7 October 2023. A/HRC/58/CRP.6. para. 47-58.13 March 2025. Accessed March 2025. https://www.ohchr.org/sites/default/files/documents/hrbodies/hrcouncil/sessions-regular/session58/a-hrc-58-crp-6.pdf.

^[10] Ibid. p. 13.

^[11] Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel. “More than a human can bear.” Para. 175.

^[12] Ibid, para. 218.

^[13] Ibid, para. 175.

^[14] Ibid, para. 176.

^[15] OHCHR. Women Bear the Brunt of Israel-Gaza Conflict. 20 November 2023. Accessed January 2025. https://www.ohchr.org/en/press-releases/2023/11/women-bearing-brunt-israel-gaza-conflict-un-expert

^[16] Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel. “More than a human can bear.” para. 177.

[17] OHCHR. Women Bear the Brunt of Israel-Gaza Conflict. 20 November 2023. Accessed May 2025. https://www.ohchr.org/en/press-releases/2023/11/women-bearing-brunt-israel-gaza-conflict-un-expert

^[18] ICJ.. Application of the Convention on the Prevention and Punishment of the Crime of Genocide in the Gaza Strip (South Africa v. Israel), Order of 26 January 2024, para. 70. 26 January 2024. Accessed January 2025. https://www.icj-cij.org/sites/default/files/case-related/192/192-20240126-ord-01-00-en.pdf

[19] Palestinian Feminist Collective. The Palestinian Feminist Collective Condemns Reproductive Genocide in Gaza. Accessed January 2025. https://palestinianfeministcollective.org/the-pfc-condemns-reproductive-genocide-in-gaza/

^[20] See Jawaid, Ali, Martin Roszkowski, and Isabelle M. Mansuy. “Chapter Twelve – Transgenerational Epigenetics of Traumatic Stress.” Progress in Molecular Biology and Translational Science, Vol. 158. 2018. Accessed April 2025. https://doi.org/10.1016/bs.pmbts.2018.03.003.

^[21] Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel. “More than a human can bear.” p. 11.

^[22] See Palosaari, Esa, Raija-Leena Punamäki, Samir Qouta, and Marwan Diab. “Intergenerational Effects of War Trauma Among Palestinian Families Mediated via Psychological Maltreatment.” Child Abuse & Neglect 37, no. 11 (November 2013): 955–968. Accessed April 2025. https://www.sciencedirect.com/science/article/abs/pii/S0145213413001142.

^[23] See Quinn, Edward B., Chu J. Hsiao, Felicien M. Maisha, and Connie J. Mulligan. “Prenatal Maternal Stress Is Associated with Site-Specific and Age Acceleration Changes in Maternal and Newborn DNA Methylation.” Epigenetics, 2023. Accessed April 2025. https://doi.org/10.1080/15592294.2023.2222473;

McGill, Megan G., et al. “Maternal Prenatal Anxiety and the Fetal Origins of Epigenetic Aging.” Biological Psychiatry 91, no. 3 (2022): 303–312. Accessed April 2025. https://doi.org/10.1016/j.biopsych.2021.07.025; Mulligan, C.J., et al. “Epigenetic Signatures of Intergenerational Exposure to Violence in Three Generations of Syrian Refugees.” Scientific Reports 15 (2025): 5945. Accessed April 2025. https://doi.org/10.1038/s41598-025-89818-z.

^[24] Articles 7(1)(g), 8(2)(b)(xxii), 8(2)(e)(vi) Rome Statute.

^[25] Articles 7(1)(g), 8(2)(b)(xxii), 8(2)(e)(vi) Rome Statute.

^[26] International Criminal Court, Policy on Gender-Based Crimes, ICC-OTP, December 2023, paragraph 37, available at: https://www.icc-cpi.int/sites/default/files/2023-12/2023-policy-gender-en-web.pdf. Accessed April 2025.

^[27] Ibid, para. 107.

^[28] Ibid, para. 86.

^[29] Ibid, para. 87.

^[30] Ibid, para. 120.