Being pregnant in a war zone is difficult enough. But when a woman is expecting multiple babies, the uncertainty of survival can make it all seem even more overwhelming.
Nisreen Abu Zreik, a 35-year-old mother of three from Nuseirat in central Gaza, had been living with constant worry since learning that she was pregnant with quadruplets. Given the ongoing crisis, she was unsure whether she’d be able to access the antenatal care she needed. Displacement, difficult living conditions and mounting financial pressure had already taken an emotional toll on her family, and the thought of caring for four more children weighed heavily on Nisreen and her husband.
At the same time, Nisreen was grieving the loss of her mother, who had been her greatest source of emotional support. Feeling lonely and fearful about the future, she struggled to find hope during what should have been a joyful time.
“In crises, the risks of pregnancy don’t disappear—they multiply,” says Lauren Bellhouse, Senior Advisor for Maternal and Newborn Health at International Medical Corps. “That’s why we focus on keeping essential maternal and newborn healthcare running, even in the most challenging conditions.”
Integrated Care for Complex Cases
Nisreen and her husband recognized the complexity of the pregnancy and the need for Nisreen to be under close observation. Nisreen was admitted to International Medical Corps’ field hospital in Deir Al Balah on May 31, 2026, when Nisreen was 29 weeks pregnant. Upon admission, she underwent a comprehensive multidisciplinary assessment, after which our medical team prepared an individualized care plan for her.
Nisreen’s care plan went beyond medical treatment to include specialized psychosocial support. Our Mental Health and Psychosocial Support (MHPSS) team helped her cope with the feelings of anxiety, fear and sadness that she was experiencing. Through counseling and psychological awareness sessions, Nisreen learned relaxation and deep-breathing techniques, and acquired skills to manage stress more effectively.
Given the complex nature of Nisreen’s case, the Obstetrics, Anesthesiology and Neonatal Intensive Care teams:
- prepared a comprehensive response plan in advance;
- prepped the operating room and kept the incubators and necessary medical equipment ready; and
- assigned specific roles to the doctors, nurses and midwives so that each baby could receive individual care.
On the morning of June 15, Nisreen showed signs of spontaneous onset of preterm labor. At 1:30 p.m., doctors successfully performed an emergency cesarean section—Nisreen delivered two girls and two boys, their birth weights ranging from 960 grams and 1.5 kilograms (from about 2.1 to 3.3 pounds).
“This was one of the most complex cases we have dealt with recently,” says Dr. Abdul Nasser Al-Kahlout, OB-GYN at the field hospital. He explains that quadruplets are high-risk pregnancies that require meticulous preparation and full coordination among all departments: “The success of the operation and the mother’s stable condition were the result of collaborative efforts and meticulous planning that began well in advance of the delivery.”
Personal Attention to Babies
Upon birth, each infant received immediate individualized care—including rapid assessment, temperature stabilization, respiratory support and continuous monitoring of vital signs—before being safely transferred to the neonatal intensive-care unit (NICU), where they continued to receive specialized care based on their needs. As per the response plan, one doctor was available for each baby.
“Receiving four premature babies simultaneously presented a significant medical and logistical challenge, but thanks to our preparation and the seamless teamwork, we were able to provide immediate care to each infant from the very first moments of birth,” says Dr. Mohamed Salam, a consultant pediatrician in the field hospital’s NICU. “Our goal was to ensure early stabilization of each newborn and give them the best possible chance for growth and recovery.”
Over the following days, Nisreen continued to receive medical and psychological care, which helped improve her emotional state significantly—her anxiety levels decreased, her sleep improved and she became more optimistic. She also learned how to ask her family and social support network for help, and became better prepared to handle the new responsibilities that lay ahead.
On June 18, we discharged Nisreen from the field hospital in stable condition, while her babies continued to receive specialized care. “I never imagined I’d be able to get through all of this,” she says. “I was afraid of the pregnancy, childbirth and the huge responsibility that awaited me. But the support I received from the doctors, psychologists and the hospital staff gave me the strength to keep going.”
Hundreds of Assisted Births Every Month
Nisreen’s journey highlights the critical role of integrated healthcare services—including emergency medical care, maternal and newborn care, and MHPSS—provided across our three field hospitals (in Al Zawaida, Deir Al Balah and Gaza City). The comprehensive maternal and newborn-care services we provide to civilians include:
- safe delivery;
- emergency obstetric care (including cesarean section, a common yet potentially complex surgical procedure); and
- antenatal and postnatal care.
We also provide physiotherapy sessions and MHPSS services to pregnant women and to children when needed. In 2025, our skilled birth attendants in Gaza assisted with more than 5,000 deliveries—including more than 1,000 C-sections—across the three field hospitals. On average, some 700 deliveries, including more than 200 C-sections, are performed each month at the Deir Al Balah and Gaza field hospitals.
Learn more about our lifesaving work in Gaza.