How Israel’s assault on Gaza amounts to a ‘war on women’

The dire living conditions, constant bombardment and lack of basic hygiene facilities are making life excruciating for women and girls – I’ve seen it firsthand, writes sexual and reproductive health doctor Israa Saleh

Displaced Palestinian women from Rafah walk next to their shelters in Deir Al Balah, southern Gaza (EPA/Mohammed Saber)

As the world advances in many aspects of healthcare and human rights, the women of Gaza face an utterly different reality. We face a silent struggle, one of resilience tested by relentless aggression and deprivation, where the simple act of managing a menstrual cycle becomes a battle for dignity and basic human rights.

Menstruation, pregnancy and childbirth should be natural and manageable parts of life, yet they’ve become sources of immense stress and struggle for girls and women in the region. There are almost 700,000 girls and women of menstrual age, in addition to the thousands of girls who had their first menstrual cycle during Israel’s war on the Gaza Strip.

As a doctor specialising in sexual and reproductive health, I have borne witness to these immense and heartbreaking struggles. Every day I see their strength, but also the deep pain and indignity they endure. This perspective is not just professional; it is deeply personal. As a woman, experiencing it alongside them, I strive to support those who are most vulnerable in this fragile setting.

I know the misery of menstruating in such circumstances, when there are no sanitary products. Usually, women and children are the most affected groups in catastrophic situations.

The aftermath of childbirth is an especially vulnerable time, where we have witnessed several women coming to our clinics to follow up after delivery, and when examined, they use pieces of tent or cloth to try to absorb the blood. Bleeding after delivery is far heavier compared to normal menstruation.

After I got my master’s degree in the UK, I decided to return to Gaza to support the women and girls here. It was during this time that I was accepted to my PhD to continue my studies in the UK. I can only hope that this horror will end and I’ll be able to leave Gaza to study. I would like to leave under better circumstances; I don’t want to leave because of this war.

While we live with the consequences of the massacres, the bombardments and displacement, I have imagined and compared our lives as women here with the lives of women living outside the Gaza Strip.

I keep thinking about the adolescent girls, starting puberty and experiencing menstruation for the first time in their lives here in Gaza, compared with those in other places. Here, the living conditions are dire: you’re living in a tent, in the summer season, with the shortage of clean water, lack of pads and infection sources everywhere.

Then there’s the psychological and biological immaturity, vulnerability and sensitivity of entering puberty, combined with the continuous feeling of insecurity, unsafety, stress, and painful losses. Menstruation makes it even harder.

For a girl in another part of the world, the experience of getting her period for the first time could not be more different. She lives in a comfortable home with her family. She might have her own bedroom and access to a private bathroom.

The bathroom is equipped with all the necessary facilities, including a continuous clean water supply, soap, and a proper waste disposal system for sanitary products. One of her parents will hopefully be around; a comfortable bed, a clean bathroom and hot drinks are available. Naturally, she may feel nervous, but reassured and informed – unless she is living in period poverty, which is a very real problem even in the UK – she can easily seek medical care that is affordable and accessible.

When I am with patients, I try to discuss with them the health risks and emphasise the importance of trying to maintain self-care and personal hygiene routines. However, with the constant forced displacement and lack of facilities, most women are faced with the challenges of living in tents or overcrowded shelters and refugee camps. There are shortages of clean water, soap, tissues and underwear. There is nearly no access to sanitary and hygiene products. The wait to access the toilets for a few minutes can be hours.

Women are resorting to using unsafe alternatives to pads like cloth, clothes, sponges – or reusing used pads. This can lead to infection, as well as isolation and feelings of stress and vulnerability.

However, despite efforts by medical and aid organisations to alleviate some of the suffering during months of bombardment – the UN’s top court, the ICJ, has ruled that claims of genocide during this time are “plausible” – the high need and further restrictions on supplies continue to have a damaging effect.

In many places in the world, including Gaza, menstruation is met with silence, considered a private matter that should not be discussed openly. Sometimes, this leaves many girls and women unprepared and isolated. The lack of open conversation means that misinformation and shame flourish, making an already challenging situation even more overwhelming.

Because of the continuous bombings, forced displacement of citizens and the restrictions on aid and personal hygiene products, natural parts of life like menstruation, pregnancy and childbirth are also under attack.

No girl or woman should have to face these struggles, or have her health jeopardised because of her period. It is heartbreaking to see this entirely avoidable pain and suffering.

Israa Saleh is a doctor specialising in sexual and reproductive health with the French organisation Medicins Du Monde in Gaza