السمية البيئية واضطرابات الصحة الإنجابية: تقييم حالات الإجهاض والتشوهات الخلقية ووفيات الفترة المحيطة بالولادة في غزة (2023–2026)

Background: The military escalation in Gaza since October 2023 precipitated an unprecedented humanitarian catastrophe characterized by healthcare infrastructure destruction, environmental contamination, and disruption of reproductive health services. Objective: To evaluate the incidence and temporal trends of miscarriage, congenital anomalies, preterm birth, stillbirth, and perinatal mortality in Gaza (October 2023–June 2026), and examine their association with environmental toxicity and healthcare collapse. Methods: A retrospective ecological analysis was conducted using secondary data from the Palestinian Ministry of Health, Palestinian Centre for Human Rights, UNRWA-WHO joint reports, and Health Information Centre statements (November 2025–June 2026). Pre-conflict baseline data (2019–2022) were used for comparison. Spatial analysis using Moran's I and Getis-Ord Gi statistics was performed. Sensitivity analyses assumed 10–30% underreporting. Results: The miscarriage rate surged to 460 per 1,000 live births by April 2026 (baseline: 140/1,000), representing a threefold increase. Approximately 5,000 miscarriages were recorded in 2025. Congenital anomalies more than doubled: 322 cases in 2025 and 385 by spring 2026, dominated by cardiac (33%), neural tube (13%), and urological (18%) malformations. Stillbirth rates rose from 6.0 to 10.3 per 1,000 births; preterm deliveries increased by 52% (4,100 cases in 2025). Monthly live births declined by 67% (6,076 in November 2025 to 2,004 in April 2026). An estimated 6,600 intrauterine deaths occurred in 2025. Over 67% of pregnant women suffered severe anaemia. Spatial analysis identified North Gaza and Gaza City as significant hotspots. Conclusion: Gaza is experiencing a catastrophic disruption of reproductive health driven by synergistic effects of environmental toxicity, healthcare collapse, malnutrition, and displacement. Immediate international intervention, environmental remediation, and longitudinal surveillance are imperative.