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Dire living conditions, coupled with overcrowded shelters and widespread displacement, have forced Gazan women to resort to unconventional measures to delay their menstrual cycle.

Norethisterone, a medication typically prescribed for severe menstrual pain, heavy bleeding, and endometriosis, is being used as a means of delaying menstruation.

The scarcity of necessities such as clean water and feminine hygiene products like sanitary pads or tampons has reached an alarming level.

A by UNRWA of the gendered impacts of the October 2023 escalation in Gaza revealed that the inadequate provision of hygiene supplies in local markets and coming into Gaza exposes women and girls to diseases and infections, while also undermining their dignity.

"The tablets work by effectively stabilising the levels of progesterone hormone, preventing the natural process of uterine lining shedding and leading to a delayed menstrual cycle"

Inadequate access to toilets, bathing spaces, and laundry services can have a profound impact on women's mental and social well-being, especially during menstruation.

Overcrowding in shelters has also led to limited privacy for women and girls, who are forced to wait in long queues to access the few bathrooms and toilets available, even to change clothes.

As a means of coping, many have reduced the frequency of their showers to once a week, as revealed by the analysis conducted by UNRWA.

“It’s very difficult to manage my menstruation in these conditions, I can smell myself and I am avoiding being close to people,” a statement from a displaced female in the emergency shelter mentioned in the UNRWA analysis.

The severely overcrowded shelters are plagued by a scarcity of menstrual hygiene products and limited access to medical attention.

“Women and girls in Gaza are in overcrowded and overstretched shelters without food, water, privacy, or sanitation facilities limited to no operational toilets which is increasing protection risks,” according to Sarah Hendriks, UN Women’s deputy executive director ad interim.

“The impact of this conflict on women and girls is beyond words. As is often the case in conflicts, women are disproportionately affected, and the road to recovery for them will be measured in years if they survive,” Sarah said.

Access to water in Gaza has become extremely challenging due to the disruption of necessary provisions by the Israeli government.

As a result, people are facing double jeopardy of being deprived of crucial supplies and being impaired by airstrike damage.

It is crucial to prioritise menstrual hygiene as failure to do so can lead to a range of serious health risks affecting reproductive health and reducing fertility potential.

These risks include an increased likelihood of urinary tract infections, childbirth complications, and transmission of infections such as hepatitis B and thrush due to neglecting hand cleanliness as a part of product change practices.

“Neglected actions that may appear harmless, like not being able to thoroughly wash hands post-changing menstrual products, can pave the way for many infections to take over,” Dr Areej Hamad, a gynaecologist from Gaza who is operating at Al-Helou International Hospital told ������.

Women are already in palpable grief and distress, with dehydrated bodies, headaches due to insufficient nutrition and unhygienic surroundings that multiply their chances of various illnesses and have a harmful influence on them in different aspects, according to Dr Areej.

Side effects

“The tablets work by effectively stabilising the levels of progesterone hormone, preventing the natural process of uterine lining shedding and leading to a delayed menstrual cycle,” Dr Areej explained.

Menstruation is a difficult time for many women and some turn to pills for relief. However, though these pills can provide short-term relief from painful symptoms and delay periods by up to 20 days if taken three days before the expected start date, they can also cause side effects such as erratic vaginal bleeding, nausea, fluctuating menstrual cycles, dizziness, and mood swings.

Dr Areej underlines the need for caution in considering these consequences but acknowledges that countless women in Gaza are compelled to take risks in the face of continuous Israeli bombardment and blockade.

The United Nations has noted that limited access to essential supplies and facilities poses unique challenges for those living in shelters.

Moreover, the lack of understanding among men and boys about menstrual health adds to the obstacles faced by women and girls. The mere thought of dealing with their menstrual cycle while living in shelters has been a constant source of stress for these women.

Amal Saleh who works at the women’s affairs centre in Gaza told ������,��“The majority of women don’t have access to period pads and even if they did, they cannot change in privacy as often as necessary or use soap and water for washing, because there is severe rationing to the use of toilets, or convenient facilities to dispose of used menstrual-related materials.

"Women are feeling discomfort, and fear and are not even able to manage their periods smoothly, adding extra stress to the situation they are in,” Amal added.

"We have deep wounds and we are barely functioning as humans, the period hormones and stress are adding extra pressure on us mentally and physically, and we are drained. We go hours and hours without food and water, how will our bodies cope"

Water shortages

The actions taken by Israel to cut off the supply of power and water to Gaza have caused severe consequences for the region's residents, causing families to significantly limit their daily usage of water and their everyday activities due to these restrictions. This collective punishment against Gaza's civilian population is considered a war crime.

“Due to the stress these poor women are enduring, many are experiencing extreme menstrual pain, irregular periods, and heavy bleeding. These overwhelming challenges leave women struggling to maintain hygiene and manage the stress that such a situation demands,” Areej told ������.

Although the World Health Organization recommends between 50 to 100 litres per individual per day, people must now limit themselves to consuming about three litres of water due to the lack of availability.

Only a limited amount of humanitarian aid, including bottled water, was supplied to Gaza through Egypt's border between October 21 and 23, just 4% of the daily average received before October 7.

“We have deep wounds and we are barely functioning as humans, the period hormones and stress are adding extra pressure on us mentally and physically, and we are drained. We go hours and hours without food and water, how will our bodies cope?” Amal said.

The issue of menstruation-related stigma, as per Amal, leads to feelings of shame and embarrassment among women. This is further intensified since many of these women, who are now widowed, have to send their male relatives to buy the necessary menstrual products, such as pads or pills.

The dire circumstances coupled with trauma stemming from the conflict have a severe impact on the women and girls in Gaza.

According to a recent gender analysis by UNRWA, hospitals in Gaza that provide Sexual and Reproductive Health Rights (SRHR) have been destroyed in the airstrikes. This has cut off any access to healthcare for women who were already denied these rights and healthcare services before the conflict.

The displaced population has highlighted mental health as the area most impacted by the current escalation. This is because it compounds pre-existing trauma from previous escalations, according to UNRWA gender analysis.

Humanitarian organisations estimate that the current average water consumption is three litres per day per person for all needs, including drinking, cooking, and hygiene.

Due to Israel's blockade, it has become increasingly difficult to acquire essential goods such as medical supplies, putting pressure on local stores and pharmacies.

These establishments are facing limited stock and logistical issues due to damaged roads, which makes restocking even harder. As a result of this situation, women are now turning to unconventional options, such as period-delaying tablets, which are more available in some pharmacies.

The scarcity of vital items, such as medication, has been amplified by Israel's restriction. Main routes that provided sustenance have been ruined, causing stores to increasingly struggle with depleted stock.

Medical materials are becoming increasingly rarely available, adding to the troubled situation. In light of this, women are forced to look at unconventional alternatives that are more available in pharmacies to cope with the conditions they are in.

Rodayna Raydan is a Lebanese British journalism graduate from Kingston University in London covering Lebanon

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