Birth in shelters: Midwives' lived experiences in providing childbirth care amidst war in Gaza

The warfare against the Gaza Strip in the occupied Palestinian territory, starting in October 2023, caused massive destruction of infrastructure, including homes and hospitals. Within two years (October 2023 to October 2025), most of the 2.1 million inhabitants were displaced, and more than 69,500 people were directly killed, of whom more than 70% were women and children. To enhance preparedness in maternal care during war, it is important to understand how midwives respond to emergencies in conflict zones. This study seeks to explore the experiences of midwives in delivering childbirth care to women in Gaza within shelters, tents, and amidst the rubble during wartime.

We employed a descriptive qualitative phenomenological design. We used a purposeful snowball sampling approach to identify midwives who had assisted women in giving birth in shelters or tents during the war. Face-to-face in-depth interviews were conducted with nine midwives between January and April 2025, and underwent reflexive thematic analysis.

An overarching theme was identified: "Midwives torn between fear and professional compassion while struggling for humanity in a ruthless war". Three additional themes were developed: "Unprotected in ruthless warfare", "Professional role and contradictive emotions", and "Challenges and potentials for midwives during war and emergencies".

The study recommends the development of clear preparedness policies aligned with midwives' scope of practice that support their professional role when caring for pregnant women in war, emergency, and humanitarian contexts. Given the volatile context of the oPt, Palestinian midwives should be actively involved in preparedness strategies for emergency response. They need guidance, support, necessary supplies, connection to backup resources, and training to assist births safely outside hospital settings.