Nuhail Muharram was three months pregnant when a doctor told her the foetus had died and would have to be removed. Then she waited six weeks because the medication was not available.
"Every day I lived with the pain, knowing the foetus was dead," she says. "I had two choices. Wait for the pills, or wait to start bleeding."
The 31-year-old mother of four from the Sabra district of Gaza City has been displaced six times since the war began. She discovered she was pregnant in March, between one displacement and the next.
Nuhail went to the hospital, had the tests, had an ultrasound, and was told the pregnancy was progressing normally.
She went back a fortnight later and was reassured again.
"When the doctor examined me the next time, he said the foetus was dead and incomplete, and that I needed an abortion," she says. "I was shocked, especially because I had been going back to him regularly, and every time he told me things were fine."
She had felt nothing. "I never expected it. I had no sense that the foetus had died, and the shock was enormous."
The doctor told her that the conditions the war had created were likely among the causes: cooking over firewood, physical exhaustion, walking long distances without transport, hunger, and poor nutrition.
The six weeks that followed were the hardest of it. "Every day that passed hurt, in my body and in my mind."
Her health has not returned. "My body became frail. I tire quickly, and my joints hurt. I reached a point where all I wanted was for someone to look after me."
'I had no feeling that this could happen'
Yusra (prefers to use her first name for privacy) is 29, has two children, has been displaced more than five times, and now lives in a tent west of Gaza City.
She learned she was pregnant in April 2026 and followed the pregnancy carefully from the first weeks, visiting a doctor three times and completing every test. Each time, she was told the foetus was developing normally.
"Every time I went, she reassured me the pregnancy was normal. I had no feeling that this could happen to me."
At twelve weeks, sitting inside her tent, she began to bleed heavily.
"I was very frightened. They took me to the hospital quickly, straight into the operating theatre, under full anaesthesia."
She woke to the news that the pregnancy was gone. Her haemoglobin had fallen to seven.
"Since then, I have had dizziness, exhaustion, and pain throughout my whole body. My health has not gone back to what it was."
No specific medical cause was given, only that the conditions of the war, the displacement, the strain and the unrelenting pressure may have been behind it.
Zaher al-Wahaidi, who directs the health information unit at Gaza's Ministry of Health, says the first half of 2026 shows an unprecedented rise in recorded miscarriages: 3,958 cases between January and June.
June recorded the highest number, at 790. April recorded the highest rate, 377.25 miscarriages per thousand live births.
Over the six months, the rate was 208.5 per thousand live births, compared with 64 per thousand in the second half of 2025. It has risen roughly 3.3 times in under a year.
Zaher says 73.6 percent of cases occurred in the first trimester, before thirteen weeks, and 26.4 percent in the second, between 13 and 24 weeks. Among pregnant women on the ministry's register, 57.1 percent were anaemic.
The curve rose from 93.28 per thousand in January to its April peak, fell back in May and June, and remains far above anything recorded before.
What the delivery room sees
Maysoun Suleiman Abu Braik heads the delivery room department at Al-Awda Hospital in Nuseirat. Her staff has recorded more women arriving with pregnancy loss, with early bleeding, and with pregnancies at risk of miscarriage.
Many arrive after their condition has already deteriorated, she says, because repeated displacement, the difficulty of moving around and the interruption of routine antenatal care delayed them getting there at all. She is careful to note that establishing the precise scale of the increase requires official statistics.
What she describes is an accumulation. Severe psychological pressure from bombardment, bereavement and displacement, alongside malnutrition, anaemia, dehydration and a shortage of drinking water.
Limited availability of basic medicines and supplements, iron and folic acid among them, and of the drugs needed for chronic conditions, including hypertension, diabetes and thyroid disease.
Conditions inside shelters and tents compound it: overcrowding, poor sanitation, and a higher risk of infectious disease. So does the physical labour of displacement itself, carrying belongings, walking long distances for water or food, and rarely sleeping properly.
With infrastructure destroyed by Israel and fuel and gas scarce, many women cook over firewood and inhale smoke for hours, alongside the dust and pollutants of the ruins.
Malnutrition, she says, is among the most dangerous factors of all. A woman who cannot get enough protein, energy, iron, folic acid and calcium risks anaemia, restricted foetal growth, low birth weight and premature delivery, and the risk of losing the pregnancy rises when that combines with infection, exhaustion and absent medical care.
Al-Awda's own records show the pattern:
'Permanently alert'
What pregnant women in Gaza face is not one threat but a set of interlocking ones: continuous fear, bombardment, displacement, malnutrition, dehydration, physical exhaustion and the difficulty of reaching healthcare at all, explains Said al-Kahlout, a mental health specialist.
A pregnant woman in war lives in a state of permanent alert. Her body stays braced because the danger keeps recurring, and stress hormones including cortisol and adrenaline stay elevated.
That response is normal in the face of threat.
Sustained for months, it affects sleep, appetite, blood pressure, immunity and mental health, particularly when there are no intervals of safety in which the body can recover.
He describes insomnia and nightmares, palpitations, muscular tension, loss of appetite, persistent exhaustion, difficulty concentrating, panic attacks, depression and symptoms of post-traumatic stress.
War imposes what he calls continuous trauma, in which the painful experience never ends but renews itself with each bombardment, each displacement, each fear for a family member.
Studies link exposure to armed conflict with higher risks of certain pregnancy complications, including premature birth and low birth weight, though never to a single factor.
Losing a pregnancy in these conditions is harder and more complicated, he says, because a woman does not lose only the pregnancy.
She may have lost her home, or a member of her family, or her sense of safety, while the danger continues around her and there is no safe space in which to grieve or recover.
The response, he argues, cannot be medical alone. It has to include psychological support, social protection, and recognition that losing a pregnancy is a real loss deserving care rather than blame.
"In war, a woman may not only lose her pregnancy," he says. "She may lose her sense of safety with it, and her trust in her own body, and her picture of the future."
A legal question
Abdullah Sharshara, a lawyer and chairman of the Ajyal Association for Creativity and Development, argues that international humanitarian law and international human rights law impose clear obligations toward pregnant women in armed conflict, as among those most exposed to health and humanitarian risk.
Those obligations include guaranteeing access to antenatal, delivery and postnatal care, protecting medical facilities and personnel, securing medicines and medical supplies, and not exposing pregnant women to risks arising from siege, starvation or attacks on health infrastructure.
A rise in miscarriages during war, he says, should not be treated only as a set of individual medical events.
It can constitute a legal and human rights indicator of a possible violation of the right to health, if the cases are shown to be connected to factors produced by the conflict: the targeting or disabling of health facilities, absent medical care, malnutrition, severe psychological pressure, or restrictions on reaching services.
"The right to health, under international instruments, is not limited to providing treatment," he says.
"It also includes guaranteeing the conditions that allow pregnant women to receive safe and continuous care, protecting their lives and the lives of the foetuses they carry."
Where medical and statistical evidence supports it, he argues, such cases can be relied on as evidence of the conflict's direct effect on reproductive health, and of the scale of civilian harm.
But for Nuhail Muharram, she is not thinking about evidence.
She is thinking about the six weeks she spent carrying a pregnancy she already knew was over, waiting for medication that a hospital in Gaza could not give her.
Ansam Al-Kitaa is a freelance journalist based in Gaza. For years, she has covered the successive wars in Gaza and their humanitarian and social impacts for international and local outlets
This piece is published in collaboration with Egab