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Since the start of Israel’s latest genocide in Gaza in October 2023, Sandra Adler Killen, an emergency room and pediatric registered nurse and internationally board-certified lactation consultant, has conducted four medical missions in Gaza, some lasting as long as 30 days. Her first deployment was in March 2024, providing pediatric care out of Palestinian Red Crescent Society tents in Al Mawasi, Khan Younis. After returning home, she focused on capacity-building initiatives in Gaza, remotely teaching and training local clinicians, including pediatricians, neonatologists, OB-GYNs, midwives, and nurses in lactation care. 

In August 2024, Adler Killen joined the GINA Infant Nutrition Alliance, an organization that has supported thousands of breastfeeding women in Gaza through healthcare workers on the ground and remotely. The organization also helped Adler Killen return to Gaza with the medical solidarity organization Glia in March and October 2025, and most recently in April 2026. During these missions, she primarily worked in the southern Gaza, volunteering in Al Aqsa, Nasser, and Al Helou hospitals, among others. Adler Killen is also part of an international telehealth lactation consultant team. With the assistance of Arabic translators, the team offers virtual care to thousands of mothers and pregnant women in Gaza. 

During her March 2025 mission in Gaza, Adler Killen lost her mother. She attributes her ongoing commitment to the mothers of Gaza to the teachings of her own.

On Feb. 18, 2026, Adler Killen spoke with Prism about the ongoing crisis for mothers and newborn babies in Gaza, discussing the increasingly normalized tragedy of pregnant women under constant threat by Israeli weapons, the long-term effects of genocide on mothers and babies as the future of Gaza, and the role of Israel’s cyclical “ceasefires” and blockades on newborns.

This interview has been edited for clarity and brevity.

Marah Abdel Jaber: What did a day in the field look like for you? What kind of restrictions did you face in your practice that are distinct from your work in the U.S.?

Sandra Adler Killen: During my first deployment, the medications were restricted to a certain extent. We had very few analgesics that we were allowed to bring in for pain management. We were doing minor outpatient surgical procedures, so it was an issue. We were doing procedures with conscious sedation medication, which is very different from what we would do in the States. For example, if you’re doing an outpatient surgical procedure on somebody who has a bullet inside of them that isn’t too deep, we would use certain medications there that we would never consider using here because we didn’t have access. Our team kept all of the medical supplies and equipment with us in our vehicles. We would bring them to the tent, set up, and take them back every single day. But, as you can imagine, it was fairly limited because we only brought whatever we could carry that we thought was essential and was permitted. These are not truck shipments. We often didn’t have the right materials, equipment, or medications to actually treat patients effectively and just made do with what we had. 

Abdel Jaber: How did you manage patient care in these conditions?

Adler Killen: We simply had to be creative. It certainly wasn’t optimal care, it was simply based on what we had available. But after my first mission, we couldn’t bring any equipment in, only personal medications. The following trips were very different. I depended upon what was available in the hospital, and that was extremely limited. If we needed to feed a preterm baby orally who couldn’t transfer to the breast, or babies in the neonatal intensive care unit (NICU), sometimes we had to use the wrong size feeding tube. 

I slept and stayed at the hospital. I was very independent, working and setting up my trainings daily. In my subsequent missions, I trained local Gazan clinicians, including neonatologists, doctors, nurses, midwives, pediatricians, and OB-GYNs. It was truly just about teaching. We would use real cases to teach and train; some of the training was didactic, and some was hands-on.

Abdel Jaber: What was notable about the cases that you treated across your trips?

Adler Killen: The first time I entered, it was predominantly pediatric cases, especially in the mass casualty shootings. There were multiple entry and exit wounds, most of them caused by quadcopters. The patients ranged anywhere from 2 to 10 years old. As you can imagine, that was the most extraordinary and devastating thing we encountered. During my other two entries, the amount of congenital birth defects—heart defects, cleft lip and palate, preterm infants, and extremely low birth weight infants—was exceptional. I’ve never seen anything like it in my practice. It was a drastic number of babies born with these comorbidities. 

Abdel Jaber: What might this suggest about the war tactics Israel deploys in Gaza?

Adler Killen: I can’t speak to the targeting of children, that’s not for me to say. But, in terms of what I experienced with newborns, the conditions in Gaza were certainly teratogenic. There is a severe lack of sanitation, a lack of clean water, displacement, and an unsafe ability to get prenatal care because people feared being killed en route to the hospital. There is also insufficient nutrition. The extent of malnutrition that we experienced due to the blockade of any food entering Gaza, and certainly healthy food, was dire. I entered not long after a period of extreme starvation. Many children and adults were dying. And then you have all of the buildings that have been destroyed, the toxins in the air, the armaments, the bombs, the missile attacks, and the nonstop bombing at night. Of course, people aren’t sleeping. The stress and PTSD wreak havoc on people’s nervous systems. That’s potentially going to lead to more issues with premature births. 

Abdel Jaber: Did any specific cases stick with you? 

Adler Killen: There are so many; it’s really difficult to pick one or two. One day, I had three consecutive mothers with devastating cases. The first mother was 17 years old. Five days after she got married, her husband was killed by Israeli gunfire. Not long after his killing, she found out that she was pregnant with twins. She gave birth to two preterm babies,  a son and a daughter. Her son died a few hours after birth. I visited her for support and to provide some of her breast milk to her surviving daughter. When I returned the next day, her daughter had died.

My next patient was injured in a bombing, and she suffered from a traumatic brain injury. She had left-sided paralysis, and I was there to support her in feeding her newborn. Her husband was also killed during her pregnancy. The third mother was injured by gunfire. She was experiencing constant pain and is now paralyzed in her left leg. She cannot walk. She was trying to figure out positions to feed her baby. She was also shot once before, while pregnant with her previous child. She didn’t breastfeed that baby at all because she was recovering from her wounds, but she really wanted to breastfeed her newborn. That was a single day of cases.

what sustained me is the connection I have with these mothers and how they live their lives with such equanimity and grace, alongside all the horrors that they’re experiencing. This is why I continue to return to Gaza.

Sandra Adler Killen

Abdel Jaber: To what extent does this reflect the general conditions of mothers and newborns in Gaza? 

Adler Killen: Certainly, these situations are not unusual. I mean, you get to a point where nothing shocks you anymore. It’s so hard for me to articulate this. The amount of love these mothers have for their children, the amount of grace they have, the amount of warmth that they share with me, even while holding all of this, is just extraordinary. We encountered many similar cases, but what sustained me is the connection I have with these mothers and how they live their lives with such equanimity and grace, alongside all the horrors that they’re experiencing. This is why I continue to return to Gaza.

Abdel Jaber: Did you notice any specific shifts in maternal or neonatal care throughout your missions? 

Adler Killen: After the “ceasefire” was announced, we were able to get more women to the hospital and clinic for support. They were getting timelier care. They also had no money, so we had to pay for their transportation, which was still very expensive. When I went the previous time, it was almost impossible to get mothers to come because of the situation, the fear of the bombing, and the expense of transport. There was also more formula, which made my job more challenging. Right after the ceasefire ended, a huge influx of formula was allowed into Gaza.

Formula is medicine; we use it when we need to, but we know it has worse health outcomes for the baby. It’s not as optimal, but more importantly, they don’t have the ability to properly sanitize the bottles in Gaza. Consequently, many fragile, preterm babies were coming in with a multitude of respiratory and gastrointestinal issues. Some of them became septic and didn’t survive. When I first arrived in October 2025, we saw a large number of newborn babies in the NICU. They didn’t have the correct formula to feed newborns, and they were dying. Then, once the ceasefire was announced, there was another huge influx of formula entering, leading to a cycle of more babies with gastrointestinal and respiratory issues. Because of the conditions in Gaza, the increase in formula use leads to significantly worse outcomes.

Abdel Jaber: Working directly with mothers and babies, how do you assess the long-term impacts of Israel’s genocide on Gaza’s future generations?

Adler Killen: Babies are the future. It’s going to take a long time to rebuild. I could go on about how the lack of educational opportunities is impacting the future of Gaza, with all of the universities and schools destroyed. The future of the Palestinian people is greatly affected by access to good healthcare and quality education. We know that the lack of access to medical education, care, medications, and medical supplies is going to impact the growth, development, and health of all of these babies. There isn’t enough research on the specific conditions of Gaza because this is unprecedented, but we know that these factors have historically led to lower IQs, shorter stature in children, a multitude of learning disabilities, and long-term health outcomes that we can’t even imagine. The one thing I do know is the commitment of the people in Gaza, their focus on care, and community support. They’re doing everything they can to mitigate these long-term health outcomes.

Abdel Jaber: What did Gaza teach you?

Adler Killen: Besides the mothers, the commitment of the medical staff was incredible. They showed up every day, even when their tents had been destroyed and flooded. When they didn’t have access to clean water. Even when it wasn’t safe for them to travel. They continued to show up with the most capable, warm, generous, and dedicated mindsets. They give more than any clinicians I have ever seen. I had team members whose siblings were just killed, or whose family members are struggling with cancer and heart disease, unable to access the medications they need to survive. And yet, they still show up. With full hearts, commitment, and a love for caring and making a difference for the future of the Palestinian people.

Editorial Team:
Sahar Fatima, Lead Editor
Lara Witt, Top Editor
Stephanie Harris, Copy Editor