At six months pregnant, displaced Palestinian woman Fatima Arfa wishes she could be buying cute clothes and toys for the special day when she delivers a healthy, safe child.
Instead, she spends much of her time seeking medical help in Gaza, where health services have all but collapsed over 21 months of war since the Hamas onslaught of October 7, 2023.
As she searches, Arfa, 34, is weak and fearful that malnutrition will sabotage her pregnancy as Israel presses on with a military campaign that has led to widespread hunger among children and adults and reduced the enclave to rubble.
She longs for simple foods like milk, eggs and red meat that could improve her health and increase the chances of delivering a healthy baby. But just trying to deal with deficiencies is exhausting and highly risky under a steady stream of strikes.
“I’m coming from a far-away place, and on foot too, because I need to have a blood transfusion because of a very big deficiency, malnutrition,” said Arfa, staring at medical imaging of her unborn baby.
In June, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) warned that an estimated 55,000 pregnant women in Gaza face growing health risks such as miscarriage, stillbirth and undernourished newborns.
Tackling those grim realities is challenging for doctors who face severe shortages of medicine and fuel to keep overwhelmed hospitals running as the nearly two-year war between Israel and Hamas rages.
During a consultation with Arfa, Fathi al-Dahdouh, director of external clinics at Al-Helou Hospital, examines documents about her health.
She has anaemia and hopefully she can receive two units of blood and needs admission to hospital because she can’t live a normal life with low energy levels, or walk, he said.
“We hope that God will stop this war and open the crossings so that green food supplies, fruits, and vitamins can enter, along with these things,” said al-Dahdouh.
Thousands of starving Gazans who frantically wave pots around at food collection points risk violence merely walking to those areas. Israeli airstrikes can hit at any minute and most Gaza residents have been displaced.
Israel has accused Hamas of hijacking aid deliveries and embedding itself in civilian infrastructure, including hospitals and clinics.
Arfa is getting weaker by the day and generating enough energy on a meagre diet is a huge challenge.
“It is very difficult, and in the middle of the heat. I leave small children at my house, and until now they may not have had breakfast, and neither have I,” she said, sitting in a makeshift tent near her children, wondering how she will be able to support them, and her husband Zahi.
Her daughter serves food from a cooking pot into a bowl for the whole family of seven. Zahi, 40, complains that much of Gaza’s population relies on mostly lentils.
Sometimes he wanders around flattened neighborhoods desperate for flour, anything that could give his wife the strength to produce life.
“More than once, I was exposed to death. I failed every time I tried to even get a can of tuna or a can of peas for the children. I couldn’t,” said Zahi.
According to Gaza’s Hamas-run health ministry, more than 57,000 people have been killed in the Strip since the war there began on October 7, 2023.
The Hamas-provided death toll cannot be independently verified and does not distinguish between civilians and combatants. Israel says it has killed some 20,000 combatants in battle as of January and another 1,600 terrorists inside Israel during the Hamas onslaught that sparked the war. The onslaught killed some 1,200 people and saw 251 taken hostage.