Reproductive Violence in Occupied Gaza

Israel’s commission of reproductive violence on the Gaza Strip exemplifies the impunity surrounding violations of Palestinians’ right to reproductive health. Since Israel’s breach of the Israel-Hamas ceasefire on 18 March 2025, renewed military operations have jeopardized safety of pregnant women, newborns, and those in need of reproductive healthcare.

Context and Scope of the Commission’s Findings

On 13 March 2025, the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel (“the Commission”) published a report titled “More than a human can bear”: Israel’s systematic use of sexual, reproductive and other forms of gender-based violence since 7 October 2023. The notion of “reproductive violence” is broadly defined as interference with a person’s reproductive autonomy. In occupied Gaza, root causes of such violence can be traced to systemic restrictions, some imposed by the occupying power, and compounded by a protracted blockade and political fragmentation. These factors create significant barriers to prenatal, obstetric, and postnatal care. This report documented the perpetuation of reproductive violence in Gaza on the premise that the Occupying Power is legally obligated to protect and facilitate the right to health, including access to reproductive healthcare.

Israel’s Obligations as Occupying Power

As concluded by the International Court of Justice (ICJ) in its advisory opinion on 19 July 2024, Israel’s occupation of the Gaza strip and the West Bank, including East Jerusalem, is not only unlawful, but it also triggers responsibilities under international humanitarian law (IHL) as an Occupying Power: namely to respect, protect, and fulfil the human rights of Palestinians. By examining how the Commission applies IHL to Israel’s alleged sexual and reproductive violence, this piece expounds that ensuring the unique needs of women and girls in conflict must be fully upheld as a matter of binding international law.

Destruction of Maternal and Neonatal Facilities

IHL provides a critical framework for understanding an Occupying Power’s obligations to ensure specialized, non-discriminatory healthcare to pregnant women in armed conflict. This responsibility is not merely recommended but mandated by international law, reflecting a convergence of IHL obligations and human rights principles of autonomy and humane treatment.  The 2016 ICRC Commentary on Common Article 3 underscores protections for pregnant women during armed conflict, particularly in detention settings:

“The age of a person deprived of liberty may require appropriate treatment, for example in terms of the kind of food or medical care provided; and pregnant or nursing women in detention may similarly require tailored nourishment and medical care or adjustments in the organization and equipment of their accommodation.”

This language emphasizes the obligation to provide specific, suitable care for pregnant and nursing women in the context of deprivation of liberty. Rule 134 of the ICRC’s Customary IHL Study stipulates that “the specific protection, health and assistance needs of women affected by armed conflict must be respected.” In practical terms, this entails affording pregnant women priority access to medical facilities when clinically indicated, securing adequate nutritional support and pregnancy-specific supplies, and protecting them from sexual violence. These obligations align with Additional Protocol I which specifies that “the protection and care due to the wounded and sick is also due to maternity cases and ‘other persons who may be in need of immediate medical assistance or care, such as … expectant mothers.” (AP I, art 8(a)). Pregnant women are thus entitled to adequate medical care consistent with their specific health needs.  While states must carry out these obligations “to the fullest extent of the means available to them” (AP I, art 10 and art 12), the underlying principle is that feasibility or resource constraints cannot be used to justify failing to protect pregnant individuals from serious, foreseeable harm. In an occupation setting, this obligation extends to the Occupying Power, which must ensure – so far as circumstances permit- unimpeded access to reproductive healthcare.

Denial of Medical Supplies and Access

The Fourth Geneva Convention explicitly provides heightened safeguards for pregnant women and mothers of young children (GC IV, arts 16, 23, 50, 76, 89, 91, 132), mandating Occupying Powers to preserve civilian lives and well-being, such as ensuring unimpeded access to medical services, supporting humanitarian relief, and refraining from targeting hospitals (GC IV, art. 14, 18). Building on this foundation, the ICRC Commentaries affirm that pregnancy demands “particular care”, found throughout the Fourth Geneva Convention and Additional Protocol I, further clarifying that humane treatment necessarily encompasses obstetric, gynecological, and related healthcare (GC IV, arts. 27, 55 and AP I, arts. 15, 54). Evolving legal interpretations reinforce that reproductive healthcare is not merely a moral entitlement, but a protected right.

Destruction of Maternal and Neonatal Facilities

In setting out Israel’s responsibilities as the Occupying Power, the Commission cites numerous instances in which Israel allegedly failed, or refused, to meet its IHL obligations in Gaza.  Maternal and neonatal facilities, including those in al-Shifa Hospital and al-Nasser Hospital, were reportedly destroyed (Commission’s Report, paras. 39–40). The Commission notes that both hospitals provided essential obstetric and neonatal care that could not be supplied elsewhere in Gaza. Doctor’s Without Borders has documented that direct bombardment made these facilities non-operational, thereby forcing thousands of pregnant women to seek alternative, often unsafe, treatment. These attacks breach the Occupying Power’s duty to respect protected medical units under GC IV (art. 18) and Additional Protocol I (art. 12). The Commission also discusses the destruction of specifically designated reproductive healthcare facilities, such as al-Emirati Maternity Hospital and al-Awda Hospital, which “served about 540,000 women and girls of reproductive age in Gaza” (Commission’s Report, para. 39). Testimonies indicate that the bombings took place although the sites were clearly marked as civilian medical facilities. Hence, these attacks also violate the rules on distinction and proportionality (Additional Protocol I, arts. 48, 51), as facilities used exclusively for humanitarian or medical purposes must not be targeted.

Denial of Medical Supplies and Access

Additionally, the report considers Israel’s alleged blockage of medical supplies crucial to obstetric care, including anesthetics, antibiotics and surgical equipment. It highlights cases of caesarean sections without anesthesia, in some cases leading to dire health outcomes for both mother and child (Commission’s Report, paras. 47–49). Medical witnesses reported forced hysterectomies and increased maternal death rates due to lack of fuel, electricity and basic equipment. These outcomes underscore failures to meet humane treatment obligations under Common Article 3 and more specific requirements to provide adequate healthcare to “gynecological and reproductive health”. (AP I, art. 8(a); 2016 ICRC Commentary on GC I, para 1432-1436).

Sexual Violence and Mistreatment in Detention

Further reproductive harms were highlighted in the context of detention. The report references the counts of both male and female detainees who were repeatedly strip-searched (Commission’s Report, para. 92, 125, 193, 197), victim to sexual violence and rape as a means of punishment (Commission’s Report, para 116, 122, 123, 124, ), and denied adequate food and water even in the later stages of pregnancy (Commission’s Report, para. 127, 195). Female and male detainees report assaults to genitalia, including one instance of Israel Security Forces (ISF) personnel wielding an electrical probe to a male detainee’s sexual organs (Commission’s Report, 119, 126, 194 ). These actions contravene Common Article 3 of the Geneva Conventions by inflicting outrages upon personal dignity and cruel or degrading treatment(GC III, art. 1(c)).

Occupying Powers are obligated to allow passage of medical supplies and humanitarian aid for civilians and “expectant mothers and maternity cases” (GC IV (art. 23)). As of 26 March 2025, Israel’s obstruction of fuel, water, electricity, and medical supplies into the Gaza strip has rendered the obstetric services needed by expectant mothers completely nonfunctional. Essential hospital functions such as sterilization, anesthesia, and neonatal care have been severely compromised. Such actions violate GC IV (art. 23) and Article 43 of the Hague Regulations, which oblige the Occupying Power to ensure public health and facilitate medical assistance.

Conclusion: Interpreting IHL to Protect Reproductive Healthcare

Amid Israel’s renewed offensive in Gaza, which has already caused thousands of Palestinian deaths and injuries, the Commission’s findings take on increased significance. By methodically detailing hospital bombings, the destruction of IVF clinics (Commission’s Report, paras. 41–42) and the blockage of essential obstetric supplies (GC IV, art. 23), the Commission illustrates how these measures disproportionately affect pregnant women and infants, and undermine a protected group’s ability to sustain life. Even if courts do not definitively accept the Commission’s genocide analysis, its core argument rests on established IHL obligations requiring Occupying Powers to protect maternal health infrastructure, maintain the flow of medical goods and refrain from restricting a population’s capacity to bear children or survive.

If international law proves unable – or unwilling- to address such intersecting injustices, it risks perpetuating the very impunity it was designed to challenge. Palestinians in Gaza continue to endure human-made conditions of healthcare deprivation and prolonged violations of reproductive rights violations. The international community must take heed. IHL and human rights principles have evolved to guarantee humane treatment, including adequate reproductive healthcare, for all civilians. Yet only by demanding accountability can we begin to dismantle the structural conditions that sustain reproductive violence in armed conflict and move closer to an environment where reproductive justice is, at last, attainable.