Maternal deaths climbed in a UNRWA cohort of 17,713 Gaza pregnancies

A study published in the Bulletin of the World Health Organization tracked 17,713 refugee women who were pregnant in the Gaza Strip on 8 October 2023 and found 168 maternal deaths through June 2024 — a pregnancy-related mortality ratio of 948 per 100,000 pregnancies, against a maternal mortality ratio of 30 per 100,000 live births before the conflict [s1]. Stillbirth, neonatal-death and preterm-birth rates all rose over the same period, even as almost all deliveries stayed inside health facilities [s1].

The two comparison figures do not share a denominator — one is measured per pregnancy, the other per live birth — so the gap is not a clean fold-change, and the authors present them side by side rather than as a single ratio [s1]. What is not in doubt is the direction and the scale.

How the cohort was assembled

The women were all registered for antenatal care with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which let researchers follow a defined, pre-identified group rather than reconstruct one after the fact [s1]. Outcomes were pieced together from UNRWA's electronic health records, a phone survey the agency ran, and the Palestinian Ministry of Health's lists of deaths for October 2023 to June 2024 [s1]. That triangulation matters in a setting where no single system captures every event; it also means the count inherits whatever each source missed, and the authors are clear that the true toll could be higher.

The pattern of deaths by maternal age suggested that most of the 168 were trauma-related rather than obstetric in the usual sense [s1]. That is an important qualifier: it points to injury from the war itself, not primarily to a collapse in the mechanics of childbirth — though the two are hard to separate when a birth happens near a front line.

The newborn numbers

Among women with known pregnancy outcomes, the stillbirth rate was 10.3 per 1,000 births, against 6.0 per 1,000 before the conflict [s1]. The neonatal mortality rate was 9.4 per 1,000 live births, up from 6.6 [s1]. Preterm birth ran at 13.6%, against 9.7% before [s1]. None of these is a catastrophic multiple of the baseline on its own; together, and read against the maternal figure, they describe a population of pregnancies pushed into higher risk across every measured stage.

One finding cuts against the expectation of total collapse: 97.3% of deliveries remained facility-based [s1]. But the facilities changed. Births shifted from government to non-governmental-organisation sites, and hospital stays shortened — a move to lower-level care that the authors flag as a concern about quality, not a reassurance about access [s1].

What a hospital-floor study adds

A separate facility-based study in the International Journal of Gynecology & Obstetrics documented 686 pregnancy-related encounters at Al-Helou Maternity Hospital in Gaza from late April to early September 2025, and it fills in the conditions the UNRWA cohort can only imply [s2]. Among those women (median age 28, interquartile range 23 to 33), 92.9% reported eating no more than two meals a day and 71.7% were anaemic, with haemoglobin below 11 g/dL [s2]. Nearly four in five, 78.7%, were currently displaced, over half of them living in tents; 57.0% reported bombing nearby within the previous 24 hours, and 98.0% reported smoke exposure [s2].

Access to care was thin: only 32.1% reported reaching any prenatal care [s2]. Deliveries at the hospital were 57.4% normal vaginal and 37.6% caesarean, the latter often driven by a prior caesarean [s2]. Among the 665 neonates, median birthweight was 3,000 g and 12.9% were admitted to neonatal intensive care, though 98.6% were discharged alive [s2]. It is a single-hospital snapshot, descriptive and not population-representative, but its exposure figures put texture on why the cohort-level rates moved.

How to read it

Both studies are observational and both lean on records kept under conflict conditions, so neither can isolate cause. The honest summary is narrower than a headline ratio: in a large, defined group of pregnant women in Gaza, deaths of mothers and newborns and the share of early births all rose, the maternal deaths look largely trauma-driven, and care did not vanish so much as degrade — moving to smaller facilities and shorter stays [s1].

The maternal picture sits alongside what other measured corners of this crisis have shown, from child wasting tracked by arm circumference to the independent count of violent deaths. What to watch is whether the shift to lower-level delivery care shows up later as complications the acute figures did not capture.

Sources

• [s1] Maternal and neonatal outcomes in a cohort of pregnant women during conflict, Gaza Strip — Bulletin of the World Health Organization. https://doi.org/10.2471/BLT.25.293829
• [s2] Maternal and neonatal outcomes in Gaza amid armed hostilities in 2025 — International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70984