PHR leadership and staff recently presented key findings and evidence at the 61^st Session of the United Nations Human Rights Council (HRC) in Geneva. The team delivered several statements before the Council, partnered with other NGOs to amplify findings about the impact of attacks on health, and met with states and other partners about ongoing human rights violations in the Democratic Republic of the Congo, Ethiopia, Gaza, and Ukraine.

Attacks on Health and Civilians in Ukraine and Beyond

Four years into Russia’s full-scale invasion, attacks on health in Ukraine increased 50% in 2025, despite promises of ceasefire and peace negotiations. In an interactive dialogue with the Independent International Commission of Inquiry on Ukraine, PHR International Advocacy and Ukraine Program Coordinator Uliana Poltavets delivered a statement sharing data on the human costs of these attacks.

Renewed attacks on energy infrastructure are driving health harms and weaponizing winter conditions. Health workers we surveyed reported recurring power disruptions affecting their facilities – causing the delay and denial of life-saving care. Disruptions to medical devices, treatment routines, and basic services, often combined with water and heating outages, have led to heightened risks for people with chronic illness, disabilities, and older adults. 

Documenting direct and reverberating impacts of attacks on health is essential for accountability and deterrence. Documentation by commissions of inquiry is indispensable to this work. The Council should renew the Ukraine Commission of Inquiry’s mandate and ensure all investigative mandates are sufficiently funded.

PHR also co-hosted three side events related to attacks on health, including impacts of attacks on health by Israel in Gaza and during Russia’s full-scale invasion of Ukraine.

Our first side event, “Reverberating Impacts of Attacks on Health,” explored how impunity persists for unprecedented levels of attacks on health from Gaza to Ukraine to Syria , with civilians paying the price. The event underscored the full breadth of civilian harm, including reproductive violence, resulting from attacks on health and called for consideration of these harms in legal assessments of the legality of these acts by parties to conflict.

The side event “Russia’s War on Civilians in Ukraine” examined how Russia has deployed tactics to suppress resistance, erase Ukraine identity, and exert power over civilian life – conduct that may amount to war crimes and crimes against humanity under international law. We urged member states and UN mechanisms to pursue meaningful investigation, prosecution, reparations, and investment to address Ukraine’s damaged systems, lost medical expertise, untreated trauma, and disrupted communities.

A third side event held by PHR and partners, “Health Care in the Dark,” drew upon recent field research documenting the measurable health harms of systematic power disruptions. Expert analysis examined how legal accountability frameworks – including the roles of the International Criminal Court and UN human rights mechanisms – can bring together states, NGOs, and civil society to address the evidentiary gaps that hinder accountability.

Children in Armed Conflict

PHR also spoke out on grave violations that continue to be committed against children in conflict settings in Ethiopia, Gaza, and beyond. In an interactive dialogue with the Special Representative of the Secretary General on Children in Armed Conflict, PHR Executive Director Sam Zarifi delivered an oral statement expressing concern over the scale and severity of these harms and urging accountability efforts.

In Ethiopia, PHR has documented conflict-related sexual and reproductive violence, including multiple perpetrator rape and forced witnessing of sexual violence, impacting children in the Tigray, Amhara, and Afar regions. We urged the Special Representative to advocate for Ethiopia to be listed as a situation of concern to mandate reporting to the Security Council and Human Rights Council. 

In Gaza, PHR has also documented how attacks on health facilities, and restrictions on humanitarian aid, including medical supplies and food, have led to health harms for children and newborns, including death. We expressed deeply alarm over the intensity of violence perpetrated against children in Gaza by Israeli armed and security forces, including through attacks on health and the denial of humanitarian access.  

These violations demand accountability. The international community should prioritize documentation and accountability for crimes against children including by supporting mandate positions and trauma-informed expertise within human rights investigative teams, dedicated funding streams, and ongoing support at the state, regional, and international level.

Torture and Abuse Against Immigrants in the United States

PHR and our partners continue to document how the U.S. government inflicts deliberate suffering on asylum seekers and immigrants. In an interactive dialogue with the Special Rapporteur on Torture and Other Cruel, Inhuman, or Inhuman Treatment, PHR Medical Adviser Dr. Katherine Peeler delivered a statement to sharing PHR’s investigative findings concerning solitary confinement practices and preventable deaths in immigration detention.

Our evidence exposes how prolonged solitary confinement in U.S. immigration detention meets the UN’s definition of torture and other cruel, inhuman, or degrading treatment.

In interviews with migrants deported to Honduras from the United States, PHR has also documented the deliberate family separation occurring in violation of the U.S. government’s directives aimed at family unity. 

We urged the Special Rapporteur to conduct a country visit to the United States and to address these escalating practices. 

“Of all the years I’ve been here, this has been the most unusual and difficult year we’ve had. The emergency began on January 31 [2025], due to the change in government under the new [US] president. The difference is that now they are being mistreated more in [US] detention centers, especially. […] And there are many cases of people who have been separated from their families, many cases. If you ask those who came today, if you had asked who left children in the United States, 80 percent would raise their hands.” Medical worker who works with deportees at La Lima Reception Center

“Todos los años que he estado aquí, el año más atípico o más difícil que hemos tenido ha sido este año. La emergencia inició prácticamente el 31 de enero, año por lo del cambio de gobierno del presidente. La diferencia es que ahora están siendo más maltratados en los centros detención sobre todo. […] Si usted le pregunta a los que vinieron hoy, si hubieran preguntado quiénes dejaron hijos en Estados Unidos, el 80 por ciento levanta la mano.” Trabajadora medicaque trabaja con deportados en el Centro de Recepción La Lima

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Executive Summary

Since taking office in January 2025, the second Trump administration has rapidly expanded immigration enforcement, including detention and deportation of individuals living in the US interior. At the same time, the administration has weakened or disregarded numerous existing laws, policies, and safeguards designed to ensure due process, protect family unity, and preserve parental rights, with profound consequences for immigrant families and receiving countries. Detentions and deportations are likely to accelerate significantly, as the administration continues to implement the $170 billion dollars Congress provided for immigration enforcement under H.R.1, the “One Big Beautiful Bill.”

Unlike in prior years, when the deported population largely consisted of individuals and families that had recently crossed the US-Mexico border, the second Trump administration has primarily targeted longtime US residents, many of whom have lived in the country for years or even decades. The pace and scale of immigration enforcement has increased exponentially; immigration arrests more than quadrupled in 2025, leading to the highest rates of immigration detention in US history. Immigration and Customs Enforcement’s (ICE) own data confirms that 92 percent of the detention increase has been driven by people without any criminal record. Many of those detained and deported are parents with US citizen children.

Significant numbers of detained and deported parents are experiencing violations of US policy designed to protect family unity and parental rights. However, there is little publicly available information to assess the scope and scale of those violations, which include deporting parents without providing them an opportunity to bring their children with them. When parents are deported quickly and without an opportunity to arrange for the care of their children, their children often remain in the US without stable caregivers or support. Many remain in the informal care of friends, family members, or even babysitters, often without formal custody arrangements or legal protections. Their caregivers may themselves be vulnerable to immigration enforcement, leaving these children in even more precarious circumstances.

To begin addressing this information gap, the Women’s Refugee Commission (WRC) and Physicians for Human Rights (PHR) traveled to San Pedro Sula, Honduras.

Researchers co-located with service providers in the reception centers that receive deportees and conducted dozens of interviews with reception center staff, physicians and psychologists, government officials, and deportees themselves.

Researchers uncovered significant violations of the administration’s directive on detained parents, which requires that parents facing deportation be given an opportunity to decide what will happen to their children. From the cases researchers observed, these violations are leading to many family separations that, absent meaningful assistance with reunification, may become long-term or even permanent.

Researchers also uncovered significant abuses of pregnant, postpartum, and lactating women detained in violation of US policy.

Key Findings Include:

• ICE is violating its own requirements to prevent family separations. Violations observed by WRC and PHR include:
  • ICE is often not asking the people they arrest if they have children.
  • ICE is often not ensuring that children of the people they arrest are safe, even when parents notify arresting agents that their children will be left alone, or urgently ask to make immediate care arrangements for them.
  • ICE is often not allowing parents to decide what will happen to their children if they are deported, and in some cases is disregarding written attestations by parents who wish to be reunified with their children before removal.
• Significant numbers of parents interviewed were deported without their children. Many were never asked if they had children or given the opportunity to bring their children with them. Some parents were separated from infants, including one mother separated from a baby less than two-months old.
• Children who are left behind in the US when their parents are deported often face precarious or uncertain living situations. Many parents reported leaving their children in the informal care of friends or family members.
• Pregnant, postpartum, and lactating women are being detained without access to adequate nutrition and medical care. Some were denied access to essential healthcare despite being in acute medical distress.
• Receiving countries like Honduras lack the necessary infrastructure, financial support, and basic information from the US government to help efficiently reunify separated families, which could lead to long-term separations.

While not the focus of this study, nearly every person interviewed discussed the dehumanizing and traumatizing treatment they experienced while in immigration detention. Most described inedible food, lack of privacy (including having to undress, shower, and use the toilet in front of other people), denial of medical treatment and medications, and pervasive verbal mistreatment. Many described not being able to contact their families or their attorneys. All were exhausted after frequent transfers between detention facilities throughout the US and multiple flights before arriving in Honduras. This report honors their stories.

On November 10, 2025, just after 4:00 p.m., we uploaded our final written submissions on behalf of eight survivors of post-election sexual violence to Kenya’s Supreme Court digital filing system. The moment felt both heavy and hopeful, marking the next step in a twelve-year legal journey that has made its way up to the Supreme Court.  

Watching the confirmation message appear on my screen felt like exhaling after holding my breath for far too long. After eighteen years, survivors of sexual violence that occurred during the 2007–08 post-election chaos might finally see justice, while the rest of the country begins to grasp the violence of this crime. 

The suffering did not end when the fighting stopped 

The 2007-08 post-election violence in Kenya was one of the darkest chapters in our history: more than 1,333 lives lost, nearly 663,000 people displaced, thousands were sexually assaulted, mutilated, beaten, or tortured. Homes were burned. Families were torn apart. Communities were shattered. 

And for women and men who survived sexual violence, the suffering did not end when the fighting stopped. The persistent lack of accountability for these violations continues to stand in the way of healing of the individuals affected and the country as a whole.  

“My daughter keeps asking about her father,” a survivor once told me. “What do I tell her if even my country refuses to acknowledge what happened?” Her words sit heavy on my chest. 

“My daughter keeps asking about her father,” a survivor once told me.”What do I tell her if even my country refuses to acknowledge what happened?” Her words sit heavy on my chest. 

I joined PHR long after these courageous survivors first walked into court in 2013. But working closely with them over the past year, listening to their stories, and accompanying them through setback after setback, I have come to understand the weight of the injustices we are asking this country to confront. 

On March 8, 2026, as people around the world mark International Women’s Day (IWD), these survivors are one step further in their fight for justice; their struggle the embodiment of this year’s theme: Rights. Justice. Action. For ALL Women and Girls. 

The Supreme Court 

How can it be that both the High Court and the Court of Appeal held that four of our plaintiffs, each of whom was violated by a non-state actor, were not entitled to compensation because they had not filed police reports during the unrest? Can the law really punish them for surviving? 

Of the eight survivors in our case, the courts compensated only four. Three of these women were violated by state actors. The fourth, although violated by a non-state actor, managed to report her case at a police station despite the chaos. The remaining four, who faced the same violence but had no safe way to report it, were denied compensation. 

Our appeal asks the Court a simple but deeply consequential question: Should survivors of sexual violence be denied justice simply because it was too dangerous, or impossible, for them to report it at the time? 

During the post-election unrest, roads were blocked by militia groups. Police stations were deserted or had become sites of violence themselves. Survivors in our case even recounted seeing police officers — the very people they were supposed to report their ordeals to — committing brutal sexual assault. 

In that environment, leaving your home to report a violation was not just unrealistic. It was life-threatening. 

The Waki Commission and countless affidavits from survivors of sexual violence during that period paint the same picture: a country engulfed in fear, uncertainty, and total breakdown of law and order. Survivors were not choosing to hide in silence but to stay alive, seeking medical care only when they could do so safely. They found shelter where they could. They carried their trauma quietly until they were able to bring this case to court. 

A painful and discriminatory distinction 

The courts created a dangerous hierarchy: 
– those who could report, and those who could not; 
– those deemed credible enough for justice and those deemed invisible. 

Almost two decades later, we are preparing for another general election. The children conceived through rape eighteen years ago are now young adults, many sitting for their final high school exams. Next year they will be old enough to participate in the same democratic process that failed their mothers. Two generations are now owed justice.  

Kenya’s legal and moral obligation  

Kenya’s obligation to protect, investigate, and remedy violations is grounded in the 2010 Constitution and reinforced by every major human rights treaty we have ratified, including the International Convention on Civil and Political Rights (ICCPR) , Convention on the Elimination of All forms of Discrimination Against Women (CEDAW), the Protocol to the  African Charter on Human and Peoples’ Rights on the Rights of Women in Africa also commonly referred to as  the Maputo Protocol. 

Our clients are not asking for charity. They are asking for the rights the Constitution already promises them. 

In their affidavits, the survivors said: “These violations are ongoing for as long as we remain unseen, unheard, and uncompensated.” 

Standing on the right side of history 

On this International Women’s Day, we must ask what “Rights. Justice. Action” truly look like. 

It begins with recognition, a formal acknowledgment from the highest court that terrible crimes were committed, and that the State’s failure to protect them constituted a further grave violation of their rights. 

Reparations will also be critical. For eighteen years, survivors have carried the weight of medical expenses and lost livelihoods, on top of the enduring psychological trauma.  

Action must then go further. Precedent set. Sexual violence is a crime. The fact that the perpetrator is a non-state actors or the absence of a police report must never again be used as a means for the State to evade its responsibility to prevent sexual violence during times of unrest, or to allow for impunity afterward. 

Suzanne Kidenda, PHR’s Interim Head of Office, captured this perfectly as we filed the submissions when she said: “After twelve exhausting years in court, this is the survivors’ last shot. We hope justice will not only be done but be seen to be done.” 

Executive Summary

After Hamas’ brutal October 7, 2023 attack on Israel, subsequent Israeli military operations in Gaza have caused devastation and displacement. Beginning early in the conflict, humanitarian actors and civil society raised significant concerns about the likely impact on the health and survival of pregnant women1 and infants – two groups granted specific protection during armed conflict.2 The UN Independent International Commission of lnquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel (UN COI) reviewed evidence through July 2025 and found that Israel’s attacks on facilities providing reproductive health care and restrictions on food and medical supplies were intentional and systematic and resulted in devastating harm to the reproductive capacity of people in Gaza.3

This report affirms the UN COI’s findings and presents new evidence of the continued and worsening harms of the conflict on pregnant and postpartum women and infants from January through October 2025. The report analyzes how the health impacts of (i) attacks on health care facilities, (ii) restrictions on humanitarian aid, and (iii) acute malnutrition have translated into violations of the rights of women and infants in Gaza and constitute reproductive violence in violation of international law. Finally, drawing on this evidence, the report outlines urgent recommendations to ensure that people in Gaza receive adequate medical care and nutrition assistance, accountability, and justice.

Despite these reports, throughout early 2025, Israel continued to restrict access to humanitarian aid in Gaza.4 This occurred through a complete humanitarian aid blockade from March to May 2025, the subsequent introduction of the humanitarian aid distribution mechanism, the Gaza Humanitarian Foundation (GHF). which was widely critiqued as “engineered scarcity”,5 and despite the ceasefire reached in October. Following repeated warnings issued by the Integrated Food Security Phase Classification (IPC). famine ‘with reasonable evidence’ was finally determined in Gaza in August 2025.6

Between May and June 2025, the Palestinian Ministry of Health reported a 41 percent decrease in birth rate in Gaza compared to the same time period in 2022; there was a significant increase in miscarriages that affected more than 2,600 women, and 220 pregnancy-related deaths that occurred before delivery. 7 The ministry also reported a sharp increase in premature births and low birth weight cases; over 1.460 babies were reported to be born prematurely, while more than 2,500 were admitted to neonatal intensive care. Newborn deaths also increased, with at least 21 babies reported to have died on their first day of life.8 However, due to the near-complete collapse of Gaza’s health information system after October 7, 2023, systematic data collection was severely limited, making it likely that these numbers represent a significant undercount. Even since the ceasefire was reached these conditions continue; in October 2025, UNICEF reported that they identified 9,300 children under five years of age with acute malnutrition and that 8,300 pregnant and breastfeeding women were admitted to health facilities for treatment for acute malnutrition.9

In this study, Physicians for Human Rights (PHR) and the Global Human Rights Clinic at the University of Chicago Law School (GHRC) assess the foreseeable risks to pregnancy and neonatal health posed by these developments and examine the impact of attacks on health and restrictions on food and medical supplies on women of reproductive age, including those trying-to-conceive as well as pregnant, postpartum, and lactating women, and newborns from January to October 2025 when a ceasefire was signed.

The destruction of Gaza’s health infrastructure, combined with restrictions on food and medical supplies including baby formula, has created an environment in which the fundamental biological processes of reproduction and survival have been systematically destroyed, resulting in known and foreseeable harm, pain, suffering, and death.

Analyzing 78 testimonies of international health care providers who worked in Gaza on short-term medical missions, this report documents the maternal and neonatal deaths, physical and mental suffering, and infertility experienced because of the compounded impacts of malnutrition and the inability to access reproductive health care supplies and services. To determine the foreseeability and preventability of these harms, PHR and GHRC reviewed these accounts against the record of warnings issued concerning risks to reproductive capacity as a result of the tactics of war used in Gaza, 23 reports of attacks on reproductive health care facilities in Gaza from January to September 2025,10 and the established medical literature on the known reproductive harms resulting from acute malnutrition and denial of proper prenatal and postpartum care.11

Key Findings

a. Inability to access medical care and proper nutrition harmed reproductive capacity by causing infertility, miscarriage, complications, and maternal death for women, as well as poor health outcomes for newborns

Israel’s restrictions on medical supplies in Gaza are extreme, inconsistent, and deliberately opaque, and have resulted in significant harm to reproductive services.12 A broad range of essential items, from medications to non-pharmaceutical products, have been denied under the “dual-use” designation or delayed due to unclear bureaucratic policies.13 Moreover, the food rations GHF distributed in Gaza had been characterized as far from enough to meet the basic needs of people in Gaza and did not meet minimum requirements of international humanitarian standards.14 Clinicians interviewed by PHR and GHRC reported the severe impacts oflimited access to food – including medically indicated baby formula for malnourished or premature infants – and health care on women and children in Gaza. These clinicians described increased maternal and neonatal deaths, life-threatening complications that would have been preventable or treatable elsewhere, ongoing physical and mental suffering, and long-term harm to fertility.

Malnutrition leading to infertility, miscarriages, complications, and death

Health care providers reported women presenting with menstruation issues, infertility, and anemia due to prolonged malnutrition. Similarly, pregnant women developed critical complications during pregnancy, some of which resulted directly from acute malnutrition and some of which were made more difficult to manage due to acute malnutrition; this resulted in observed increases in miscarriage and preterm birth.15

A nurse who worked in Gaza in January 2024 shared:16

“[W]e clinically saw it in women not having periods because they’re so severely malnourished. We saw it in women who were having miscarriages, women who weren’t lactating, because when you’re pregnant or lactating, your caloric intake requirement increases. And these otherwise healthy women with no comorbidities were not producing any breastmilk, even though they had in previous pregnancies.”

A gynecologist who worked in Gaza in February 2024 noted:

“Every single woman I’ve seen pregnant or not was malnourished.”

Lack of supplies for labor and delivery

Those women in Gaza who became pregnant frequently experienced preterm and prolonged labor requiring medical services, including cesarean sections. However, the supplies needed for these procedures, including anesthesia medications, blood products, and sterile equipment to ensure safe delivery, were not available or accessible due to restrictions on medical supplies and destruction of medical infrastructure. 17

Limited lactation and access to formula

Mothers struggled to feed newborns and infants due to impeded lactation resulting from severe maternal malnutrition accompanied by micronutrient deficiencies, dehydration, severe maternal anemia, and extreme mental and physical stress. In cases where breastfeeding was not possible despite clinical support, infants, including preterm babies who met the medically recognized indications for breastmilk substitutes, required access to age-appropriate therapeutic formulas.18 Yet, severe restrictions on bringing baby formula into Gaza further limited clinicians’ ability to ensure babies had the nutrition they needed to survive and avoid malnourishment.19 These compounding challenges placed already vulnerable infants at heightened risk of malnutrition, infection, preventable illness, and death.

b. Attacks on reproductive health facilities limited access to care to prevent and treat pregnancy and neonatal complications and health harms

Attacks on health care facilities offering or specializing in reproductive health care across Gaza have been extensively documented by the UN COI. 20 For more than two years, Israel has repeatedly attacked hospitals providing broad reproductive services, as well as more specialized units. These attacks destroyed all facilities providing infertility treatment and further limited the availability of specialized services that were already limited before October, 2023.21

Clinicians highlighted that treating the consequences of malnutrition in pregnancy was made more difficult due to limited beds in blockaded facilities, damaged hospitals and inoperable facilities, and barriers to accessing medical supplies. Between January and September 2025, the World Health Organization (WHO) reported that multiple health facilities providing reproductive health care were attacked, blockaded, and raided.22 According to the World Health Organization, as of March 14, 2025, only eight out of 21 hospitals and four field hospitals were partially operational for maternal health care.23

An interviewed health care provider who visited Gaza in early 2025 described what Kamal Adwan Hospital looked like after being attacked and raided by Israeli forces:

“It was just toxic. There is this poisonous smell in the air, acrid smoke still hanging, everything burned and charred, crunching medication vials under our boots. Kamal Adwan had one of the only functioning neonatal ICUs in the North at the time. We walked through the neonatal ICU, which hadn’t been burnt, but had been destroyed. There were incubators that had been smashed and strewn about. The whole facility was destroyed.”

Health care providers interviewed were reluctant to use surgical interventions due to lack of medical supplies, equipment, and critical sanitation and infection control measures, which could also endanger preterm babies and women. Health care providers were forced to discharge acutely malnourished women within hours after delivery because of space constraints despite their concerns about the high risk of post-surgical infections compounded by malnutrition and shortage of medical supplies. Neonatal intensive care units were also destroyed or lacked supplies and equipment, leading to predictable fatalities among premature babies who, under normal circumstances, could have survived.

c. Suffering and death of pregnant, postpartum, and lactating women and newborns were foreseeable and predicted

The death and serious mental and physical suffering experienced by women and infants in Gaza during the ongoing conflict were both foreseeable and predicted. Despite the known and predicted risks of pregnancy complications, impeded lactation, and poor newborn health, attacks on hospitals and restrictions on humanitarian aid persisted from January through October 2025.

Since the beginning of the war in Gaza, humanitarian organizations, human rights groups, and multiple UN agencies warned that Israel’s restrictions on humanitarian aid – including food, fuel, and medical supplies – would have catastrophic consequences for maternal and neonatal health due to the anticipated collapse of essential health services and the compounded vulnerability of women and children in conflicts.24 Access to food and medical care in Gaza fell far short of international standards on nutrition and health care in conflict.25 Despite the recommendations of the UN COI, the advisory opinion issued by the International Court of Justice in relation to the obligations of Israel in Gaza, and three provisional measures rulings by the International Court of Justice warning of the risk of genocide in Gaza,26 Israel continued to restrict food and medical supplies and to destroy medical infrastructure between January and October 2025.27

The available evidence indicates that the predicted and predictable consequences of food deprivation, destruction of medical infrastructure, and restrictions on medical supplies in Gaza were deliberately or recklessly disregarded, resulting in an avoidable crisis that has harmed women’s ability to menstruate, have healthy pregnancies, give birth safely, and breastfeed, and caused infants to die of dehydration and malnutrition. Beyond the immediate impact, future generations may suffer from the physical, social, and even genetic effects.28 Collectively, the outcome is devastating the reproductive capacity of Palestinians in Gaza.29

d. Tactics of war in Gaza constitute reproductive violence, demanding investigation, accountability, and reparations

Pregnant, postpartum, and lactating women in Gaza suffered negative reproductive health outcomes because of (i) targeting of health care facilities, (ii) restrictions on essential medical supplies entering Gaza, and (iii) acute malnutrition due to limits on essential humanitarian food aid, should be considered victims and survivors of reproductive violence.

Reproductive violence is defined as acts or omissions that cause harm by interfering with reproductive autonomy and rights or violence directed at people because of their actual or perceived reproductive capacity.30 Reproductive violence is prohibited under provisions of international humanitarian law (IHL) and international human rights law (IHRL) and can constitute international crimes, including war crimes, crimes against humanity; or acts of genocide.31 Our research supports the findings of the UN COI that shows a pattern of perpetration of attacks on hospitals in violation of the IHL special protections for and prohibition on attacks on medical facilities.32 Under IHL warring parties must take precautions during hostilities to minimize harm to civilians; any harm caused by attacks must be proportionate to the direct military advantage gained. Israel has stated that its attacks on hospitals are justified under IHL because of “militarization” of hospitals by Hamas.33 It is important to note that none of the clinicians we interviewed reported any misuse of hospitals by any Palestinian armed groups for improper military purposes. Regardless of the ultimate accountability of the armed parties for any particular attack, which requires independent investigation and adjudication, the overall destruction of the health care system in Gaza as a result of these attacks is incontrovertible, as is the foreseeable harms of this destruction on mothers and newborn infants. Beyond this, the report findings underscore the importance of ensuring that the harms to pregnant and postpartum women and newborns documented as arising from the direct and reverberating impacts of strikes be considered in any assessment of adherence to the principles of proportionality and precaution in attacks on hospitals in Gaza.

In addition, this report presents evidence relevant to determinations of other breaches of international law by Israel, including violations of the IHL obligation on occupying powers to ensure adequate supply of medical supplies and food in Gaza; war crimes of starvation, inhuman acts, and willfully causing great suffering; crimes against humanity of persecution and other inhumane acts; and genocidal intent to destroy the group of Palestinians in Gaza and genocidal acts of causing serious bodily and mental harm and inflicting conditions of life calculated to bring about physical destruction of the group.

In light of the evidence implicating reproductive violence, there must be thorough and independent documentation and evidence preservation, investigation of allegations of crimes, and prosecution to hold perpetrators accountable and ensure compliance with international law. Further, survivors and families of victims must have access to remedies and reparations, including access to care and nutrition to prevent worsening health harms caused by reproductive violence.

e. Restoration of access to reproductive health care and adequate water, nutrition, and sanitation is urgently needed to halt the harms documented

The report documents the suffering and biological damage inflicted on pregnant and lactating women and their newborns and underscores the urgent need for justice and accountability as well as long-term interventions to restore medical services, remedy malnutrition, and support the affected populations with rehabilitation and recovery. At the time of publication of this report, immediate action is required to ensure unrestricted humanitarian access so that food, clean water, fuel, and medical supplies can enter Gaza at the scale necessary to meet the health and nutritional needs, restore reproductive and neonatal medical services, and reverse the negative impacts of acute malnutrition.

One immediate priority is to implement high-dose micronutrient supplementation protocols – specifically for iron, folate, and calcium – for all women of reproductive age to reverse the physiological effects of prolonged acute malnutrition beyond just ensuring caloric needs are met. Additionally, it will be critical to prepare facilities and staff to manage refeeding syndrome, including developing protocols for gradual nutritional rehabilitation, electrolyte monitoring, and medical stabilization and to ensure that therapeutic foods, micronutrient supplements, and therapeutic milks for infants with severe wasting are readily available.

In the mid- and long-term, significant investment is needed to address the lasting impacts of acute malnutrition and reestablish systems to provide reproductive and neonatal health care aligned with international standards. This includes rebuilding and restoring damaged or destroyed health facilities, including maternity wards, neonatal intensive care units, nutrition services, and fertility services, and restoring access to lifesaving medications, equipment, and reproductive health services. Additionally, efforts should be made to ensure specialized treatment for complex, conflict-related obstetric trauma is available, including surgical repair for obstetric fistulas, severe pelvic floor trauma, and chronic reproductive tract infections.

Additionally, there is a need for further documentation to study the long-term impact and potential mental health and intergenerational harms on the affected population and to devise reparations and remedies to address these long-term and intergenerational harms. Finally, comprehensive reparations measures should be implemented, which include rebuilding essential services like medical care, psychosocial support, and nutritional rehabilitation, along with restitution, compensation, satisfaction, and guarantees of non-repetition as necessary.34

Conclusion

At the time of writing this report, there is a ceasefire in place in Gaza. While reports of hostilities and repeated violations of the ceasefire continue to emerge, progress toward accountability for violations of international law, including reproductive violence, remains slow. Restrictions and limited access to food and other humanitarian aid, including health care, have continued and remain inadequate to meet current needs.35 Further, the gendered harms of the conflict in Gaza remain largely obscured. The scope and nature of reproductive violence – including its impact on the survival of Palestinians in Gaza – require comprehensive and independent investigation, documentation, and accountability. The harms caused by reproductive violence and acute malnutrition are ongoing and urgently need to be remedied. Our findings underscore that each day that passes without adequate food and access to medical care for pregnant and lactating women and newborns diminishes the reproductive capacity, safety, and autonomy of Palestinians in Gaza.

Our findings underscore that each day that passes without adequate food and access to medical care for pregnant and lactating women and newborns diminishes the reproductive capacity, safety, and autonomy of Palestinians in Gaza.

While the UN Security Council adopted a resolution on November 17, 2025 endorsing the United States’ “Comprehensive Plan to End the Gaza Conflict,”36 which included commitments concerning humanitarian aid and the establishment of a temporary transitional governance body in the form of a technocratic, apolitical Palestinian committee, it is essential that the needs of women of reproductive age and infants are not overlooked in rehabilitation and recovery efforts.37 PHR and GHRC urge all actors to cease violence against health care; ensure unconditional and unhindered humanitarian access in accordance with international humanitarian principles; and advance accountability, justice, and reparations.

Recommendations

To All Parties to the Conflict:

– Immediately cease all forms of violence against health care facilities, health care workers, and humanitarian personnel in compliance with international law;

– Ensure the protection and unhindered functioning of humanitarian actors and facilitate their safe and sustained access throughout Gaza; and

– Grant full and safe access to independent international investigative mechanisms to assess the humanitarian situation; document and investigate all alleged violations and preserve evidence where relevant; and evaluate the impacts of parties’ policies and practices on civilians’ rights.

To the Government of Israel:

– Immediately cease targeting civilians and civilian objects and revise military protocols to conform to the principles of discrimination, proportionality, and precaution, including the reverberating impact of attacks on health care, in order to ensure effective and adequate protection of pregnant and lactating women, infants, and other atrisk populations;

– Respect and implement the orders of the International Court of Justice requiring that Palestinians in Gaza have access to supplies of daily life, including food, medical care and services;

– Immediately lift all restrictions on the entry of specialized neonatal nutrition products, including hydrolyzed formulas and liquid ready-to-feed formulas, indicated in medically recognized situations where breastfeeding is not possible or sufficient; and

– Fully cooperate with international accountability mechanisms and facilitate their access to Israel and the occupied Palestinian territory to conduct independent and impartial investigations.

To Hamas and Other Palestinian Armed Groups:

– Refrain from any conduct that places civilians, health care workers, or humanitarian personnel at risk;

– Ensure that humanitarian aid reaches civilians without diversion or interference, in line with obligations under international humanitarian law; and

– Refrain from any actions, including militarization, that compromise the neutrality of health facilities and humanitarian sites.

To the Transitional Palestinian Body Governing Gaza:

– Prioritize the rehabilitation and rebuilding of Gaza’s health system, including restoring essential reproductive, maternal, and neonatal services;

– Support Palestinian health workers in Gaza by providing adequate training, protection, and compensation; and

– Strengthen coordination with humanitarian partners to ensure continuity of care for pregnant and lactating women and newborns.

To the United States and Other Members of the Board of Peace:

– Ensure the unconditional entry of humanitarian aid, including medical supplies, fuel, clean water, and food, through all viable routes, without restrictions or delays, and at a scale sufficient to meet current needs and enable long-term recovery; and

– Support UN-led efforts, including World Health Organization, UN Population Fund, and UN Children’s Fund programs focused on reproductive and neonatal health.

To UN Member States:

– Urge all parties to the conflict to abide by international humanitarian law and all UN Security Council resolutions on humanitarian aid, access, and reconstruction;

– Strengthen the implementation of UN Security Council Resolution 2286 to protect health facilities and personnel, investigate attacks on health care, and hold perpetrators of these violations accountable;

– Pursue accountability through all relevant avenues for violations of international law in Gaza; and

– Support the reconstruction of Gaza’s health system and ensure the reinstatement of the right to health as a human right in Gaza.

To International Accountability Mechanisms and UN Human Rights Mechanisms:

– Investigate, pursue accountability, and secure reparations for reproductive harm resulting from attacks on health care, restrictions on humanitarian aid, and starvation; and

– Recognize reproductive harm – such as preventable miscarriages, stillbirths, maternal morbidity and mortality, neonatal deaths, and long-term health consequences of starvation and denial of care – as a distinct category of injury warranting appropriate reparative measures.

To Health Actors and Donors:

– Prioritize the rapid scale-up of maternal and neonatal services, including emergency obstetric care, neonatal intensive care units, safe delivery services, and postnatal care, in accordance with internationally recognized humanitarian standards;

– Deploy medical teams with specialized expertise in obstetrics, neonatology, malnutrition treatment, fertility treatment, and trauma-informed care to support and rebuild the collapsing health system in Gaza; and

– Prepare facilities and staff to manage complex heath presentations related to reproductive health harm, acute malnutrition, and refeeding challenges, including through ensuring the availability of necessary supplies including food aid and therapeutic food products.

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End Notes

1. We recognize that those with reproductive capacity include cis-gender women, non-binary, and other gender-diverse individuals. Throughout this report, we will use the term women to refer specifically to females with reproductive capacity, which may include where relevant, adolescent girls, while acknowledging the limitations of this terminology.
2. United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), “Rapid Gender Analysis: Gendered Impacts of the October 2023 Escalation in Gaza,” October 23, 2023, https://www.unrwa.org/resources/reports/rapid-gender-analysis-gendered-impacts-october-2023-escalation-gaza; Oxfam International, “Babies Dying from Preventable Causes in Besieged Gaza – Oxfam,” November 23, 2023, https://www.oxfam.org/en/press-releases/babies-dying-preventable-causes-besieged-gaza-oxfam; Global Nutrition Cluster, “Nutrition Vulnerability and Situation Analysis / Gaza,” February 2024, https://www.nutritioncluster.net/sites/nutritioncluster.com/files/2024-02/GAZA-Nutrition-vulnerability-and-SitAn-v7.pdf; World Health Organization, “Women and Newborns Bearing the Brunt of the Conflict in Gaza, UN Agencies Warn,” November 3, 2023, https://www.who.int/news/item/03-11-2023-women-and-newborns-bearing-the-brunt-of-the-conflict-in-gaza-un-agencies-warn; United Nations Office for the Coordination of Humanitarian Affairs, “Humanitarian Situation Update #239 | Gaza Strip,” November 19, 2024, https://www.ochaopt.org/content/humanitarian-situation-update-239-gaza-strip; Fionnuala Ní Aoláin KC (Hons), “A Zone of Silence: Obstetric Violence in Gaza and Beyond,” Just Security, February 21, 2024, https://www.justsecurity.org/92562/a-zone-of-silence-obstetric-violence-in-gaza-and-beyond/.
3. Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel, “Legal Analysis of the Conduct of Israel in Gaza Pursuant to the Convention on the Prevention and Punishment of the Crime of Genocide,” September 16, 2025, https://www.un.org/unispal/wp-content/uploads/2025/09/a-hrc-60-crp-3.pdf.
4. United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory, “Gaza Humanitarian Response Update | 11-24 May 2025,” May 27, 2025, https://www.ochaopt.org/content/gaza-humanitarian-response-update-11-24-may-2025.
5. United Nations, “UN Aid Teams Plead for Access amid Reports Gazans Shot Collecting Food,” UN News, May 28, 2025, https://news.un.org/en/story/2025/05/1163756; Office of the United Nations High Commissioner for Human Rights, “UN Experts Call for Immediate Dismantling of Gaza Humanitarian Foundation,” August 5, 2025, https://www.ohchr.org/en/press-releases/2025/08/un-experts-call-immediate-dismantling-gaza-humanitarian-foundation; International Court of Justice (ICJ), “Advisory Opinion: Obligations OF Israel in Relation to the Presence and Activities of the United Nations, Other International Organizations and Third States in and in Relation to the Occupied Palestinian Territory,” October 22, 2025, https://www.icj-cij.org/sites/default/files/case-related/196/196-20251022-adv-01-00-en.pdf.
6. Integrated Food Security Phase Classification (IPC), “IPC ALERT: Worst-Case Scenario of Famine Unfolding in the Gaza Strip,” July 29, 2025, https://www.ipcinfo.org/ipcinfo-website/countries-in-focus-archive/issue-133/en/; United Nations Children’s Fund (UNICEF), “UN Agencies Warn Key Food and Nutrition Indicators Exceed Famine Thresholds in Gaza,” July 29, 2025, https://www.unicef.org/press-releases/un-agencies-warn-key-food-and-nutrition-indicators-exceed-famine-thresholds-gaza.
7. United Nations, “UNFPA Situation Report on the Crisis in the Occupied Palestinian Territory -May/June 2025,” July 17, 2025, https://www.un.org/unispal/document/unfpa-situation-report-on-the-crisis-in-the-occupied-palestinian-territory-may-june-2025/.
8. Ibid.
9. “Malnutrition Persists as Winter Sets in, Threatening Children’s Lives and Wellbeing in Gaza,” accessed December 17, 2025, https://www.unicef.org/press-releases/malnutrition-persists-winter-sets-threatening-childrens-lives-and-wellbeing-gaza; “Born Vulnerable: The Toll of Maternal Malnutrition and Stress in Gaza,” accessed December 17, 2025, https://www.unicef.org/press-releases/born-vulnerable-toll-maternal-malnutrition-and-stress-gaza.
10. An “attack” on health care facilities refers to any type of violence, obstruction, or threat of violence that results in physical damage to the facility or causes a temporary or permanent suspension of its operations in a way that negatively affects the availability of or accessibility to medical services.
11. See Annex: Health Consequences of Starvation Compounded by Limited Access to Health Care.
12. Physicians for Human Rights and Global Human Rights Clinic, “‘We Could Have Saved So Many More’: Anguish and Death Caused by Israel’s Restrictions on Medical Supplies in Gaza​,” July 9, 2025, https://phr.org/our-work/resources/we-could-have-saved-so-many-more-anguish-and-death-caused-by-israels-restrictions-on-medical-supplies-in-gaza/.
13. Physicians for Human Rights and Global Human Rights Clinic, “FAQs: Access to Health Care Supplies and ‘Dual Use’ Items and Restrictions,” July 9, 2025, https://phr.org/our-work/resources/faqs-access-to-health-care-supplies-and-dual-use-items-and-restrictions/.
14. United Nations, “UN Aid Teams Plead for Access amid Reports Gazans Shot Collecting Food.”
15. International Planned Parenthood Federation (IPPF), “Press Release: Gaza Nine Months on, Pregnant Women Carry the Burden of Conflict,” July 9, 2024, https://www.ippf.org/media-center/press-release-gaza-nine-months-pregnant-womencarry-burden-conflict.
16. Interviews conducted before January 2025 were included to contextualize and illustrate the cumulative impact of Israel’s policies, including those in place before the March 2025 complete humanitarian aid blockade.
17. Physicians for Human Rights and Global Human Rights Clinic, “‘We Could Have Saved So Many More’: Anguish and Death Caused by Israel’s Restrictions on Medical Supplies in Gaza​,”
18. United Nations Children’s Fund (UNICEF), “UNICEF Programming Guidance: Procurement and Use of Breastmilk Substitutes in Humanitarian Settings,” June 2021, https://www.unicef.org/media/100911/file/BMS-Procurement-Guidance-Final-June-2021.pdf.
19. European Parliament, “Parliamentary Question | Access to Baby Formula in Gaza,” July 7, 2025, https://www.europarl.europa.eu/doceo/document/O-10-2025-000023_EN.html.
20. The Independent International Commission of Inquiry on the Occupied Palestinian Territory and Israel, “Treatment of Detainees and Hostages and Attacks on Medical Facilities and Personnel (7 October 2023 to August 2024),” September 11, 2024, https://docs.un.org/en/A/79/232.
21. Health Information Unit – Ministry of Health, “Annual Report 2022 – Ministry of Health: Southern Governorates – Gaza Strip,” May 2023, https://www.moh.gov.ps/portal/wp-content/uploads/2023/07/annual-english-202218-7-2023.pdf; United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory, “Gaza Humanitarian Response Update | 31 August – 13 September 2025,” September 17, 2025, https://www.ochaopt.org/content/gaza-humanitarian-response-update-31-august-13-september-2025.
22. World Health Organization, “oPt Emergency Situation Update: Issue 65,” September 28, 2025, https://www.emro.who.int/images/stories/palestine/Sitrep_65.pdf.
23. World Health Organization, “oPt Emergency Situation Update: Issue 57,” March 14, 2025, https://www.emro.who.int/images/stories/palestine/Sitrep_57.pdf.
24. United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), “Rapid Gender Analysis”; Oxfam International, “Babies Dying from Preventable Causes in Besieged Gaza – Oxfam”; Global Nutrition Cluster, “Nutrition Vulnerability and Situation Analysis / Gaza”; World Health Organization, “Women and Newborns Bearing the Brunt of the Conflict in Gaza, UN Agencies Warn”; United Nations Office for the Coordination of Humanitarian Affairs, “Humanitarian Situation Update #239 | Gaza Strip.”
25. “UNRWA Situation Report #184 on the Humanitarian Crisis in the Gaza Strip and the West Bank, Including East Jerusalem,” UNRWA, accessed September 8, 2025, https://www.unrwa.org/resources/reports/unrwa-situation-report-184-situation-gaza-strip-and-west-bank-including-east-jerusalem; United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), “UNRWA Situation Report #197 on the Humanitarian Crisis in the Gaza Strip and the Occupied West Bank, Including East Jerusalem,” November 18, 2025, https://www.unrwa.org/resources/reports/unrwa-situation-report-197-situation-gaza-strip-and-west-bank-including-east-jerusalem.
26. International Court of Justice (ICJ), “Advisory Opinion: Obligations of Israel in Relation to the Presence and Activities of the United Nations, Other International Organizations and Third States in and in Relation to the Occupied Palestinian Territory”; Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel, “Legal Analysis of the Conduct of Israel in Gaza Pursuant to the Convention on the Prevention and Punishment of the Crime of Genocide”; International Court of Justice, “Application of the Convention on the Prevention and Punishment of the Crime of Genocide in the Gaza Strip (South Africa v. Israel): Orders,” accessed November 21, 2025, https://www.icj-cij.org/case/192/orders.
27. United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory, “Gaza Humanitarian Response Update | 11-24 May 2025.”
28. Elmar W. Tobi et al., “DNA Methylation Signatures Link Prenatal Famine Exposure to Growth and Metabolism,” Nature Communications 5 (November 26, 2014): 5592, doi:10.1038/ncomms6592.
29. For further detailed information on the medical literature related to the physiological impacts of acute malnutrition on women and newborns, see the annex.
30. ICC Office of the Prosecutor, Policy on Gender-Based Crimes, pg. 14 (2023). See also Rosemary Grey,, The ICC’s First “Forced Pregnancy” Case in Historical Perspective, Journal of International Criminal Justice, Vol. 15, Issue 5 (Dec. 2017); UN Women and Global Justice Center, “Documenting Reproductive Violence: Unveiling Opportunities, Challenges, and Legal Pathways for UN Investigative Mechanisms,” September 2024, https://www.unwomen.org/sites/default/files/2024-09/research-paper-documenting-reproductive-violence-en.pdf.
31. ICC OTP, Policy on Gender-Based Crimes, pg. 14 (2023). See also Rosemary Grey, The ICC’s First “Forced Pregnancy” Case in Historical Perspective, Journal of International Criminal Justice, Vol. 15, Issue 5 (Dec. 2017); Ibid.; International Criminal Court, “Rome Statute of the International Criminal Court,” 2021, https://www.icc-cpi.int/sites/default/files/2024-05/Rome-Statute-eng.pdf. For crimes against humanity, see Art. 7(1)(g). For war crimes, see Art. 8(2)(b)(xxii), 8(2)(e) (vi))
32. Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel, “Legal Analysis of the Conduct of Israel in Gaza Pursuant to the Convention on the Prevention and Punishment of the Crime of Genocide.”
33. Israel Defense Forces (IDF), “Exploitation of Civilian Infrastructure: Hamas’ Operations in Hospitals | IDF,” accessed November 30, 2025, https://www.idf.il/en/mini-sites/hamas-operations-in-hospitals/.
34. Office of the United Nations High Commissioner for Human Rights, “Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law,” accessed November 30, 2025, https://www.ohchr.org/en/instruments-mechanisms/instruments/basic-principles-and-guidelines-right-remedy-and-reparation.
35. United Nations, “Aid Deprioritised as Commercial Goods Flow into Gaza, UN Warns,” December 15, 2025, https://news.un.org/en/story/2025/12/1166595.
36. United Nations Security Council, “Security Council Resolution 2803 (2025),” November 17, 2025, https://docs.un.org/en/S/RES/2803(2025).
37. BBC, “What Does Wording of Gaza Ceasefire Agreement Tell Us?,” October 10, 2025, https://www.bbc.com/news/articles/ckgyr8e0gl2o; United Nations, “Israel Has Rejected over 100 Aid Requests since Gaza Ceasefire, UN Say,” UN News, November 6, 2025, https://news.un.org/en/story/2025/11/1166295.

Since assuming office in January, the second Trump administration has actively pursued a variety of detention and deportation practices that tear parents from their children and leave them at risk of long-term, even permanent separation.

Over six days in late November 2025, the Women’s Refugee Commission (WRC) and Physicians for Human Rights (PHR) traveled to Honduras, where approximately 300 people are being returned every day, to speak with people immediately after their deportation from the United States. Our delegation spoke with service providers, doctors, psychologists, government officials, and newly arrived deported adults who had just disembarked from deportation flights. Through interviews with dozens of adults who arrived without their children, WRC and PHR learned the nature of the family separation crisis currently unfolding.

In contrast to prior years, when most deportees were individuals who had been detained while trying to cross the border, the majority of returnees with whom we spoke were longtime US residents. Many of their children are US citizens. Of the parents we spoke to, more than half had been deported without being given an opportunity to bring their children with them. Some of them described that, despite their efforts, they were unable to obtain basic information about their children’s location or care.

In some cases, we spoke with mothers who arrived in acute distress because they had been unable to speak with their children or the person caring for them. One father, who had been apprehended by US Immigration and Customs Enforcement (ICE) at work while his children were at home with a babysitter, had been able to make a telephone call while in the US to make temporary childcare arrangements. One mother, who had been deported without being given the opportunity to bring her two month-old child, a US citizen, back with her, could talk of little more than her frantic desperation to have her newborn baby back.

What we saw violates longstanding US policy to preserve family unity. Read In Parents’ Own Words: Documenting the Stories of Separated Parents in Honduras.

As the 16 Days of Activism Against Gender-Based Violence unfolds around the world, conversations often center on the scale of the problem. We hear about alarming statistics, stories of harm, and the persistent barriers survivors face in their pursuit of justice, like how only 14 per cent of all women and girls worldwide (about 557 million) live in countries with robust legal protections guaranteeing women’s fundamental human rights. 

But in a meeting room in the heart of Nairobi this November, the focus shifted from what is broken to what is beginning to work. Not only the problems, but the solutions.  

As the 16 Days of Activism Against Gender-Based Violence reminds the world that violence thrives in silence, the work of PHR and its partners in Kenya and the DRC tells another story: one where innovation, collaboration, and courage are rewriting what is possible. 

On November 19th and 20th, Physicians for Human Rights (PHR) convened a roundtable on scaling MediCapt and strengthening forensic evidence documentation, bringing together innovators from Kenya and the Democratic Republic of Congo (DRC). MediCapt is a secure digital application that enables clinicians to document medical evidence of sexual violence, capture forensic photographs, and store information safely in the cloud. It replaces unreliable paper systems with structured, standardized, and secure digital documentation, preserving the chain of custody and improving the quality of evidence presented in court. PHR developed MediCapt in response to the very challenges that participants at the roundtable know all too well: lost or damaged files, insecure storage, inconsistent documentation, overworked staff, and broken links between the health, police, and justice sectors.  

Among the participants of this forum sat clinicians, heads of medical facilities, law enforcement officers, magistrates, government officials and digital health specialists, all of whom play a role in the documentation and prosecution of sexual and gender-based violence cases. Many in the room had never met before. But they shared one common reality: too often, people who survive sexual violence have their court cases collapse not because justice is impossible, but because critical evidence is missing, incomplete, or lost. 

One participant from a medical facility in Nakuru, Kenya shared that in a recent sexual violence case, the physical PRC (Post Rape Care) form, a crucial piece of medical evidence, had gone missing. Without the PRC form, there is simply nothing to corroborate the findings of the medical examination, effectively stripping the case of its evidentiary backbone, even when a survivor was ready to pursue justice. Instead, because the data collected with MediCapt was safely preserved in the cloud, the clinician simply reprinted the MediCapt-generated digital PRC form. The court accepted it. Justice did not stall. The court proceedings were able to proceed because critical medical evidence was preserved. Other clinicians shared similar stories. These accounts have enormous implications: in a system where paper is fragile and accountability depends on precision, a digital record protected a survivor’s chance at justice. 

MediCapt is also proving effective and adaptable in vastly different contexts; from the dense informal settlements of Mukuru in Nairobi to the fast-growing metropolitan landscape of Naivasha and at varying levels of health facilities. Despite differences in infrastructure, security, and population dynamics, MediCapt continues to respond to the realities on the ground. Participants also shared excitement about its next frontier: expansion to enable wider reach in Kenya and DRC, and potentially into new geographies such as Tanzania and Iraq. It is this flexibility, the ability to function across crisis and conflict, urban, and peri-urban spaces, that has positioned MediCapt as not just a regional solution, but potentially a global one. 

In her address, PHR’s Director of Programs, Karen Naimer, JD, LLM, reminded participants that technology alone cannot deliver justice. 

“Each of your roles, when taken together, collectively supports survivors’ access to justice through proper documentation. Clinicians, police officers, magistrates, technologists, policymakers; none of these roles stand alone. It is your collaboration that gives survivors a real chance at justice. And that work must continue long after this roundtable ends.” 

Her message underscored a simple but powerful truth: innovation is only as strong as the people who carry it forward. 

By the close of the roundtable, participants had co-created a set of practical, context-specific recommendations aimed at improving MediCapt’s functionality, strengthening integration into national systems, and ensuring its long-term sustainability. Just as importantly, they left with renewed commitment; not only to a tool, but to a shared vision of justice for survivors. 

As the 16 Days of Activism Against Gender-Based Violence reminds the world that violence thrives in silence, the work of PHR and its partners in Kenya and the DRC tells another story: one where innovation, collaboration, and courage are rewriting what is possible. 

One case. One clinic. One country. One survivor at a time. 

And through MediCapt, their stories are no longer lost. 

As part of Russia’s full-scale invasion of Ukraine, evidence is mounting of widespread torture and sexual violence perpetrated against Ukrainians. Survivors often face compounded harm from stigma, limited accountability pathways, and the challenges of navigating domestic justice systems.  

Against this backdrop, Physicians for Human Rights (PHR) is sharing our specialized experience using survivor-centered, trauma-informed methods to strengthen documentation of torture and sexual and gender-based violence in Ukraine. Our model goes beyond technical skill building for individual clinicians. In contexts around the world, we work to strengthen sustainable approaches to survivor medical care and treatment, forensic documentation, and access to justice by taking a systems-wide approach. In doing so, we co-design and develop standardized forms to support forensic documentation of torture and sexual and gender-based violence that can be integrated into national response frameworks. Through decades of partnerships in places like the Democratic Republic of the Congo, Kenya, and Iraq we’ve foster multisector networks to enhance collaboration among medical, law enforcement, and legal professionals, and ensure the comprehensive and compelling evidence collected can be preserved and stand up in court as part of supporting survivors’ healing.  

PHR is sharing our specialized experience using survivor-centered, trauma-informed methods to strengthen documentation of torture and sexual and gender-based violence in Ukraine.

Through our collaborations with the medical community and advocacy for institutional policy reforms, PHR is helping health care workers to more intentionally center survivors in their medical practice, with empathy and dignity, so survivors can be more supported when seeking pathways to justice and accountability.   

The Challenge of Documentation 

High quality medico-legal documentation is crucial to achieve justice, provide holistic care, and seek necessary redress for survivors. As the numbers of survivors of torture grow, there are deficits in experts trained in medico-legal documentation, and regulatory restrictions limit the pool of such experts. Additionally, the absence of a nationally mandated standardized form to document forensic evidence in cases of torture, including sexual violence, is another barrier to achieving justice for survivors.  

PHR’s Ukraine program is addressing these challenges at both the policy and practice levels. One major focus has been supporting domestic legal reforms regulating medical documentation of domestic and gender-based violence (Ministry of Health’s Order 278). The planned amendments – currently pending adoption by the Ministry of Health – would introduce a standardized medico-legal certificate based on principles of the Istanbul Protocol, International Protocol on Documentation and Investigation of Sexual Violence in Conflict, and other international guidelines. The amendments would also incorporate a survivor-centered, trauma-informed approach to medical care and forensic documentation and allow non-forensic clinicians to contribute to documentation after appropriate training. In pursuing these policy reforms, PHR collaborated closely with health and legal professionals, and survivor representatives to cultivate national ownership of these reforms. We also worked together to introduce new innovations, such as obtaining informed consent from survivors before undergoing a medical evaluation and including conflict-related sexual violence in the scope of documentation.  

Dialogue Puts New Clinical Practices in Motion 

To address the need for clinicians who are trained in medico-legal documentation according to the Istanbul Protocol and other renowned standards, PHR, together with the World Health Organization (WHO), convened more than 25 Ukrainian forensic and non-forensic clinicians for a training on medico-legal documentation of torture and sexual violence in Lviv, Ukraine in July 2025. It followed an introductory overview of medico-legal documentation of torture and sexual violence delivered in June at the UNBROKEN Mental Health Center in Lviv which brought together more than 150 clinicians who work with survivors of captivity, torture and CRSV. 

A cornerstone of the July training was the integrated survivor-clinician dialogue, which PHR organized jointly with the Denis Mukwege Foundation, where representatives from more than 10 survivor organizations shared their lived experience and the barriers they face in addressing justice. Clinicians, in turn, spoke to the systemic constraints of their work. This mutual exchange deepened trust, clarified gaps, and inspired pathways for collaboration.  

Some survivors shared that the forensic evaluations they had undergone at national health facilities were traumatic experiences because the evaluations were held in rooms that reminded them of the prisons in which they were detained. For example, survivors shared that the bars on the windows of the hospital examination rooms triggered significant anxiety. Upon hearing survivors share this experience, one forensic psychiatric expert took immediate action and issued an order mandating the removal of bars on windows in all their national health institutions across the country.  

Over a four-day training, clinicians practiced survivor-centered, trauma-informed interviewing, evidence documentation, and medico-legal reporting using the Istanbul Protocol guidelines and Ukrainian standardized tools. They engaged in case-based discussions and hands-on exercises while also exploring self-care strategies to mitigate vicarious trauma (the cumulative effects of exposure to information about traumatic events and experiences). Post-training assessment showed significant knowledge gains – particularly among forensic experts – and participants praised the opportunity to connect across sectors. Participants showed the strongest gains in ethical principles and interview techniques and understanding the purpose of medico-legal documentation. 

As Ukraine continues to face the devastating consequences of Russia’s invasion, these collaborations show that health professionals and survivors working together can bring justice, accountability, and healing closer.