Aya could not find formula milk for her malnourished newborn.^[1] Battling infections and exhaustion, she travelled daily to overcrowded and under-resourced clinics that could not provide necessary treatment for her baby.^[2] Sujoud, discharged mere days after a C-section, recovered in a shelter without a bed or medical care, where her jaundiced newborn must sleep on cold floors, exposed to more disease.^[3] Tagreed carried her infant home through rubble, without diapers, milk, or warm clothing.^[4]

These testimonies are not an anomaly. They paint a stark picture of the intersecting layers of reproductive violence inflicted upon Palestinian women in Gaza. The deliberate targeting of healthcare infrastructure, systemic deprivation of resources, and conditions forcing women to give birth in unsafe environments create an inescapable cycle of trauma.

Such acts, compounded by the broader context of Israel’s blockade and military aggression, constitute reproductive violence and potentially genocide under international law. The International Criminal Court (ICC), with its mandate and ongoing investigation into Palestine, has the unique opportunity to address these crimes and implement a creative prosecutorial strategy through the implementation of its policies surrounding gendered and reproductive crimes.

Widespread Attacks on Healthcare Infrastructure

The destruction of Gaza’s healthcare system has been catastrophic. As of December 2024, nearly 600 attacks on healthcare facilities were recorded, including the targeting of a Medecins sans Frontieres (MSF) convoy in late November 2023.^[5] These attacks have decimated Gaza’s already fragile healthcare system, including its maternity services. As of January 2025, emergency obstetric and newborn care is only available at seven out of 18 partially functional hospitals across Gaza, four out of 11 field hospitals, and a community health centre.^[6] These resources are grossly insufficient for the estimated 50,000 pregnant women in Gaza, including 5,500 who are due to give birth imminently.^[7] In addition, the destruction of Gaza’s largest IVF center in December, including 5,000 embryos, signals a calculated attack on Palestinian reproductive autonomy.^[8]

The temporary ceasefire announced on January 15, 2025 between Israel and Hamas has offered a brief respite, allowing some displaced families to return home^[9] and facilitating the entry of some humanitarian aid, including medical supplies and food.^[10] Yet, for women like Aya, whose infants require sustained medical attention, the damage inflicted over the preceding months cannot be undone in days, especially when hospitals remain critically under-resourced.  Medical professionals warn that the ceasefire alone cannot reverse the collapse of Gaza’s maternal and neonatal healthcare system.^[11] While some emergency assistance has trickled in, the broader humanitarian infrastructure remains in ruins, leaving thousands of women and newborns without reliable access to care.

The Impact on Maternal and Neonatal Health

The consequences of Israel’s relentless attacks have been devastating for women and newborns in Gaza. UN experts reported a staggering 300% increase in miscarriage rates as of May 2024, driven by stress, malnutrition, and the destruction of healthcare infrastructure.^[18] Women are forced to give birth in overcrowded shelters, lacking medical assistance, hygiene, and privacy.^[19] Emergency surgeries, including C-sections, are often performed without anaesthetics due to shortages, and doctors have reportedly needed to use mobile phone flashlights during surgeries due to lack of electricity.^[20] Premature births have risen sharply, largely due to the lack of access to prenatal care and the extreme physical and psychological toll of the ongoing blockade and conflict.^[21]

“Women are forced to give birth in overcrowded shelters, lacking medical assistance, hygiene, and privacy.”

These dire conditions persist after childbirth. Similar to Sujoud, many women are discharged mere hours after delivery due to lack of resources, leading to life-threatening complications.^[22] Reports also indicate a rise in hysterectomies performed to manage uncontrolled postpartum bleeding.^[23] The neonatal mortality rate is also at an all-time high, with newborns dying at alarming rates due to the lack of electricity and fuel for incubators.^[24] Additionally, food poverty has reached crisis levels, with 95% of pregnant and breastfeeding women facing severe malnutrition^[25]. This crisis not only compromises their ability to breastfeed but also prevents them from recovering adequately after childbirth, perpetuating a devastating cycle of poor maternal and child health.^[26]

Systemic Deprivation: Reproductive Health under the Blockade

The blockade on Gaza exacerbates the crisis by depriving women of essential resources. Limited access to clean water, hygiene products, and medical supplies has led to infections, malnutrition, and deteriorating reproductive health. Women are often forced to makeshift materials for menstrual hygiene,^[27] while some have resorted to taking norethisterone tablets—commonly prescribed for menstrual disorders—in desperate attempts to suppress their menstrual cycles.^[28]

Additionally, the extreme stress and food deprivation have disrupted menstrual cycles for many women.^[29] The lack of access to clean water and safe sanitation facilities has increased the risk of severe infections, including hepatitis B and thrush, further compounding the already dire health situation. These challenges are particularly severe for adolescent girls, elderly women, and women with disabilities, who encounter heightened obstacles in accessing inclusive and disability-accommodating services.^[30] Given that women and girls make up 45% of Gaza’s population with disabilities,^[31] the absence of accessible shelters, clean water, and proper sanitation facilities significantly intensifies their hardship and exposes them to greater risks.

Deliberate Targeting of Reproductive Autonomy

Israel’s attacks can be considered reproductive violence, a phenomenon affecting or aimed at the victim’s reproductive system, and is a distinct manifestation of gender-based violence.^[32] While it may overlap with forms of sexual violence, this distinction is necessary to capture broader experiences and address specific harms.^[33] Simply put, sexual violence violates the right to choose whether and how to engage in sexual activity, while reproductive violence violates the right to decide whether, how and under what circumstances to reproduce.^[34]

“Reproductive violence violates the right to decide whether, how, and under what circumstances to reproduce.”

These actions must not be dismissed as mere collateral consequences of conflict but rather understood as deliberate measures targeting the Palestinian population in Gaza. The United Nations Special Rapporteur on Violence Against Women and Girls highlighted the gendered nature of these atrocities, stating^[35]: “While these atrocities affect both women and men, their impact is gendered and disproportionately affects women. [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.’”

This view is echoed by South Africa in its application to the International Court of Justice (ICJ), where it accused Israel of breaching the Genocide Convention by implementing measures intended to prevent births within the Palestinian group.^[36] The ICJ has subsequently 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.^[37]

The Palestinian Feminist Collective has termed these actions as reproductive genocide, describing them as policies, practices, and discourses that restrict, target, or diminish the life-giving capacities, choices, and health of communities rendered vulnerable by systemic military violence.^[38] Reproductive genocide not only affects short-term health outcomes but also has long-term repercussions on the life chances and reproductive autonomy of Palestinian women and their communities.

Expanding Justice Under the Rome Statute: The Case for Creative Prosecution

The ICC’s ongoing investigation into the situation in Palestine presents a critical opportunity to comprehensively address reproductive crimes. The Office of the Prosecutor (OTP) has explicitly recognized reproductive violence in its 2023 Policy on Gender Based Crimes, affirming its commitment to prosecuting such acts under the Rome Statute.^[39] The Rome Statute explicitly criminalizes three forms of reproductive violence: forced pregnancy as a crime against humanity and a war crime (Articles 7(1)(g), 8(2)(b)(xxii), 8(2)(e)(vi)); enforced sterilization as both (Articles 7(1)(g), 8(2)(b)(xxii), 8(2)(e)(vi)); and genocide by preventing births within a national, ethnic, racial, or religious group (Article 6(d)).^[40] However, the policy also indicated that other acts—such as forced contraception, forced abortion, forced breastfeeding, denial of essential reproductive healthcare, or physical violence targeting reproductive organs—though not explicitly named, may still be prosecuted under different provisions.^[41]

Indeed, the Rome Statute provides multiple avenues to address these forms of reproductive violence. Attacks on medical infrastructure essential for reproductive care may fall under Article 8(2)(b)(ix) as war crime, while the denial of medical assistance may constitute a grave breach of international law under Article 8(2)(a)(iii). Acts of torture and inhumane treatment, including forced conditions leading to hysterectomies, may violate Articles 7(1)(f) and 8(2)(a)(ii). Additionally, systematic deprivation of basic needs may amount to collective punishment (Article 8(2)(b)(xxv)), while imposing conditions designed to destroy populations may constitute extermination (Article 7(1)(b)).

“These advancements highlight the possibility for a creative, intersectional approach to prosecution that fully addresses the gendered dimensions of war crimes and crimes against humanity.”

Given the OTP’s commitment to interpreting statutory provisions broadly to ensure accountability for reproductive and gender-based violations,^[42] its application in Gaza must include an examination of the deliberate denial of essential supplies—food, water, and medical resources—and how it has exacerbated the reproductive health crisis. The war crime of starvation has already been included in existing ICC arrest warrants against Benjamin Netanyahu and Yoav Gallant,^[43] what remains is to analyze its reproductive implications. These advancements highlight the possibility for a creative, intersectional approach to prosecution that fully addresses the gendered dimensions of war crimes and crimes against humanity.

Conclusion: A Call to Action Beyond the Ceasefire

The temporary ceasefire between Israel and Hamas offers only a fleeting pause in the immense suffering endured by the people of Gaza. It must not mark the end of international efforts to address the humanitarian and legal crisis that continues to devastate countless lives. The deliberate destruction of healthcare infrastructure, the systemic deprivation of essential resources, and the dismantling of UNRWA’s operations are not merely tragedies—they are deliberate crimes under international law.

The OTP must act with urgency and continue to incorporate a gendered perspective into its investigations to ensure that those responsible are held accountable for the full breadth of harm inflicted. The prosecution of reproductive violence in Gaza will set a critical precedent for international justice. It is not just about legal accountability—it is about acknowledging and addressing the long-term, generational impact of these crimes on Palestinian women and their communities.

States Parties to the Rome Statute must also unite in unwavering support of the Court and resist external pressures that seek to threaten its mandate. As one of Israel’s strongest allies, the United States has continuously sought to undermine the ICC’s legitimacy through various measures aimed at discrediting its work—including imposing sanctions through an Executive Order to obstruct the Court’s operations.^[44]  It is especially crucial at this moment for the international community to remain vigilant against efforts to shield perpetrators of war crimes from accountability.

Reproductive violence inflicted on Palestinian women is an assault on their dignity, their future, and their ability to live and thrive. The world must recognize this for what it is: a systematic and deliberate attack on humanity itself. The time for action is now. The stories of Aya, Sujoud, and Tagreed are more than heartbreaking—they are a clarion call for justice. Their voices must echo through the halls of power, compelling leaders, institutions, and individuals to stand in defence of the fundamental rights of the Palestinian people. It is not just a fight for justice; it is a fight for humanity’s conscience.

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

Footnotes

^[1] Alhaq. Giving Birth in Displacement. Accessed January 2025. https://www.instagram.com/reel/C2K7wEUNBhD/?igsh=YjdnbnkyZzk2M210.

^[2] Ibid.

^[3] Ibid.

^[4] Ibid.

^[5] World Health Organization (WHO). Situation Report 52. p.1. Accessed January 2025. https://www.emro.who.int/images/stories/Sitrep_52.pdf?ua=1

^[6] OCHA. Humanitarian Situation Update 255 – Gaza Strip. Accessed January 2025. https://www.ochaopt.org/content/humanitarian-situation-update-255-gaza-strip

^[7]  World Health Organization (WHO). Situation Report 52. p.2.

^[8] SRI International. 5,000 Lives in One Shell: Israeli Strikes Destroy Gaza’s IVF Embryos. 18 April 2024. Accessed January 2025. https://sri.org.pk/5000-lives-in-one-shell-israeli-strikes-that-destroy-gazas-ivf-embryos/

^[9]  Regan, Helen, et.al. Palestinians Return to Northern Gaza. 27 January 2025. Accessed January 2025. https://edition.cnn.com/2025/01/27/middleeast/palestinians-return-north-gaza-intl-hnk/index.html

^[10] Rajvanshi, Astha. Aid to Gaza Amid Ceasefire. 22 January 2025. NBC News. Accessed January 2025. https://www.nbcnews.com/news/world/aid-gaza-ceasefire-israel-palestinians-hamas-rcna188699.

^[11] WHO. Ceasefire in Gaza Brings Hope, but Challenges Remain. 19 January 2025. Accessed January 2025. https://www.who.int/news/item/19-01-2025-the-ceasefire-in-gaza-brings-hope–but-immense-challenges-lie-ahead-to-restore-the-health-system

^[12] Al Jazeera. Israel Notifies UN of Ending Ties with UNRWA Amid Famine Warnings. 4 November 2024. Accessed January 2025. https://www.aljazeera.com/news/2024/11/4/israel-notifies-un-of-ending-ties-with-unrwa-amid-warning-of-famine-in-gaza

^[13] UNRWA. Statement by Philippe Lazzarini, Commissioner-General. 28 January 2025. Accessed February 2025. https://www.unrwa.org/newsroom/official-statements/statement-philippe-lazzarini-commissioner-general-unrwa-united-nations

^[14]Ibid.

^[15]Mason, Jeff and Kanishka Singh. Trump to target UN rights body  https://www.reuters.com/world/trump-order-us-withdrawal-un-human-rights-council-halt-unrwa-funding-2025-02-03/

^[16] Ibid.

^[17]UN News. UNRWA ‘continues to deliver’ as Israeli ban comes into effect. 30 January 2025. Accessed February 2025.https://news.un.org/en/story/2025/01/1159601

^[18] OHCHR. Onslaught of Violence Against Women and Children in Gaza. May 2024. Accessed January 2025. https://www.ohchr.org/en/press-releases/2024/05/onslaught-violence-against-women-and-children-gaza-unacceptable-un-experts#:~:text=They%20noted%20that%20women%2C%20girls,are%20estimated%20to%20be%20female.

^[19] Tami Rafidi. The Womb as a Weapon in Palestine. Friedrich-Ebert-Stiftung. 16 May 2025. Accessed January 2025. https://feminism-mena.fes.de/e/the-womb-as-a-weapon-in-palestine.html

^[20]

Nadworny, Elissa, Anas Baba and Selena Simmons-Duffin. Giving Birth Amid Gaza’s Devastation. 27 October 2023. NPR. Accessed January 2025. https://www.npr.org/sections/goatsandsoda/2023/10/27/1209140259/giving-birth-amid-gazas-devastation-is-traumatic-but-babies-continue-to-be-born

^[21] IRC. Pregnant Women and Mothers in Gaza Fight to Survive. 2 April 2024. Accessed January 2025. https://reliefweb.int/report/occupied-palestinian-territory/pregnant-women-and-mothers-gaza-are-fighting-keep-themselves-and-their-babies-alive-amidst-healthcare-collapse-irc-warns

^[22] UNFPA. Relentless Attacks Leave Gaza’s Women and Girls in Crisis. 27 October 2023. Accessed January 2025. https://www.unfpa.org/news/relentless-attacks-collapse-health-and-safety-systems-leave-gazas-women-and-girls-facing

^[23] 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/

^[24] MSF. Newborns at Risk as Nasser Hospital Runs Out of Fuel. 8 January 2025. Accessed January 2025. https://reliefweb.int/report/occupied-palestinian-territory/newborns-and-other-patients-risk-nasser-hospital-gaza-runs-out-fuel-msf-warns

^[25] WHO. Children’s Lives Threatened by Rising Malnutrition in Gaza. 19 February 2024. Accessed February 2024. https://www.who.int/news/item/19-02-2024-children-s-lives-threatened-by-rising-malnutrition-in-the-gaza-strip

^[26]Ibid.

^[27]Tami Rafidi. The Womb as a Weapon in Palestine.

^[28]Alsaafin, Linah and Ruwaida Amer. No Privacy, No Water: Gaza Women Use Period-Delaying Pills Amid War. 31 October 2023. Accessed February 2025. https://www.aljazeera.com/news/2023/10/31/no-privacy-no-water-gaza-women-use-period-delaying-pills-amid-war

^[29]Tami Rafidi. The Womb as a Weapon in Palestine.

^[30] UN. Gender Alert: Gaza – A War on Women’s Health. September 2024. p. 8. Accessed January 2025. https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2024/09/gender-alert-gaza-a-war-on-womens-health/gender-alert-gaza-a-war-on-womens-health-en.pdf

^[31] WHO. Public Health Situation Analysis – oPt. 2 May 2024. p.8. Accessed January 2025. https://www.un.org/unispal/wp-content/uploads/2024/05/WHO-PHSA-oPt-020524-FINAL.pdf

^[32] Altunjan, T. (2021). Reproductive Violence and International Criminal Law. International Criminal Justice Series. p.98-99. doi:10.1007/978-94-6265-451-8

^[33] Ibid,. p.99. doi:10.1007/978-94-6265-451-8

^[34] Ibid.

^[35] 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

^[36] ICJ. Application of the Convention on the Prevention and Punishment of the Crime of Genocide in the Gaza Strip (South Africa v. Israel), para. 95-100. Accessed January 2025 at: https://www.icj-cij.org/sites/default/files/case-related/192/192-20231228-app-01-00-en.pdf.

^[37]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

^[38]Palestinian Feminist Collective. The Palestinian Feminist Collective Condemns Reproductive Genocide in Gaza.

^[39] ICC. 2023 Policy on Gender Based Crimes, para. 35. December 2023. Accessed January 2025. https://www.icc-cpi.int/sites/default/files/2023-12/2023-policy-gender-en-web.pdf

^[40] Ibid, para. 37.

^[41] Ibid, para. 37.

^[42]Ibid, para. 47.

^[43]ICC. Pre-Trial Chamber Rejects Israel’s Challenges. 21 November 2024. Accessed January 2025. https://www.icc-cpi.int/news/situation-state-palestine-icc-pre-trial-chamber-i-rejects-state-israels-challenges

^[44] The United States White House. Imposing Sanctions on the International Criminal Court. Executive Order. 6 February 2025. Accessed February 2025. https://www.whitehouse.gov/presidential-actions/2025/02/imposing-sanctions-on-the-international-criminal-court/