© 2025 Palestine Center for Public Policy
The destruction of Gaza’s reproductive health infrastructure has created a legal and humanitarian crisis of historic scale. As of July 2025, over 50,000 pregnant women remain displaced, many giving birth without skilled care, sterile supplies, or physical shelter. According to the World Health Organization (WHO), 94 percent of Gaza’s health facilities are damaged or destroyed. This includes nearly every maternity hospital and the sole in vitro fertilization (IVF) clinic. Women have delivered in tents, schools, and during displacement, often without electricity, anesthesia, or trained providers. Maternal mortality, preterm birth, and infant death rates have surged.
These are not just humanitarian failures. They represent breaches of binding international law. The Geneva Conventions, the Convention on the Prevention and Punishment of the Crime of Genocide (Genocide Convention), and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) require the protection of maternity wards, unimpeded access to medical supplies, and non-discriminatory access to maternal care. These obligations remain binding regardless of political context or allegations of misuse.
In March 2025, the United Nations Independent International Commission of Inquiry (UNIICI) concluded that the destruction of Gaza’s only IVF clinic constituted a deliberate strike on Palestinian reproductive capacity. That finding, based on satellite imagery, forensic analysis, and corroborated timelines, has been supported by multiple UN Special Rapporteurs and health law scholars. These acts, when assessed under Article II(d) of the Genocide Convention, raise legitimate legal concerns.
This brief calls for action within existing United States and international legal frameworks. These include a formal U.S. government review of military assistance, emergency support for reproductive care through vetted agencies, and a public commitment to judicial independence. Protecting maternal and neonatal health in Gaza is not only a moral responsibility. It is a legal requirement and a test of U.S. credibility as a defender of civilian protection.
The collapse of reproductive healthcare in Gaza reflects a structural legal failure that requires urgent international response. Under international humanitarian law (IHL), pregnant women and newborns are entitled to heightened protection, including access to delivery care and medical supplies. These are not aspirational ideals. They are enforceable obligations under the Geneva Conventions, the Genocide Convention, and CEDAW.
Since October 2023, these protections have been systematically denied. The UNIICI found that the destruction of the Al-Basma IVF clinic was a targeted attack on Palestinian reproductive capacity. This conclusion, grounded in forensic and legal evidence, is corroborated by the WHO, the United Nations Population Fund (UNFPA), and the International Committee of the Red Cross (ICRC). The result is not only immediate suffering but structural erasure. As UN Special Rapporteur Dr. Tlaleng Mofokeng and the O’Neill–Lancet Commission have noted, the denial of reproductive healthcare in occupied or racialized territories constitutes a form of reproductive violence and subjugation.
The legal frameworks are clear. What remains is enforcement. This brief applies binding legal standards to the documented destruction of Gaza’s reproductive system and recommends actionable policy tools that uphold both law and U.S. strategic integrity.
The legal obligations governing reproductive healthcare in conflict are unambiguous. Under the Geneva Conventions, which the U.S. has ratified and helped establish, maternity hospitals and medical units are protected. Article 16 of the Fourth Geneva Convention requires that maternity wards be safeguarded at all times. Article 23 mandates the unimpeded passage of medical supplies for pregnant women and children. These protections apply universally, even when military assets are allegedly nearby. A facility only loses protection if it is directly used to commit acts harmful to the enemy, and even then, only after a clear warning and time to evacuate. Suspicion or proximity does not nullify legal protections.
As of July 2025, WHO and UNFPA confirm that 94 percent of Gaza’s health facilities are damaged or destroyed. This includes all maternity hospitals and the only IVF clinic. The UNIICI found that the Al-Basma IVF clinic was not being used for military purposes. The clinic provided fertility treatment and preservation for cancer patients and families under medical supervision. Its destruction was deemed a targeted strike based on satellite evidence, witness accounts, and operational timelines. These findings have been supported by multiple international bodies, including the WHO and humanitarian NGOs.
Under the Rome Statute of the International Criminal Court (ICC), it is a war crime to intentionally attack medical facilities and a crime against humanity to cause severe suffering to civilians. While intent must be proven for criminal conviction, the scale and repetition of these attacks meet the threshold for investigation. The U.S., though not party to the Rome Statute, has supported ICC actions in Sudan, Myanmar, and Ukraine. Failure to apply the same legal reasoning to Gaza weakens U.S. legal credibility. Institutional bias claims must be tested against facts. Legal findings cannot be dismissed solely on political grounds.
The Genocide Convention, ratified by the U.S. in 1988, prohibits acts intended to destroy a group, including measures to prevent births (Article II(d)). In Gaza, the obliteration of maternity care, the IVF clinic, and access to obstetric supplies have severely impaired reproductive capacity. Although genocidal intent is challenging to prove, the pattern and foreseeability of harm require legal scrutiny. Evidence must be evaluated on legal grounds, not avoided because of discomfort with terminology.
Reproductive rights also include access to contraception. Under CEDAW and the International Covenant on Economic, Social and Cultural Rights (ICESCR), women are entitled to reproductive autonomy, including family planning during crisis. In Gaza, displaced women have been denied access to modern contraceptives and forced to carry pregnancies under siege and starvation conditions. This violates bodily autonomy and transforms reproduction into a tool of subjugation.
The Convention on the Rights of the Child (CRC), signed by the U.S., affirms every child’s right to survival and requires adequate maternal care. Though the U.S. has not ratified CEDAW, ICESCR, or CRC, it routinely applies these standards in its own human rights reporting, establishing their status as international norms.
UN Security Council Resolution 1325 (2000), implemented by the U.S. under the Women, Peace, and Security Act of 2017, reinforces the obligation to protect reproductive health in conflict zones. Ignoring Gaza while invoking these standards elsewhere undermines the rule-based order the U.S. seeks to uphold.
Customary IHL, codified by the ICRC, also applies. Rule 55 mandates unimpeded delivery of humanitarian relief, including for maternal care. The ICRC has confirmed that the blockade of Gaza violates this rule by obstructing incubators, anesthesia, and antibiotics. These are not policy choices. They are legal failures.
Continuing military support without initiating a legal review undermines the consistent application of international humanitarian law. In prior conflicts such as Afghanistan, Darfur, and Ukraine, the United States applied legal frameworks to condemn attacks on civilians and safeguard access to healthcare. Applying different standards to Gaza risks turning these legal principles into instruments of political convenience rather than enforceable norms. This inconsistency invites credible allegations of selective enforcement, weakens the authority of international law, and diminishes the credibility of long-standing commitments to civilian protection, women's rights, and the rule of law.
The treaties are binding. The standards are clear. The evidence is robust. The U.S. has the legal tools to ensure its assistance remains lawful and aligned with its core principles. Failure to act now risks weakening those standards worldwide, at a time when they are needed most.
The U.S. has the tools, the mandate, and the precedent. What follows are six concrete actions it can take now to uphold the law and respond to a crisis demanding more than words.
1. Conduct a Formal U.S. Human Rights Law Review of Military Aid to Israel
A Leahy Law (22 U.S.C. § 2378d) and Section 502B (22 U.S.C. § 2304) review of U.S. military aid to Israel is legally required when credible evidence of gross human rights violations exists. The destruction of Gaza’s only IVF clinic and repeated strikes on maternity hospitals meet this threshold. The State Department’s Bureau of Democracy, Human Rights, and Labor has full authority to initiate the review, and Congress may also request it. No new legislation is needed. Yet the review has not been initiated, reflecting political hesitation rather than legal constraint. This inaction undermines the credibility of U.S. law, exposes future administrations to legal and reputational risk, and signals to both allies and adversaries that U.S. human rights standards are subject to political convenience. Proceeding now is necessary to ensure legal compliance, preserve global rule-of-law leadership, and prevent lasting damage to U.S. standing.
2. Allocate Emergency Reproductive Health Funding Through UNFPA and WHO
In anticipation of a ceasefire or humanitarian pause, the U.S. should allocate $100 million from existing appropriations under the International Disaster Assistance and Migration and Refugee Assistance accounts. This funding should be directed through the Department of State’s Bureau of Population, Refugees, and Migration to the WHO and the UNFPA, the only internationally recognized actors with the operational capacity and neutrality required to deliver reproductive health services at scale in Gaza.
This allocation would lawfully support the deployment of mobile obstetric units, neonatal incubators, contraceptive access, clean delivery kits, and trauma-informed postnatal care. No new legislation is required. The Executive Branch has existing authority under 22 U.S.C. § 2601 and related waiver provisions to authorize emergency disbursement. Oversight can be maintained through standard third-party monitoring mechanisms already in use across comparable humanitarian operations.
This intervention is consistent with U.S. precedent in Syria, South Sudan, and Yemen. It preserves legal compliance under domestic and international obligations, supports rapid stabilization during a ceasefire, and reinforces the credibility of U.S. leadership in safeguarding civilian health in conflict-affected settings.
3. Preserve Procedural Neutrality in International Legal Proceedings
As a non-party to the ICC and given its strategic alliance with Israel, the United States is unlikely to endorse ongoing proceedings related to Gaza. However, to protect its global legal credibility, the U.S. should avoid obstructing the procedural functions of the ICC or the International Court of Justice. Internal guidance should confirm that the U.S. will not interfere with admissibility of evidence, cooperation by third states, or institutional funding. This mirrors past U.S. practice in Sudan, Myanmar, and Ukraine. By maintaining procedural neutrality without endorsing outcomes, the United States upholds judicial independence while preserving its foreign policy flexibility.
4. Include Reproductive Health Violations in the U.S. Human Rights Country Report
The State Department should ensure that its next annual Human Rights Report includes documentation of reproductive health violations in Gaza. These include the destruction of maternity hospitals, denial of obstetric care, and the collapse of access to modern contraception.
The Human Rights Report is the official record of U.S. assessments of legal and human rights standards worldwide. Including Gaza’s reproductive health crisis aligns with how the U.S. reports on maternal mortality and access to care in countries such as Iran, Venezuela, and Ethiopia. Omitting this data would undermine the credibility of the report and contradict U.S. commitments to non-discriminatory legal monitoring.
5. Support a UN Resolution Affirming Reproductive Health Protections During Conflict
The United States should co-sponsor a UN General Assembly resolution reaffirming that attacks on maternity hospitals and obstruction of reproductive care violate international humanitarian law. The resolution should be country-neutral and grounded in the Geneva Conventions, CEDAW, and UNSC Resolution 1325.
It should restate that reproductive healthcare is protected during armed conflict and that targeted disruption may constitute gender-based persecution or acts prohibited under the Genocide Convention. Using language consistent with prior resolutions on Syria and Ukraine, this action reinforces U.S. commitment to legal norms while avoiding Security Council deadlock.
6. Establish a U.S.-Based Working Group on Reproductive Health in Armed Conflict
The State Department and relevant health and legal stakeholders should establish an independent working group focused on reproductive rights violations in conflict. This group should include legal scholars, public health experts, former officials, and humanitarian practitioners, operating under a public-private structure modeled after the U.S. Anti-Trafficking Task Force.
Its mandate should include documenting violations, publishing legal briefs, supporting litigation through amicus filings, and providing nonpartisan briefings to Congress. No existing mechanism provides this integrated response. Building it now would fill a legal and policy gap and enable sustained U.S. leadership on gender-based protections in armed conflict, including in Gaza, Sudan, and Myanmar.
Selected References
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