WOMEN AND GIRLS FACE LONG-TERM PHYSICAL AND MENTAL HEALTH IMPACTS Beyond immediate health impacts such as malnutrition and anemia, women and girls in Gaza face longlasting physical and mental health consequences of food insecurity, hunger, and starvation. Notably, food insecurity and famine have dramatically increased gender-based violence (GBV) and protection risks for women and girls and have resulted in profound mental health and psychosocial impacts. Gender-based violence and protection risks Food insecurity, hunger, and starvation have sharply intensified the risks of GBV in Gaza. The most recent Gaza GBV Trends Analysis confirmed that denial of resources, services, and opportunities was the most reported form of GBV, accounting for 38 percent of documented cases. Survivors also reported rape, sexual assault, and sexual exploitation, though case managers warned these remain severely underreported due to stigma, fear of reprisals, and lack of safe reporting mechanisms.63 There have also been reports of women facing sexual exploitation and abuse in exchange for food or safe passage, a risk that increases when normal protection systems collapse.64 Key informants emphasized that GBV in Gaza is taking many forms, including coercion, harassment, and transactional sex for survival. One frontline worker noted: “Women are forced into situations where their only option is to give their bodies for food or protection.” KIIs and women’s testimonies emphasize that access to aid has itself become a site of violence and stigma. A pregnant woman explained: “If a woman tries to get food, she risks being insulted, harassed, or even assaulted. Even at community kitchens, women face verbal harassment and humiliation.” A widow and nurse elaborated: “At aid centers women face pushing, shouting, humiliation, even threats. I fear for my daughters in those places.” Several testimonies from women confirmed that women and girls were subjected to verbal abuse, unwanted touching, and transactional exploitation when trying to access aid. A UN protection expert warned: “In a number of cases, camp volunteers controlling lines have harassed women and girls, we need hardened PSEA and women-led crowd management.” Mental health and psychosocial impacts The war, famine, and destruction of Gaza’s social fabric have precipitated a profound mental health crisis. Even before the current war, a significant portion of Palestinian women and girls reported symptoms of depression and trauma, a consequence of years of blockade, conflict, and deprivation.65 Now, as studies have found alarmingly high rates of mental health symptoms among both children and adults, nearly every single woman and girl in Gaza requires mental health and psychosocial support.666768 Yet since October 2023, access to mental health services in Gaza has collapsed. Psychiatric clinics and counselling centers have been destroyed, medications for depression and anxiety are unavailable, and community support networks have broken down.69 Gazan women have shown remarkable resilience through repeated crises, but hunger and starvation are pushing women beyond the limits of endurance. A common refrain is that women feel they are living a “slow death sentence”. A widow and mother of three described how survival has become degrading: “Sometimes I think hunger hurts less than the humiliation we face while trying to find food.” Another widow explained: “The loss of dignity cuts as deeply as the hunger. At aid centers, women face pushing, shouting, humiliation, even threats. I fear for my daughters in those places. There are no private spaces, no hygiene, no soap, no safety.” 19