Despite Promises of Aid, Gaza’s Women Are Still Cut Off From Basic Hygiene

Inside a cold nylon tent in Deir al Balah, Amira gathered her five children as news spread that a water truck had finally arrived. It was January 2024, and after two weeks without showering, her daughters’ waist long hair was crawling with lice. They were ecstatic, but Amira knew the water wouldn’t be enough, so she made a painful decision: they would have to cut their hair short to bathe.

“My heart was ripped apart while cutting their hair,” Amira said. “But it was out of my hands.”

A month later, Amira’s 10-year-old daughter Kenzy and 8-year-old son Youssef were killed in an airstrike, after the family moved back to their partially destroyed home in a danger zone, fleeing the harsh camp conditions.

Ongoing Israeli military operations and a prolonged blockade since October 2023 have severely damaged Gaza’s water and sanitation infrastructure, with the UN’s humanitarian coordination agency, OCHA, reporting that over 75 percent of households in Gaza have declining access to water in the past month. (Residents now receive as little as 5 liters of water per person per day, far below the World Health Organization’s emergency standard.) In March, Israel’s energy minister shut down Gaza’s last desalination plant, cutting output from 18,000 to just 3,000 cubic meters per day, according to Amnesty International.

While Israel announced limited resumption of humanitarian aid on Sunday, access to essential sanitation materials for families like Amira’s remains critically restricted. Israeli prime minister Benjamin Netanyahu’s office did not immediately respond to More to Her Story’s request for comment on allegations that electricity cuts and the ongoing blockade have worsened water shortages and undermined access to basic hygiene in Gaza. 

Behind these numbers are the daily struggles of women and their families, who told More to Her Story that they’ve rationed every drop of water and have gone weeks without a shower. But the crisis isn’t only about water. 

Women who spoke to More to Her Story said the price of menstrual pads had soared from $1 to $15 for a 12-piece pack, while shampoo that once cost $4 has surged to $40, if it could be found at all. With these essentials disappearing from shelves, many were forced to turn to risky alternatives. Locally made shampoo substitutes have reportedly caused eczema, burning eyes, and pus-filled sores on the scalp.

While menstruating, some women described resorting to adult diapers, which are cheaper, or cutting up the edges of tents and tearing pieces of clothing to manage their periods. With clean water scarce and pads nearly impossible to find or afford, they often had no choice but to reuse materials for more than a day, despite serious health risks.

Rawan, who was displaced four times and has been living in tents since December 2023, said her period stopped five months into the war, likely due to stress. She left it untreated for nine months, explaining that it was easier to cope without menstruating since the refugee camp where she lived barely had water.

Amaal Syam, director of Women Affairs Center in Gaza, said the center observed that in the early months of the war, some women resorted to taking contraceptive pills to delay their periods as a coping mechanism to avoid the challenges of menstruating without water or hygiene products. But as pharmacies ran out of contraceptives, they no longer had this option.

According to UNFPA, there are 572,000 women of reproductive age in Gaza who are in “urgent need” of menstrual and hygiene products.

Willy Massay, a critical care nurse from Nebraska who volunteered twice in Gaza on behalf of WHO, said he treated about 600 to 800 women with urinary tract infections linked to poor hygiene.

Massay believes that Israeli restrictions on aid have led to “communicable and infectious diseases becoming rampant” as hygiene products and medication needed to treat conditions resulting from “overcrowding, poor hygiene, lack of water and poor nutrition” are insufficient, he said. More to Her Story interviewed healthcare workers in Gaza who spoke of widespread fungal infections, deep skin abrasions, scabies, lice, UTIs and Hepatitis A.

In June 2024, WHO reported over 103,000 cases of scabies and lice, 65,000 cases of skin rashes, and over 11,000 cases of chickenpox in Gaza.

With medicine running low due to the ongoing siege, doctors say treating even common infections has become a challenge. Doctors Without Borders warned that critical medical supplies are rapidly running out.

Mohamed Rafeq, a nurse practitioner at a dermatology clinic in Gaza, said over 1,000 women sought help for skin infections between January and March. With medicine in short supply, the clinic resorted to improvising, mixing topical treatments and dividing single-patient doses among several. The clinic, which was funded by the Belgium based NGO “The Wings of Healing,” was forced to shut down in March due to a lack of medical supplies and funding.

Juliette Touma, UNRWA’s communications director, described the sanitation crisis in Gaza’s shelters as catastrophic, with women often forced to share a single bathroom with hundreds of others. “A shower has become a luxury,” she said, adding that overflowing garbage and untreated sewage have left shelters dangerously unhygienic, stripping women of privacy and dignity.

Women described makeshift toilets in camps as unsanitary, and dehumanizing. Shaimaa, who has been displaced seven times since the war broke out and is now in a shelter in Khan Yunis, said her family built a private toilet by placing a seat over a hole dug in the sand, connected to pipes that drained into the ground. The stall, made from the same nylon used for tents, lacked a door, only a flap held shut with a tied rope and doubled as a shower space. She said they flushed it manually when water was available.

Building private toilets cost between $250 and $350, prompting families to split the cost and share the facility. Public toilets in shelters, women added, were often nothing more than holes in the ground that overflowed with human waste.

These stalls offered little privacy and winds often blew the coverings aside, exposing anyone inside. Some women said they avoided using the toilets at night, especially when they were hundreds of meters away, and instead relieved themselves in containers inside their tents.

The lack of access to water and basic hygiene also had deep social repercussions for women. Syam said they noted a rise in domestic violence cases, as some men continue to “expect women to maintain household cleanliness and personal hygiene” despite the near-total collapse of living conditions.

Touma estimates that roughly one million hygiene kits were sent into Gaza through UNRWA and their various partner aid agencies. She also blamed Israeli restrictions and the ongoing siege for severely hampering UNRWA’s efforts to meet even the most basic hygiene needs.

“Needs are much, much more than we can give,” she said.

OCHA spokesperson Olga Cherevko said the siege left them critically low on hygiene kits. “It’s the impossible task of prioritizing the most vulnerable out of a population that is 100 percent vulnerable,” she said.

A senior Egyptian Red Crescent official said 400 to 500 trucks remain idle at the Rafah crossing, and 12 warehouses in North Sinai are packed with aid. “There is intransigence from the Israeli side,” he said, citing arbitrary rejections over container size or mixed shipments.

An aid coordinator working with multiple international organizations added that COGAT, the Israeli military agency responsible for approving aid entry into Gaza, has barred items like lice shampoo, deodorant, and alcohol-based sanitizers, limits toothpaste to two tubes per kit, and refuses to provide a consistent list of restricted supplies.

COGAT did not respond to More to Her Story’s request for comment on reported restrictions of hygiene items in aid shipments, the lack of clear criteria and the alleged health impacts of those limitations.

As the blockade keeps critical aid from entering Gaza, Heather Barr, associate women’s rights director at Human Rights Watch, said the crisis is not gender-neutral.

She explained that women experience conflict differently because they often bear the brunt of caregiving responsibilities within families. Yet those realities are not adequately reflected in what gets prioritized during humanitarian responses leaving their most basic needs unmet and their dignity compromised.

That gendered burden plays out in the smallest, most personal corners of daily life.

For women like Amira, who shared a tent with 25 family members, even basic hygiene came down to collective sacrifice. She said women were asked not to shower unless they were cleaning up after their periods, a decision made by the men in the camp.

“We had to choose between showering and eventually running out of water, leaving us unable to clean ourselves after urinating or defecating, or not showering at all,” Amira said. “We decided to limit showers. You have to sacrifice for the sake of the group.”