The Gaza Strip was a month into this summer’s suffocating electricity crisis when Thair Salah Mortaja became a father for the first time. He had spent thousands of dollars to overcome infertility – first paying for drugs, then a futile operation, and finally for costly in vitro fertilisation (IVF) – but the struggle for parenthood did not end there.

His wife, Fatima, went into labour when she was just seven months pregnant, partly because of poor prenatal care. Their doctor wanted to get her to a specialist in Nablus, but the hard-to-procure permit to exit blockaded Gaza into Israel and proceed to the West Bank city didn’t come through. After a tense labour, she gave birth prematurely to triplets (multiple births are common with IVF). But the intensive baby care unit at Gaza’s largest hospital, Shifa, was already over capacity.

Thair Salah Mortaja, left, with his uncle, centre, and father, right, and his uncle’s children. Photograph: Miriam Berger

So they waited hours until an incubator became available. The doctors decided to put the son and one daughter together in the incubator, run by generators amid the power shortages. The third child remained on oxygen in a little bed beside her siblings. The overstressed intensive care unit frequently makes such arrangements for IVF twins and triplets, a doctor explained.



The war-torn and impoverished coastal enclave – which the UN has declared “unlivable” – is a surprising place to find widespread access to IVF treatment. But it is accepted by Palestinians in Gaza, for whom having children is a source of social respect, national strength and religious duty – feelings only heightened by the death and destruction around them. Amid socio-economic pressure to conceive, IVF has also been a politically expedient tool to garner goodwill: this summer, Gaza’s extremist Hamas government provided free treatment for chosen couples, as did the NGO run by the wife of another major Palestinian political player, Mohammed Dahlan.

A week on, Fatima was back home recovering while the couple’s babies remained hospitalised. Mortaja’s heart was still racing constantly. In the weeks before, and since, several babies have died waiting for the rival Palestinian Authority and Israel to approve exit permits for people to receive urgent care unavailable in resource-limited Gaza. One day that week in July at Shifa’s intensive care unit, a baby who had just died lay in an incubator, his body withered and still, before doctors removed him to make way for another.

Israel and Hamas have fought three wars since 2007, while Israel and Egypt have kept Gaza blockaded on security grounds. Now Gaza’s 2 million people are faced with unemployment and population density that is among the highest in the world, stuck in what they often describe as an open-air prison.



Palestinian boys stand beside Hamas militants as they take part in a military show against Israel’s newly installed security measures at the entrance to the al-Aqsa mosque compound in Khan Younis, in the Gaza Strip. Photograph: Ibraheem Abu Mustafa/Reuters

The dire situation worsened in June when the Palestinian Authority, which runs the West Bank, stopped paying Israel for Gaza’s electricity in an attempt to squeeze Hamas out. In response, in the dead heat of summer, Israel cut electricity and Gazans went from having eight hours of power to just three or four. Anger against the authority, its Fatah party, and Hamas, along with Israel, only grew.



In these circumstances, IVF comes with a host of complications. The fertility rate in Gaza is among the highest in the Arab region, with 4.5 children a couple, compared with the West Bank’s 3.6, according to a 2017 UN Population Fund report. Dr Bakr Qaoud, of the Gaza City Helow Centre, says more than 1,000 couples annually try the treatment in Gaza through private clinics, at a cost of $2,000-$2,500 (£1,500-£1,900) a round. He says thousands more would like it, but can’t pay.

Dr Mohamed Jouda, who runs the Hala Centre in Gaza City, says that over the years he’s been working in the field he has seen a decline in male fertility rates, which he attributes to the stresses of war and environmental factors such as the use of herbicides and other toxins.

There are, however, no formal studies of infertility rates in Gaza. Neither is there research into the impact of pesticides used by Israelis and Palestinians, although rumours in Gaza persist that the Israelis use pesticides on food imported into Gaza that contribute to male infertility.

While some conservative communities object to IVF, Hamas has supported and subsidised the treatment, funding couples during the yearly Ramadan holiday. Gaza is also politically polarised – right down to which clinics people use, says Qaoud, explaining that some are known to be Hamas funded.



Palestinian children do their homework during a power cut in Gaza. Residents of Gaza, home to 2 million people, have been experiencing long hours of electricity outage. Photograph: Mahmud Hams/AFP/Getty Images

Mortaja didn’t have any political connections to pay for IVF treatment. In the five years since his marriage, he has spent about $10,000 on hospital visits, operations and IVF. They have sold Fatima’s gold dowry and got into debt with friends and family.



Others are luckier: Ziad Khader, 35, an actor, was among 600 couples to receive free treatment from a charity run by Dahlan’s wife.

For nine years, Khader and his wife failed to conceive. Then he saw an advertisement for funding from Jaleela Dahlan’s group. His wife is now three months pregnant with twins.

Khader is from a Fatah family, and he says he is thankful for the support from Dahlan, who is also Fatah. But he loathes being indebted to anyone. He would rather support his family, he says, but there are no jobs.

“It’s a siege of ideas,” says Khader of the political and economic repression. For now, though, he can’t see beyond the excitement of his wife expecting twins.