When Nour, 32, fled her home in Beirut, she focused on one thing: staying calm.
“I was breathing slowly and holding my stomach the whole time,” she told DW. She described the night she was four months pregnant and escaped heavy shelling in her neighborhood just days before a 10-day ceasefire between Israel and Hezbollah took effect on April 17.
Noor, asking that her last name not be published, said, “Being pregnant makes everything heavier – not just physically, but emotionally as well.” “I keep asking myself if my baby is safe inside me.”
He now lives in a group shelter, one of hundreds set up across the country. Conditions are difficult: lack of privacy and inadequate hygiene all increase health risks, especially for expectant mothers.
Public shelters reached their maximum capacity in early March when the Iran-backed Hezbollah militia attacked Israel following the assassination of Iran’s supreme leader, Ayatollah Ali Khamenei, as part of the broader U.S.-Israeli war in Lebanon, which became embroiled in the broader Middle East conflict.
Lebanese health officials say Israeli airstrikes and a limited ground offensive since March have killed about 2,300 people, injured more than 7,000 and displaced some 1.2 million. Most of those displaced have still not returned home, with uncertainty looming as the ceasefire is set to end in a few days.
The health care system is collapsing
Noor’s situation is far from unique. There are thousands of women among the displaced who are facing difficult pregnancy conditions. Aid agencies have warned that the impact on women is particularly severe.
“The situation for women and girls in Lebanon is dire,” said Anandita Philipose, Lebanon representative of the United Nations Population Fund (UNFPA). He said UNFPA estimates that of the 1.2 million people displaced since March 2, “more than 13,500 are pregnant women and 1,500 are expected to give birth within the next month.”
Access to maternal care is increasingly deteriorating, facilities are damaged and resources are depleted.
“Lebanon’s already fragile health system is now on the verge of collapse,” Philippos said, pointing to increasing barriers to obtaining maternity services.
The World Health Organization reported this week that at least 51 primary health centers have closed amid the fighting, which has also killed dozens of medical workers.
The hospitals that are operational are struggling to cope.
“We can’t bring in enough supplies and will have to ration medicines if the conflict lasts more than three months,” said Zeena Khouri Stevens, vice president of health services at Beirut’s LAU Medical Center, a central hospital in the capital. “This instability further weakens the health system.”
Thousands of people left isolated in southern Lebanon
Conditions are even more precarious in the south of the country, where access to medical facilities is severely restricted.
UNFPA estimates that of the approximately 150,000 people cut off from the rest of the country, about 1,700 are pregnant women. “These women are in grave danger,” Philipose said.
Aid efforts are ongoing but are limited due to both insecurity and lack of funding. Where possible, mobile medical units have also been deployed, along with reproductive health kits, Philippoz said. Local midwives and doctors who remained behind continue to provide assistance.
Yet, the response is falling short of what is required. Philippos said the agency’s emergency appeal for March to May had sought $12 million (€10.2 million) to reach 225,000 people, but only a fraction of that had been received so far. Continued growth has already outstripped those plans.
Years of stress and uncertainty
Lebanon’s once strong health system was already under severe pressure before the latest surge.
“The system was first strained by the massive influx of Syrian refugees in 2013,” said Zed Khalif, a Beirut-based public health physician and epidemiologist. “The system suffered a more acute shock with the economic collapse in late 2019.”
After four years of economic crisis, which was deepened by the COVID-19 pandemic, the Beirut port explosion in August 2020, and a prolonged political vacuum, Lebanon launched its national health strategy, ‘Vision 2030’, in January 2023. Former Public Health Minister Firas Abiad said at the time that the plan aimed to modernize the country’s health sector.
“Despite considerable efforts by health professionals and institutions across the country and increased investment by various organizations, the system still remains highly vulnerable,” Khalife said.
Today, services are unequally distributed. Private hospitals provide the majority of care, while public facilities, and hospitals funded by NGOs, serve low-income patients. Hezbollah’s political wing operates an extensive social services network that includes schools, welfare programs, and hospitals through a wide web of affiliated organizations. Access often depends on cost, location, and personal connections – barriers that have become even more acute during the current conflict.
For many women approaching delivery, the uncertainty is overwhelming.
Yara, 28, from east Beirut, is 33 weeks pregnant and had planned to deliver in a public hospital. Now, she is unsure whether the facility will still be operational after her due date arrives.
“I dream of security and a home where I can hold my child in my arms without any fear and without the sound of any explosion,” she said.
Edited by: Jay Wingard