Maha Rauf
Period poverty is a salient and often overlooked issue in conflict zones. This is the case in the Gaza Strip where conflict is having a direct and lethal impact on women’s reproductive health. Following the escalation of hostilities by the Israeli military after the Hamas attack on Israel on 7 October 2023, intense bombardment and the imposition of a blockade – including the limited admission of food, electricity and fuel – has led to a water crisis and the complete collapse of hospitals and healthcare facilities in Gaza.
The United Nations Children's Fund (UNICEF), United Nations sexual and reproductive health agency (UNFPA), and the World Health Organization (WHO) have found that women and children are disproportionately impacted by the humanitarian crisis, not only as casualties but also in reduced access to health services and sanitation. For the approximately 700,000 women and girls in Gaza currently experiencing period poverty, the lack of water, pads, toilet paper, soap, and sanitary products to clean and wash themselves poses tremendous health risks.
Period poverty is defined as the lack of access to menstrual products, hygiene facilities, waste management and education. Menstrual health is, according to UNFPA, a crucial determinant and outcome of reproductive and sexual health – the right to which is implied in international law. The UN’s sustainable development goals highlight the right to menstrual hygiene, outlining the need to protect the ‘reproductive rights of women as a human rights issue’ and to ensure guaranteed access to ‘safely managed drinking water, sanitation and hygiene services.’
Article 14(2) of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) requires measures to be taken in the field of health to eliminate discrimination against women, including safeguarding women’s function of reproduction and access to adequate healthcare facilities. CEDAW includes the right to ‘enjoy adequate living conditions… in relation to water and sanitation which are critical for the prevention of diseases and the promotion of good health care’. The UN Special Rapporteur on the human right to safe drinking water and sanitation has commented on the current use of water as a ‘weapon of war’ in the Gaza strip – one that is in ‘brazen breach of international law’ and that ‘coupled with the massive displacement’ creates ‘the perfect scenario for an epidemic that will only punish innocents, once again’. He stated that "the impact on public health and hygiene will be unimaginable’ and added that ‘under Article 7 of the Rome Statute, intentionally depriving the civilian population of conditions of life, calculated to bring about their destruction, is an act of extermination and classified as a crime against humanity".
The staggering deprivation in Gaza needs to be urgently addressed as circumstances are so dire that women are resorting to using scraps of tent as period products and taking period-delaying pills (norethisterone tablets), which have dangerous side effects, in an attempt to manage their menstrual cycles. There is no privacy in overcrowded shelters and encampments. Lines for toilets are extremely long and many women and girls have gone weeks without being able to bathe. This inability to practice basic hygiene and safely manage their menstrual health is not only dangerous, but also humiliating and an affront to these women and girls’ dignity. This is aptly summed up by a UNICEF spokesperson’s comment, “this situation is particularly challenging for women and adolescent girls who lack safe, private, and dignified places to manage menstrual hygiene”. This is at odds with the International Covenant on Civil and Political Rights (ICCPR) highlighting individuals right to enjoy ‘the right to life with dignity’ and the International Covenant on Economic, Social and Cultural Rights’ (ICESCR) right to ‘the highest attainable standard of mental and physical well-being’.
Women in Gaza have been sharing the difficulties of managing period poverty amidst the humanitarian crisis, stressing that it is an added layer of suffering in what is already an unfathomably desperate situation. Bisan Owda, a young woman who has been documenting the siege of Gaza shared a post stating that: “...we’re suffering from being hungry, from being thirsty, from being bombed. We’re suffering from being displaced. Now, we’re suffering also because there’s no pads. It’s just a new suffering.” She shares footage of makeshift bathrooms in a Khan Younis tent encampment, consisting of a garbage basket on the ground. “There is no water”, she states in the video, “there is nothing around them. There is no infrastructure”. Jumana Shahin, an activist in Gaza remarked that the scale of the humanitarian crisis has meant that women’s needs are often relegated or neglected, commenting that “the situation is harder than you can imagine”.
While an immediate and permanent ceasefire is desperately needed, it is important also to include the specific needs of women in emergency programming. The report of the Special Rapporteur on the human right to safe drinking water and sanitation emphasises that effective menstruation management should be integrated into water, sanitation, and hygiene (WASH) strategies. As such, it is crucial to ensure the distribution of culturally appropriate menstrual products and the integration of measures such as access to safe and private toilet and bathing spaces as well as sexual and reproductive health education to improve menstrual literacy. The Rapporteur stresses that ‘approaches must go beyond advocacy to address policies, infrastructure, maintenance systems and monitoring to ensure that services are adapted to the specific needs of users’.
Conflict has always been a reproductive justice matter and the systematic denial of sexual and reproductive rights for Palestinian women in Gaza is a vital feminist issue. As capsulised by global women’s rights expert Lina Abirafeh, “Palestine is a litmus test to our collective commitment to human rights, and to the sexual and reproductive rights of all women and girls”. There is no freedom for women anywhere without reproductive freedom for Palestinian women.
Maha Rauf was an intern with the Australian Journal of Human Rights in summer 2024.