UN Report Finds Israel Guilty of Genocide and Extermination Against Women and Girls in Gaza, Through “Systematic Destruction” of Reproductive Healthcare

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On March 13, a devastating report, “‘More than a human can bear’: Israel’s systematic use of sexual, reproductive and other forms of gender-based violence since October 2023”, was issued by the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel.

The report’s most alarming findings are that, since October 2023, as described in an accompanying press release, Israel has engaged in “acts which amount to the crime against humanity of extermination”, through the deaths of women and girls “from complications related to pregnancy and childbirth due to the conditions imposed by the Israeli authorities which have denied access to reproductive healthcare.”

In addition, “through the systematic destruction of sexual and reproductive healthcare”, which has “destroyed in part the reproductive capacity of Palestinians in Gaza as a group”, the Commission found that Israel has engaged in acts “amounting to two categories of genocidal acts in the Rome Statute and the Genocide Convention”; namely, “deliberately inflicting conditions of life calculated to bring about the physical destruction of Palestinians and imposing measures intended to prevent births.”

The Commission also found “an increasing proportion of female fatalities in Gaza, which have occurred at an unprecedented scale as a result of an Israeli strategy of deliberately targeting residential buildings and using heavy explosives in densely populated areas”, documenting “cases in which women and girls of all ages, including maternity patients, were targeted”, and finding that these are “acts that constitute the crime against humanity of murder and the war crime of wilful killing.”

The Commission also “documented extremely unsafe conditions for women giving birth in Gazan hospitals, including lack of specialized personnel, medication and equipment”, with medical professionals explaining that “they faced severe challenges in managing patients’ pain and preventing infections as hospitals often lacked adequate supplies, including epidurals, hypertension medication, anesthesia, analgesia, anti-D immunoglobulin and antibiotics.”

As the Commission proceeded to explain, “Women described delivering their babies in extremely precarious conditions in hospitals impacted by the continuing hostilities, amid lack of specialized personnel, beds, pain medication and adequate facilities”, and the report noted that “the lack of pain relief medication particularly impacted women who had undergone Cesarean Sections.” Medical personnel also noted “increases in maternal morbidity and neonatal and intrapartum fetal death which was more likely due to the extremely difficult conditions, including the lack of space, medication and equipment. One obstetrician who spoke about the deaths of pregnant patients he had treated referred to them as “indirect victims of war.”

Women in Gaza also told the Commissions that they had “increasingly resorted to unsafe deliveries at home or in shelters, with little or no medical support”, while those who did manage to give birth in hospitals often found that, because of the demands on the hospital’s limited services, “they were discharged to make space for new patients just a few hours after giving birth.”

The Commission also examined the effects of Israel’s use of starvation as a method of war, and how “starvation and famine have had a severely detrimental impact on women and girls, in particular pregnant and post-partum women”, and also highlighted “the specific needs of women in relation to menstrual and reproductive health after interviewing several women who spoke about unsanitary conditions due to the overcrowding and the lack of water”, and the subsequent increase in infections.

The second half of the report deals with Israel’s “systematic use of sexual and gender-based violence”, examining the rise of violent misogyny against Palestinian women ad girls in Israel since October 7, 2023, and chronicling abuses in sections of the report dealing with the sexual harassment and public shaming of Palestinian women, sexual violence against women and men at checkpoints and during evacuations, and in detention, as well as sexual and gender-based violence by settlers and other civilians in the West Bank.

The report is the second published by the Commission in the last five months, and largely follows on from the findings of that first report last October, which, as described in an accompanying press release, established that “Israel has perpetrated a concerted policy to destroy Gaza’s healthcare system as part of a broader assault on Gaza, committing war crimes and the crime against humanity of extermination with relentless and deliberate attacks on medical personnel and facilities.” I wrote about the Commission’s findings at the time, in an article entitled, UN Report Confirms Israel Guilty of War Crimes and “Extermination” in Attacks on Gaza’s Hospitals.

The massively underestimated death toll in Gaza

In total, as the Commission also established in its latest report, of the more than 46,000 people who are confirmed to have been killed by Israeli forces in Gaza since October 2023, one-third — over 15,000 people in total — were women and girls. No one knows how many more women and girls have died or been killed, beyond the official figures, or how many more face a death sentence because of Israel’s systematic destruction of Gaza’s healthcare facilities, and its failure to allow sufficient medical supplies into Gaza since its 15 months of direct killing ended, and the ceasefire deal with Hamas began on January 19.

As medical experts and historians of warfare have long noted, beyond direct deaths, “indirect victims of armed conflict die from a variety of specific causes, usually from easily preventable diseases … or from hunger and malnutrition [as] a result of the loss of access to basic health care, adequate food and shelter, clean water, or other necessities of life”, as was stated in the Geneva Declaration Secretariat’s ‘Global Burden of Armed Violence’ report in 2008.

In July, when the official death toll in Gaza was around 37,000, medical experts who wrote to The Lancet, as I reported here, suggested that the toll of direct and indirect deaths would end up being at least five times that number, or 186,000 in total. Based on the latest official death toll, that would mean that the toll of direct and indirect deaths will end up being 230,000, of whom over 75,000 will be women and girls.

In December, however, Dr, Ghassan Abu Sitta, the British Palestinian reconstructive surgeon who worked in Gaza’s hospitals in the early months of Israel’s genocide, told Democracy Now! that it was realistic to expect that a more realistic death toll is 300,000, because of the almost complete destruction of the healthcare system, affecting those with pre-existing conditions, and mothers and babies, and also taking into account the spread of infectious diseases, meaning that 100,000 women and girls will have been killed by Israel in total.

Dr. Abu Sitta reiterated his concerns last month, along with a colleague, Prof. Nizam Mamode, a retired British transplant surgeon from Hampshire who had worked at Nasser Hospital in southern Gaza, and who told the Guardian that “the number of ‘non-trauma deaths’ could ultimately be considerably higher than 186,000.

Dr. Abu Sitta explained how “entire teams of medical specialists had been eradicated from Gaza”, and also spoke about the spread of diseases, saying, “Hepatitis, diarrhoeal disease, respiratory disease, polio that re-emerged in the war, will all continue because there’s still no sewerage and clean drinking water, still no housing, no primary-care clinics. You’re not going to be able to stop, or even stem, infectious diseases.” He also “warned of the proliferation of drug-resistant bacteria”, and pointed out that 13,000 wounded people “required immediate surgical interventions.”

The UN Commission of Inquiry also noted the obstacles raised by Israel to urgent medical treatment, and, specifically, evacuations, stating that, “in 2022, Israeli authorities approved about 13,500 patient permit applications to seek medical treatment outside Gaza”, but that, after October 7, 2023, “Israel only approved the medical evacuation of 4,947 patients until the closing of the Rafah crossing” in May 2024, and that, from then until January 15 this year, only 458 patients were evacuated.

As the Commission proceeded to explain, as a result “patients have suffered physically and mentally, and some have died owing to lack of adequate cancer treatment”, including “patients with gynaecological cancer such as ovarian, cervix and breast cancer.” The Commission “spoke to a doctor who described treating a patient with vulva cancer in December 2024. The patient’s tumour had been growing for eight months while she had waited to be approved travel outside of Gaza for radio-chemotherapy. As no non-invasive treatment was available in Gaza, the doctor had to undertake surgery. Radio-chemotherapy was needed to shrink the tumour. According to the doctor, the physical and mental suffering for the patient was immense.”

Huge healthcare challenges since the ceasefire began

On March 15, Hadeel Awad, a nurse and writer in Gaza, who worked at Al-Shifa Hospital until the Israeli army’s first violent invasion of the hospital in November 2023. She wrote that, although the resumption of aid deliveries after the ceasefire began on January 19 was, of course, essential, it “could hardly resuscitate the collapsed healthcare system in Gaza”, where “so many hospitals and clinics have been destroyed, especially in the north, that humanitarian organizations have had to set up tents to provide basic care for hundreds of thousands of survivors.”

The damage to the healthcare system in Gaza is so severe that, as Awad described it, it cannot even begin to “address the multiple health crises plaguing the civilian population”, including “the shocking number of amputees that Israel’s indiscriminate use of explosive weapons for 15 months has left behind.” As she proceeded to explain, “According to the World Health Organization, as of September 2024, 22,500 people in Gaza had sustained life-altering injuries since October 7, 2023, including severe limb injuries, amputations, spinal cord trauma, traumatic brain injuries and major burns.”

There have been some positive developments for the critically wounded in Gaza since the ceasefire began, primarily through the reopening of the Rafah Crossing to Egypt, which Israel took over and closed in May 2024, causing numerous preventable deaths in the eight months that followed. In August, Ismail Althwabta, the head of the Gaza Media Office, told a press conference that the blockade had “directly resulted in the deaths of over 1,000 children, patients, and injured people due to a lack of access to necessary medical care”, and that it had “also prevented 25,000 patients and injured people from seeking medical treatment abroad.”

On February 1, Israeli soldiers finally withdrew, and the Rafah Crossing reopened, under the control of the Palestinian Authority, with observers from the EU’s Border Assistance Mission.

Since then, more than 3,500 seriously ill or injured Palestinians have been able to secure life-saving treatment abroad, although even this hasn’t addressed the scale of the crisis. The week before the crossing reopened, António Guterres, the UN Secretary General, “called for 2,500 children to be immediately evacuated from Gaza for medical treatment after meeting US doctors who said the children were at imminent risk of death in the coming weeks”, as the Guardian reported at the time.

There is also a sting in the tail, as those evacuated for medical treatment are only allowed to travel with one relative, and there are fears, as Middle East Monitor explained in January, that those evacuated for medical treatment will never be allowed back home. As Hala Sabbah of the Sameer Project said, “There’s a big chance once the genocide ends and they open the borders that these people are not going to be able to come back.” As Middle East Monitor added, “Lawyers and asylum judges have echoed this concern, noting that evacuated families may remain separated for decades, trapped in limbo and unable to return home.”

As Hadeel Awad also explained in her article, Israel’s latest actions have also made matters worse. As she stated, “the medical supplies that came in” after the ceasefire began were “already running out”, even before Israel cruelly and illegally imposed a new siege two weeks ago, blocking all humanitarian aid, and breaking the terms of the ceasefire deal, in what was described by CNN as an effort to pressurize Hamas into “accepting new terms for an extension of the ceasefire agreement”, but which appeared to be a naked ploy by Israel to derail implementation of the second phase of the deal, which is meant to see the full withdrawal of Israeli military forces from Gaza and the release of the last 24 surviving hostages seized by Hamas and other militants on October 7, 2023.

Condemnation of Israel’s renewed siege, but continuing western hypocrisy

Israel’s re-imposition of a deadly siege on Gaza attracted widespread condemnation, not only from UN agencies and NGOs, but also from two of Israel’s staunchest supporters, Germany and the UK, whose foreign ministers joined with France “to warn that Israel could be in breach of international law by halting the entry of aid into Gaza”, which, as they described it, was “facing a ‘catastrophic’ humanitarian crisis.” As the foreign ministers added, “Humanitarian aid should never be contingent on a ceasefire or used as a political tool. We reiterate that the civilians of Gaza who have suffered so much must be allowed to return to their homes and rebuild their lives.”

These were fine words, and perhaps indicative of a belated recognition of the ever-growing mountain of evidence that Israel’s actions since October 2023 have involved war crimes, crimes against humanity and genocide, but they mean nothing without concerted action, and on that front Israel remains as fundamentally unchallenged as ever.

The report by the UN Commission of Inquiry continues a commendable tradition of the UN appointing legal experts (via the special procedures of the Human Rights Council) to analyze and report on profound violations of human rights and international humanitarian law by member states, but, as a whole, the UN remains as stymied by the lack of any enforcement mechanisms as it has been throughout its history (and Israel’s history), a position repeatedly made clear through the power, in the Security Council, of the US, one of the five “victors” of the Second World War who are the only countries permitted to wield a permanent veto, which the US repeatedly exercises on Israel’s behalf.

As for the west, neither governments nor the media can be trusted. The BBC, noticeably biased in Israel’s favor through the control wielded by its online Middle East editor, Raffi Berg, responded to the UN report by lavishly reporting Israeli complaints, including an assertion, on behalf of the Israeli government, that it “categorically rejects the unfounded allegations”, and an additional comment by Benjamin Netanyahu, who, apparently, “responded angrily”, calling the Human Rights Council “an antisemitic, rotten, terrorist-supporting and irrelevant body.”

Nowhere in the BBC’s report was it made clear that the UN’s report was fact-based, rather than based on “unfounded allegations”, or that its findings can be easily corroborated by anyone who has paid attention to Israel’s targeted genocidal war on Gaza’s hospitals and its entire healthcare system over the last 17 months, or the clear evidence of monstrously disproportionate attacks on residential buildings, in which the casualties have, predominately, been women and children.

Meanwhile, the western governments expressing “concerns” about Israel’s new siege are clearly hypocritical, as they fail to acknowledge how slavishly they supported the initial, deadly and illegal siege imposed after October 7, and they also all refuse to ban arms sales or to impose any meaningful sanctions on Israel. They also — despite recent and significant tensions regarding Ukraine — all fundamentally remain subservient in their opinions and actions regarding Israel to the US, whose leadership has passed from the despicable “iron-clad” support offered to Israel throughout the genocide by the ailing Joe Biden to the mercurial chaos of Donald Trump.

Is peace possible?

Although Trump, via his Middle East Envoy, Steve Witkoff — a property developer with no discernible background in international diplomacy — is credited with having pushed for the ceasefire to begin on January 19, his actions since have been massively counter-productive, as he — and Witkoff — have repeatedly sought to ethnically cleanse or forcibly displace the entire surviving population of the Gaza Strip (for claimed “humanitarian reasons”), so that, as Trump announced to an unsuspecting world a month ago, it could be remade as “the Riviera of the Middle East.”

Trump’s attempts to bully other nations into complicity in what would be an almost unthinkably colossal crime have, of course, failed. Neither Egypt of Jordan can afford to be strong-armed by Trump into accepting two million refugees and destabilizing their regimes, and recent suggestions — to expel everyone to Sudan, Somalia or Somaliland — look nothing short of ridiculous.

Nevertheless, Trump’s interventions have given an unwarranted boost to Netanyahu and the Israeli far-right, even though, overall, the country remains critically divided. When the ceasefire began, astute Israeli commentators recognized that it had more to do with Netanyahu’s deliberations regarding internal Israeli politics than it had to do with Trump or Witkoff, with Netanyahu aware of the growing problems caused by the hostages’ families, who correctly blamed him for sacrificing their loved ones in pursuit of a genocide, as well as the growing problems of a public cooling in their enthusiasm for endless slaughter, and a demoralized and exhausted military.

Netanyahu counted on far-right dissent within his government — which he relies on to cling to power — being placated by Trump’s evident willingness to allow massively increased violence and settler expansion in the West Bank, to stop the fanatical far-right minister Bezalel Smotrich from resigning and collapsing the government, and so far he has been proven right.

Nevertheless, the far-right pressure to resume the genocidal violence in Gaza remains a threat. Looking at the ruins of Gaza, it ought to be inconceivable that any resumption of hostilities akin to the relentless genocidal assault preceding the implementation of the ceasefire would be acceptable, but who, 17 months ago, could have foreseen the extent to which western governments, day after day, turned a blind eye to carnage and destruction on an unprecedented scale, and, in most cases, fully supported it?

If the tide is to turn, the best outcome may be through an Egyptian-led proposal for Gaza’s reconstruction, endorsed at an Arab League summit in Cairo on March 4. The $53bn plan, swiftly drawn up to counter Trump’s ethnic cleansing Riviera plan, immediately secured the support of Germany, the UK, France and Italy, although the US and Israel, predictably, refused to endorse it.

Without a coherent way forward, however, the real danger is that the ceasefire deal will collapse, Netanyahu will decide to sacrifice the remaining hostages, and the slaughter will resume. It’s horrendous enough that Israel still hasn’t properly been held to account for its many grave crimes since October 2023, including its war on women and girls, so thoroughly exposed by the UN Commission of Inquiry, and while, every day, it’s reassuring that the full-scale bombing hasn’t resumed, that is a small relief when the Palestinians of the Gaza Strip continue to die through a slower but scarcely less devastating ongoing genocide.

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Andy Worthington is a freelance investigative journalist, activist, author, photographer (of an ongoing photo-journalism project, ‘The State of London’), film-maker and singer-songwriter (the lead singer and main songwriter for the London-based band The Four Fathers, whose music is available via Bandcamp). He is the co-founder of the Close Guantánamo campaign (see the ongoing photo campaign here) and the successful We Stand With Shaker campaign of 2014-15, and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo”, which you can watch on YouTube here.

In 2017, Andy became very involved in housing issues. He is the narrator of the documentary film, ‘Concrete Soldiers UK’, about the destruction of council estates, and the inspiring resistance of residents, he wrote a song ‘Grenfell’, in the aftermath of the entirely preventable fire in June 2017 that killed over 70 people, and, in 2018, he was part of the occupation of the Old Tidemill Wildlife Garden in Deptford, to try to prevent its destruction — and that of 16 structurally sound council flats next door — by Lewisham Council and Peabody.

Since 2019, Andy has become increasingly involved in environmental activism, recognizing that climate change poses an unprecedented threat to life on earth, and that the window for change — requiring a severe reduction in the emission of all greenhouse gases, and the dismantling of our suicidal global capitalist system — is rapidly shrinking, as tipping points are reached that are occurring much quicker than even pessimistic climate scientists expected. You can read his articles about the climate crisis here. He has also, since, October 2023, been sickened and appalled by Israel’s genocide in Gaza, and you can read his detailed coverage here.

To receive new articles in your inbox, please subscribe to Andy’s new Substack account, set up in November 2024, where he’ll be sending out a weekly newsletter, or his RSS feed — and he can also be found on Facebook (and here), Twitter and YouTube. Also see the six-part definitive Guantánamo prisoner list, The Complete Guantánamo Files, the definitive Guantánamo habeas list, and the full military commissions list.

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