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Sex Reprod Health Matters
Sex Reprod Health Matters
Sexual and Reproductive Health Matters
2641-0397
Taylor & Francis

39230503
2397956
10.1080/26410397.2024.2397956
Version of Record
Editorial
Editorial
Sexual and reproductive health and rights in Palestine – securing spaces to speak out
L Ferguson, S Desai. Sexual and Reproductive Health Matters
L Ferguson, S Desai. Sexual and Reproductive Health Matters
https://orcid.org/0000-0002-1340-793X
Ferguson Laura a
https://orcid.org/0000-0003-2596-9726
Desai Sapna b
a Associate Editor, Sexual and Reproductive Health Matters, London, UK. Correspondence: laura.ferguson@med.usc.edu

b Co-Chair of Trustees, Sexual and Reproductive Health Matters, London, UK
4 9 2024
2024
4 9 2024
32 1 2397956Nova techset9 9 2024
Converted to JATS 1.2 by Nova Techset9 9 2024
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
2024
The Author(s)
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
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pmcIntroduction

As the world continues to wait for a ceasefire in Gaza, we at Sexual and Reproductive Health Matters (SRHM) reflect on our role as a journal* in bearing witness to violations of sexual and reproductive health (SRH)-related human rights. We regularly publish articles and editorials that do exactly this, including last year’s editorial on the Russia-Ukraine conflict and previous articles on Palestine.1–3 Yet, writing about the current situation has proved more complex.

Ten months into the current crisis, the journal has received only one submission specific to Palestine; we are now actively seeking articles from health service providers, human rights experts and others engaged in addressing the conflict. While several public health journals have published data on mortality and morbidity,4 sexual and reproductive health and rights (SRHR) have received far less attention.5,6

As we sat down to write this editorial – with the express intention of amplifying the gross violations of SRHR in this conflict – we considered how far the journal could or should go in addressing accountability. Amidst widespread political and personal backlash towards people voicing their views, including students, academics and others, we considered how to ensure this journal is not silent in the face of atrocious violations of SRHR – and to call attention to those most vulnerable. And, while recognising the impossibility of publishing on this topic without offending some deeply held personal and political views across the spectrum, including within our own organisation and readership, we are committed to providing a constructive space for evidence and documentation.

SRHR are inherently political, and this journal has prided itself on not shying away from politics. We have chosen to use the complex current moment to try to find clarity on what the role of a rights-based journal on SRH should be in writing and publishing about ongoing conflicts, to reflect about how we have previously written in this regard and, moving forward, to create an institutional policy to guide our editorials to ensure a consistent approach. As a journal and organisation dedicated to promoting and protecting rights and justice, we are clear that SRHM must bring attention to large-scale human rights violations with deep implications for SRHR. In this instance, we are speaking out about the ongoing violations of the health and human rights of Palestinians, with a focus on SRH.

The current situation

All war and conflict stems from complex, historically rooted geopolitics and, as has recently been described, there exist a multiplicity of interpretations of these situations.7 The current situation in Gaza did not begin on October 7th, 2023, when Palestinian armed groups attacked Israel. While it is beyond our remit to comment on the decades of history that contextualise this event – and we do recognise that civilians on both sides have experienced rights violations – it is critical to continue to amplify the SRHR implications of the ongoing atrocities that receive less attention than immediate mortality data and the humanitarian and political responses.

In recent months, the international community has made multiple statements in relation to the situation in Palestine. The United Nations (UN) Security Council, the UN Interagency Standing Committee, the World Health Organization (WHO) and others have all called for an immediate ceasefire and the expansion of humanitarian aid in Gaza.8–10 The International Court of Justice has directed Israel to ensure the delivery of basic services and essential humanitarian aid to civilians in Gaza.10 Further, the Security Council has demanded compliance with obligations under international law, deplored all attacks against civilians, expressed grave concern over the killing of humanitarian workers, and demanded “the lifting of all barriers to the provision of humanitarian assistance at scale”.11

As in all conflicts, it is civilians who bear the brunt of suffering. According to official statistics, the Israeli military operation has resulted in the deaths of over 40,000 Palestinians, most of them women and children, and the displacement, often multiple times, of 1.9 million people – constituting approximately 90% of the total population in Gaza.12 The UN has made clear statements on how the “complete siege” of Gaza ordered by the Israeli government has cut off water and electricity, displaced a large proportion of the population, created famine and destroyed basic infrastructure, including health facilities.13 Others have published important analyses of these impacts on health infrastructure and health in general.14

The negative impacts of all of this on SRHR have, however, received less attention. Following months of infrastructure destruction as well as disconnection of electricity, fewer than one-third of Gaza’s 36 hospitals and less than 30% of primary health care facilities remain partially functional, with the rest out of service.15 This greatly limits access to safe delivery facilities. Approximately 5,500 deliveries are estimated to occur monthly in Gaza and, even where women can deliver in a health facility, pressure on hospital beds requires that they be discharged very quickly, with most then having to return to temporary, overcrowded and often unsanitary accommodation.16 The context of water scarcity creates immense challenges relating not only to safe delivery but also to nutrition and menstrual hygiene management.

UNFPA has reported large increases in life-threatening obstetric complications and premature births, newborns dying because they weigh too little, women unable to breastfeed their babies because they are not getting enough food and critical shortages of nutritional supplements for pregnant and breastfeeding women.17 With access to family planning services and supplies severely disrupted, there is likely an increase in unintended pregnancies and sexually transmitted infections occurring, and reports also indicate increases in miscarriages, stillbirths and maternal deaths.18,19 As a result of Israel blocking aid efforts, medical supplies are in exceedingly short supply with widespread reports of surgeries, including Caesarean sections, being performed without anaesthesia.20

Sexual and gender-based violence (SGBV) continues to be a tool of war which can constitute a war crime. Reports, including one by the Office of the Special Representative of the Secretary General on Sexual Violence in Conflict, indicate multiple incidents of sexual violence carried out on October 7th.21 At the same time, in its recent report submitted to the UN Human Rights Council, the Independent International Commission of Inquiry on the Occupied Palestinian Territory concluded that since October 7th, the Israeli security forces have perpetrated SGBV amounting to torture or inhuman and cruel treatment.22 We underscore the difficulty noted in both reports in obtaining forensic or directly reported evidence, as is common during conflict and trauma, due to issues such as limited access to survivors and lack of operational humanitarian infrastructure. This compounds the difficulties understanding the experiences and challenges faced by any survivor of SGBV as well as the true scale of the situation. With SGBV a known feature of the current conflict and displaced populations particularly at risk, UNFPA has also reported a “total collapse of the pre-existing GBV referral pathway” in Gaza and “forced closure of most GBV response providers including police stations, safe houses, hotlines, counselling, and case management”.17

While the mental health impacts of the conflict in general are being discussed, the specific mental health impacts that result from the decimation of SRH-related rights – from losing pregnancies, from bearing children in this context, from experiencing SGBV, from inability to access services and commodities – remain under-documented. Moreover, the current attacks on women’s reproductive rights, especially rights and choices related to fertility and safe motherhood, will have continued societal and generational impacts.

Needed action

Echoing calls over the past several months, there is an imperative for immediate action. The UN Security Council has called for an “immediate, full and complete ceasefire”.11 Basic services such as water and electricity must be fully restored across Gaza, along with international investment to support reconstruction of housing, hospitals and other critical infrastructure.

Ensuring the provision of humanitarian aid and the restoration of SRH services requires immediate action. The minimum initial services package for SRH highlights the need to prevent sexual violence and respond to the needs of survivors, to prevent the transmission of HIV and other STIs and reduce related morbidity and mortality, to prevent excess maternal and newborn morbidity and mortality, and to prevent unintended pregnancies.23 The Sexual and Reproductive Health Technical Working Group in Gaza, part of the Global Health Cluster Sexual and Reproductive Task Team led by UNFPA, is working to implement this minimum package of services but continues to face severe constraints.19 Other organisations, such as the Palestinian Family Planning and Protection Association, and individuals, such as health workers, are working extremely hard in a very challenging context to meet the SRH needs of women and girls in both Gaza and the West Bank.24 Data for decision-making remain lacking and resources are grossly insufficient; Israel continues to destroy Gazan infrastructure and to block access to life-saving supplies and commodities.12 Continued access to SRH services and safe access for humanitarian efforts is imperative.

SRHM as a platform

Human rights violations, including SRHR violations, need immediate documentation and investigation. In many spaces, fear is stifling discussion of the situation in Palestine, and restricting opportunities to rigorously collect data and document SRHR violations, which may have contributed to the lack of submissions to SRHM. On such a historically charged topic, there will always be disagreements. But the world ostensibly comes together around human rights – a globally designed and agreed-upon set of rules for humanity. Where human rights, including SRHR, are violated, we must bear witness. Numerous public health organisations and advocates, including within the UN system, have spoken out on the health crisis at hand in Palestine, and the urgent need for continued pressure to end the violence.

For SRHM, egregious human rights violations and their associated SRH impacts cannot be left unaddressed. As a knowledge platform, it is our responsibility to share information on any situation where SRHR are impacted, to increase awareness of the issues and to highlight the need to uphold international human rights law as a critical tool for improving SRHR. We urge our community, readership and partners to continue to speak out on health and human rights violations, and to use this critical platform to highlight the often less-recognised implications for SRHR. The journal is committed to publishing a wide range of forms of evidence, including perspectives from those involved, service delivery accounts, rapid qualitative and quantitative research, critical analyses and testimonies. The current situation highlights the importance of multiple approaches to evidence generation to ensure the voices of the vulnerable are heard and counted – and that SRHR impacts are not ignored. We acknowledge the potential challenges in speaking out about these issues and we endeavour to work closely with authors to ensure that these voices can be safely heard; to this end, we encourage contact with the journal at editorial@srhm.org.

The SRHR impacts of war and conflict on the people in Palestine are, of course, also relevant to people living in the many other settings of ongoing conflict across the globe where we see similar patterns of violence, including the use of rape and sexual violence as weapons of war, war crimes and crimes against humanity, including the destruction of health facilities, denial of humanitarian aid and other violations of SRH-related rights. There are too many active conflicts to name and yet we cannot ignore them. SRHR violations during conflict, including sexual violence as a tool of war, have devastating physical and mental health impacts and destroy the fabric of societies already under siege. As an SRHR community, we must continue to document the rights violations, to amplify the specific SRH harms being caused and to mobilise for action to ensure SRHR are protected, especially in times of crisis and for generations to come.

Author contributions

The authors jointly conceptualised, wrote and finalised this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Provenance statement

This paper was commissioned and has been internally reviewed.

* We are grateful for the careful review and insights provided by Jane Cottingham, Faysal El Kak, Sofia Gruskin, Eszter Kismödi and Emma Pitchforth.
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