Israel’s 15-month war on Gaza, as well as severe restrictions it imposed on the flow of humanitarian aid and Israeli forces’ attacks on health facilities and targeting of healthcare workers, have led to “life-threatening danger” for pregnant women and babies, Human Rights Watch (HRW) has said in a new report.

Despite the ongoing ceasefire, the precarious conditions under which women in Gaza are giving birth are unlikely to improve, the group noted in the report published on Tuesday, as Israeli legislation targeting the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and taking effect this week is expected to severely limit the delivery of humanitarian relief to the devastated territory.

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The group found that women in Gaza have been rushed out of overcrowded hospitals, sometimes within hours of giving birth, in order to make room for war casualties. Newborn care has also been severely impacted, with one doctor at al-Helal al-Emirati Maternity Hospital in Rafah saying that the facility had so few incubators and so many preterm babies that doctors there were forced to put “four or five babies in one incubator”.

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“Most of them don’t survive,” the doctor added.

Several babies have died from the lack of shelter amid freezing temperatures.

In the 56-page report, HRW concluded that Israel — as the occupying power in Gaza — has violated the rights of pregnant women and girls, including the right to dignified care in pregnancy, childbirth, and the postpartum period, as well as the right to newborn care.

The group also stressed that two pieces of legislation passed by the Israeli Knesset last year and taking effect on Tuesday threaten to “further exacerbate the harm to maternal and newborn health”. The bills, which bar UNRWA from operating in Israel and occupied East Jerusalem and the Israeli government from contact with the agency, effectively make it impossible for UNRWA to get permits for its staff and to deliver much-needed aid to Gaza.

Belkis Wille, HRW’s associate crisis, conflict and arms director, told Al Jazeera that “despite the fact that the ceasefire could provide an opportunity for the healthcare system in Gaza to begin to be restored, because of the laws coming into effect, banning the operations of UNRWA, the reality is that these coming weeks may lead to pregnant women and newborns suffering even more than they already have”.

“The provisions of the ceasefire don’t really address any of the significant needs that are outlined in the report,” Wille added.

According to the report, as of this month, emergency obstetric and newborn care is only available at seven out of 18 partially functioning hospitals across Gaza, four out of 11 field hospitals, and one community health centre.

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All medical facilities operating in Gaza face “unsanitary and overcrowded conditions” and serious shortages of essential healthcare supplies, including medicine and vaccines. And medical workers, “hungry, overworked and at times under military attack”, are scrambling to tend to victims of attacks while also addressing countless cases of waterborne and other communicable diseases, the report adds.

HRW conducted interviews with women who were pregnant while living in Gaza during the war, medical workers from Gaza, and international medical staff working with international humanitarian organisations and agencies operating teams in Gaza.

The interviews paint a horrific picture of the war’s impact on access to basic care during pregnancy and birth.

Little information is available on the survival rate of newborns or the number of women experiencing serious complications or dying during pregnancy, birth, or postpartum, HRW notes. But the group points to testimony by maternity health experts who reported that the rate of miscarriage in Gaza had increased by up to 300 percent since war began on October 7, 2023. It also pointed to UN reports that at least eight infants and newborns have died from hypothermia due to lack of basic shelter.

Israel’s war has led to an unprecedented displacement of some 90 percent of Gaza’s residents, many of whom were displaced multiple times. That has made it impossible for pregnant women to safely access health services, the report found, noting that mothers and newborns have had almost no access to postnatal care.

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Late last year, Human Rights Watch concluded in a different report that Israel was committing “acts of genocide” by denying clean water to Palestinians in Gaza. It also found that Israel’s use of “starvation as a method of warfare” led to severe food insecurity.

Pregnant women have been particularly impacted by lack of access to food and water, with critical consequences for their own health and for fetal development. Many pregnant women have reported dehydration or being unable to wash themselves, the report added.

“Israeli authorities’ blatant and repeated violations of international humanitarian law and human rights law in Gaza have had a particular and acute impact on pregnant women and girls and newborns,” Wille said. “The ceasefire alone won’t end these horrific conditions. Governments should press Israel to urgently ensure that the needs of pregnant women and girls, newborns, and others requiring health care are met.”