In a fragile tent among the ruins of Rafah, Palestine, Bahr began to experience labor one early day in May.

With no car to navigate the debris-laden streets to the hospital, she hurried to secure a donkey cart.

As her contractions intensified, she rattled through the city's southern Gaza streets.

Upon arriving at Al Helal Al Emirati Maternity Hospital, Bahr found herself 10th in line, enduring a three-hour wait before seeing a doctor.

It took another three hours before she was finally taken to an operating room, where she delivered her daughter, Ghina, via cesarean section.

However, Bahr developed blood clots.

With no beds available for in-patients, she returned to her tent, resigning herself to traveling to and from the hospital for treatment.

Two days after giving birth, she was forced to flee her makeshift home when Israeli forces stormed Rafah.

It was the fourth time Bahr, originally from the central city of Deir al-Balah, had to flee due to conflict.

"Since the war began, it has been a constant fight for survival, even for the most basic human right: bringing a child safely into the world," said Bahr, 33, in a phone interview with the Thomson Reuters Foundation from Khan Younis in late May.

"It wasn't just the physical pain, but the constant worry gnawing at me – would my baby be OK? Would I be OK?"

Bahr is among thousands of women who have navigated bombs and bullets to give birth in a land where over 38,000 people have been killed by the Israeli military since its assault on the Gaza Strip began nine months ago.

The offensive followed Hamas' incursion into Israel on Oct. 7, resulting in around 1,200 deaths and 250 hostages.

Since then, over half of Gaza's 2.3 million residents have crowded into Rafah, seeking shelter from an offensive that has destroyed homes, schools, and vital infrastructure like hospitals and clinics.

More than 87,000 people have been injured, and the few hospitals still operational struggle to cope with the daily influx of people wounded in Israeli airstrikes.

In May, the World Health Organization reported that only about one-third of Gaza's 36 hospitals and primary health care centers were partially operational.

Israel attempts to justify its attacks on hospitals, claiming Hamas uses them for military purposes – a claim both hospital staff and Hamas deny.

For mothers like Bahr, giving birth in a war zone is just the first step in a traumatic journey marked by constant fear and anxiety.

"The makeshift tent barely shields us from the elements, let alone the constant fear that grips our hearts. It's no place to raise children or recover from childbirth," Bahr said.

"My body is barely healed from childbirth, and now I have to fight to keep my daughter alive."

Born into hell

The U.N. children's agency UNICEF has said mothers in Gaza face "unimaginable challenges" accessing adequate medical care, nutrition, and protection before, during, and after giving birth.

"The trauma of war also directly affects newborns, resulting in higher rates of undernutrition, developmental issues, and other health complications," said Tess Ingram, UNICEF's communications specialist, during a Geneva press conference in January.

"Becoming a mother should be a time for celebration. In Gaza, it's another child born into hell," Ingram said.

In May, the main maternity hospital in Rafah, where Bahr gave birth, stopped admitting patients.

The hospital has seen a drop of over 50% in staff and patients since Israeli forces entered Rafah in May, said Naheel Jarrour, an obstetrician there.

"We prepared places for pregnant women on the floor to get treatment or even to deliver their babies because there were not enough beds," she said, adding that fighting had prevented her from reaching the hospital for weeks.

Aurelie Godard, head of Medecins Sans Frontieres' medical activities in Gaza, said many women are forced to give birth outside the formal medical system.

"For many women, especially in Rafah, access to transportation and hospitals remains a challenge," Godard told the Thomson Reuters Foundation.

Despite efforts, humanitarian organizations struggle to provide services to around 2,200 women giving birth in Gaza monthly, she added.

"My friend was trapped in the north and had to deliver her baby at home," Jarrour said. "Alone in the bathroom, she cut the umbilical cord herself with scissors."

Miscarriages have also risen due to food shortages and the stress of constant danger and displacement, according to ActionAid.

Godard said critically ill patients in intensive care were also at risk due to evacuation orders requiring constant relocation of medical equipment.

Other hospitals in Rafah, like Abu Yousef al-Najjar and Kuwaiti hospitals, closed due to evacuation orders.

Hungry babies

The trauma for new mothers continues as they try to care for their babies with food, power and other essential supplies in short supply.

More than 495,000 people across Gaza face the most severe, or "catastrophic," food insecurity, according to an update from the Integrated Food Security Phase Classification, an initiative involving U.N. agencies, regional bodies, and aid groups.

Israel claims it places no limits on humanitarian supplies for Gaza civilians and blames the United Nations for slow deliveries, arguing "inefficiency."

Medicines are scarce, forcing new mothers to improvise care for their babies.

"The fear is constant. Will this homemade remedy work? Will I make things worse? This isn't the kind of fear a mother should have to live with," said 23-year-old Asmaa Salah Abu Jabal in an interview with the Thomson Reuters Foundation.

She turned to the internet for alternatives to treat her four-month-old daughter's cold.

"We cannot be doctors overnight, desperately searching the internet for answers," she said.

Nineteen-year-old Soad al-Masri described the challenge of caring for her newborn daughter, Layan, in a tent made unbearable by the scorching summer heat.

"My daughter feels suffocated in winter clothes borrowed from neighbors," she said. "It is extremely hot, and there is no air."

In search of relief, Masri often walks Layan to the seashore, hoping for a cool breeze.

"Every time, seeing my daughter struggle to breathe breaks my heart."