It took surgery and five years of IVF treatment for Amal to fall pregnant for the first and only time. That struggle against infertility lasted almost as long as her son Khaled’s short life. He was just seven years old when on 17 October an Israeli airstrike on Rafah, one of the first of the war, hit the family home.
Khaled was killed and Amal was plunged into a grief heightened by memories of her long battle to become a mother. Sometimes she struggles to keep going. “Death, in all its finality, seems less daunting than the relentless pain of living without Khaled,” she said. “He was the most precious thing in my life.”
The war in Gaza has created a grim inventory of different forms of loss. Among them is the particular pain of current and former IVF patients, in a place where large families are common and children are often the heart of daily life
Some, like Amal, had struggled with infertility for years and are now mourning the children who had arrived like personal miracles. In March another Israeli airstrike on Rafah killed Rania Abu Anza’s five-month-old twins, Wissam and Naeim, born after a decade of treatment.
Other women lost their only hope of becoming parents when the war halted treatment, the siege on Gaza halted the flow of medical supplies, and then airstrikes and fighting destroyed thousands of frozen embryos.
Nearly 50 women were midway through cycles of hormone injections, preparing for egg collection at al-Basma Center on 7 October. Another 10 were preparing for embryo transfers within days, said Baha al-Ghalayini, the founder of the centre and an IVF pioneer in Gaza. There were about 4,000 frozen embryos stored at the clinic, at least half of them belonging to couples who will not be able to undergo treatment to make new ones.
Ghalayini said his first major concerns came at the start of the war, when violence and shortages of liquid nitrogen prevented the clinic from topping up the coolant needed to keep storage containers at a steady 180 degrees below zero.
Then, in November 2023, worries about nitrogen supplies became irrelevant after an Israeli shell hit the clinic’s lab. The force of the explosion broke open the containers that for so many couples contained their first, last or only chance of having a child, thawing and destroying the contents.
“Embryo freezing represents a profound emotional and financial investment for couples trying to realise their dream of parenthood,” Ghalayini said. “The attack shattered all their dreams.”
After studying in the UK, he set up Gaza’s first fertility centre in 1997, overcoming initial resistance from religious leaders, and he has helped make IVF commonplace.
Airstrikes and fighting have destroyed buildings and state-of-the-art equipment worth hundreds of thousands of pounds, but his greatest concern is for his patients.
There were 250 women pregnant through IVF at the start of the war who needed monitoring, with many at higher risk of difficult birth. Most had to manage alone as Israeli airstrikes, attacks and evacuation orders shut down the majority of Gaza’s hospitals.
Those still operating are overcrowded and sometimes overwhelmed. Thousands of women are giving birth without medical assistance, the UN said, and combined with the lack of prenatal checks, this means mothers and newborns are dying.
Amal’s son, born in July 2016, would not have survived during this war. Born nearly two months premature, he had a twin brother, Adam, who died at three days old. Khaled was transferred to a Jerusalem hospital for specialist treatment.
A compromised immune system meant he was in and out of hospital until he was about four, but then his health improved and Amal could settle into a normal rhythm of life at their home in Tal al-Hawa, in western Gaza.
She found joy in small things, preparing school supplies and taking him to football, swimming and horse riding classes at the Friends Equestrian Club, where he had a special bond with a horse called Shams. The club has been bulldozed by Israeli forces, she said, and the horse, like Khaled, is dead.
After Israel launched airstrikes on Gaza, in response to the Hamas cross-border attack on 7 October, the family fled south to join Amal’s parents in Rafah, which Israel had declared a safe zone for civilians. Ten days later, Khaled was killed with his grandfather, uncle, aunt, cousins and 11 other relatives.
“I was at my father’s house, where we had sought refuge, reading prayers with Khaled beside me, when Israeli airstrikes devastated a neighbouring house, causing severe damage to our own,” Amal said.
Bleeding and dazed, she was taken to hospital from the ruins of their home, but when she looked for her son among the victims, she realised he was missing.
“It dawned on me then that he might still be trapped under the rubble of my father’s house. Frantically, I rushed back to the debris, calling out for my precious son, clinging to hope that he would emerge unscathed,” she said.
Her back and eyes were injured but she refused to leave through a long night as rescue teams searched for her son. “I desperately called out for Khaled while he lay trapped beneath the debris,” she said.
As the hours stretched on – the teams had little equipment to move concrete and rubble – her hopes became more modest. “I prayed fervently to be granted the chance to hold him close one last time, to see him before his burial.”
Khaled’s father was in Turkey at the time and could not return to Gaza to bury his only son. Amal carries a scar by her eye, a constant reminder of the night she lost the son she had fought so hard to bring into the world.
“Conceiving a child through IVF is torturous and demanding,” she said. “The scar is a mark I will carry for the rest of my days, a testament to the injustice I endured.”
