After two years of genocide in the Gaza Strip, experts say the enclave has experienced demographic destruction, a systematic, deliberate, or structural reduction of the population caused by Israel's relentless and never-ending violence.
The human cost of this demographic destruction is visible in many ways: Gaza's population pyramid has been distorted by falling birth rates, rising miscarriages, congenital abnormalities, and intrauterine deaths (stillbirths) — all worsened by inadequate healthcare for pregnant women.
This is expected to persist for years as a vast majority of Gaza's healthcare infrastructure has been damaged, destroyed, or rendered non-functional due to Israeli violence since October 2023.
The impact goes beyond immediate health outcomes. The decline in birth rates and the rise in miscarriages carry long-term social, psychological and health consequences that will affect future generations and the structure of a society in which children account for 47% of the population, according to official data.
For Palestinian researchers, these shifts are neither accidental nor temporary.
Rami al-Shaqra, head of the Palestine Institute for Strategic Studies, told The New Arab that the drop in births was not natural, but caused by the destruction of hospitals, lack of healthcare, and the starvation of pregnant women. He warned this would create a clear generational gap in the years ahead.
Rami explained that Israel was betting on breaking Palestinians demographically, while Palestinians were betting on survival and rebuilding generation after generation.
"History so far has stood with the Palestinian bet," he shared.
He added that the demographic imbalance extends beyond health, affecting the wider structure of society through family disintegration, a rise in the number of orphans, and distortion of the age composition, and while these effects are significant and long-term, they are not inevitable.
However, Rami believes that recovery is possible through deliberate social and health policies, intensive care for orphans, rebuilding education and empowering affected families.
"Recovery is not immediate, but it is possible and depends on rebuilding the health sector, supporting women psychologically and socially, and creating a minimum level of safety and stability," he said.
Temporary recovery
According to data from the information systems unit at the Palestinian Health Ministry, obtained by The New Arab, birth rates clearly increased during periods of calm and relative stability, despite the sharp decline during the two war years, when births fell by between 20% and 42% compared with previous years.
That said, in 2025, the unit recorded 48,600 births, resulting in 49,267 live births including twins — a 20% decline compared with pre-war levels, when 54,700 births were recorded in 2022.
The decline was sharper in 2024, with 38,000 births — a 42% drop compared with pre-war years — but after the January 2025 ceasefire, the situation began to improve, with pregnancies recorded later that year indicating that stability encourages higher birth rates.
Zaher al-Wahidi, head of the information unit at the Gaza Health Ministry, told The New Arab that the unit recorded 4,900 babies born at normal weight — defined by the ministry as 2.5kg — a 60% increase compared with pre-war figures.
The unit also recorded 4,000 premature births and around 5,000 registered miscarriages, though the actual number is likely higher, as some women did not seek care at health centres or miscarried in tents and homes.
Zaher said intrauterine deaths reached 611 cases, compared with 327 in 2022, an increase of 47%. Congenital abnormalities also rose, reaching 315 cases — including holes in the heart, bladder and genital organs — up from 184 cases in 2022, an increase of 58%. In addition, 452 newborns died in the first week after birth in 2025.
Ceasefire doesn't mean safety
It is important to note that even with a ceasefire in place, the effects of the war on pregnant women continue, with clinics reporting persistently high rates of miscarriages, premature births and intrauterine deaths.
Nagham Shahin, six months pregnant, was hoping to learn the sex of her foetus during a routine check-up when doctors discovered congenital abnormalities and fluid around the abdomen.
Her husband told The New Arab: "The news was shocking and affected her psychological state."
He added that the complications were likely linked to the most recent Israeli military operation in Gaza City, during which the family was displaced without vehicles and nearby areas were shelled, forcing repeated evacuations and constant fear.
With only three months remaining until delivery, the prospect of a baby being born with deformities was particularly difficult.
A Palestinian woman, Hiba Lafi, also said she had not planned to become pregnant, but when she did, the pregnancy initially progressed normally until a third-month check-up revealed a molar pregnancy outside the uterus, forcing her to have an abortion. Upon further tests, doctors advised her not to become pregnant for a year.
Hiba, who had four children before the war, explained that she had never experienced similar problems before, and that heavy shelling near her home in Shujaiya in October 2023 caused severe psychological stress and breathing difficulties, leading to hospitalisation.
She added that witnessing the killing of children and the struggle to protect them during the genocide made her avoid pregnancy.
However, during the ceasefire in October 2025, she became pregnant again, only to face an ectopic pregnancy that left her unable to sleep for days.
As for pregnant women living near the so-called 'yellow line', which refers to Israeli-designated military zones and buffer areas inside the Gaza Strip, they also continue to face insecurity.
Safa Sami Saad, for example, was severely affected when an explosive-laden vehicle detonated near her displacement area at the Shujaiya junction, three days before she developed complications in her pregnancy.
Her husband told The New Arab that she "screamed in fear, then developed influenza and complications."
Medical examinations later showed the foetus had died in the womb, forcing an abortion. He said it was a shock, particularly as the foetus had been in good condition before the blast, and Safa, who was four months pregnant, had not faced similar problems before the war.
At a primary healthcare centre in al-Daraj, Gaza City, conditions also remain dire. The centre is overcrowded, with pregnant women and those bringing newborns for vaccinations filling seats in corridors, outside doctors' rooms and waiting areas from early morning, while services remain severely constrained.
Reham Hijazi, director of the al-Daraj Primary Health Care Centre, said recent ultrasounds showed an increase in foetal abnormalities, including missing heads and heart deformities, as well as foetal loss in late pregnancy for unknown reasons.
"Mothers are suffering from malnutrition, which affects foetal health and the psychological state of pregnant women. Many are experiencing depression and fear of pregnancy because of concerns about childbirth, child-rearing and food provision. Despite this, fertility rates remain relatively good," she told The New Arab.
Reham added that pregnant women are experiencing increased vaginal and urinary infections, leading to premature birth and miscarriage, while living in tents without access to clean water or adequate food.
"Declining birth rates would lead to a shortage in the next generation, indicating that children were among the targets during the war as the foundation of society," she added.
"The aim is to weaken fertility in Gaza to prevent the emergence of a new generation."
Challenges ahead
Looking ahead, Gaza's health system faces a severe strain, with most primary healthcare centres out of service and limited capacity to support pregnant women.
Of 157 government, private and UNRWA-run primary healthcare centres, 95 are out of service, leaving only 62 operational and limiting the ability to address the ongoing impact of the war on pregnant women.
Ahmed al-Farra, head of paediatrics and obstetrics at Nasser Medical Complex, said care centres previously served as a medical safety net through continuous follow-up.
Their absence, he explained, led to major problems, including reduced foetal growth and an increase in premature births.
"These infants are vulnerable to respiratory infections due to weak immunity and poor weight gain. If the child is female, she may experience short stature later in life and face complications during pregnancy," he said.
"This means the effects of the war will persist for generations," he added.
Ahmed added that many children born prematurely may develop conditions such as autism and anxiety, placing an entire generation at risk, and said the main causes of declining birth rates during the war included displacement, poor living conditions in tents, lack of privacy, fear and anxiety over survival, and difficulty accessing largely destroyed health centres.
This is an edited translation from our Arabic edition, translated by Afrah Almatwari; to read the original, click here.