This past June marked the 25th birthday of Louise Brown, the first baby to be conceived outside her mother's womb. 

In Vitro Fertilization (IVF), or the combination of the egg and sperm outside the womb in a laboratory, has become a commonplace practice in many parts of the world. It is still, however, considered a luxury for most. 

IVF is a complex and expensive procedure. Only 5% of infertile couples seek the treatment in the United States, the world’s richest nation.

The average cost of an IVF cycle there is $12,400, not including the required drugs, according to the American Society of Reproductive Medicine, with couples usually requiring at least 2-3 trials. 

It might therefore come as a surprise to find that in the impoverished Gaza Strip, IVF clinics have boasted unprecedented success despite record high unemployment rates and the ongoing Intifada.

It is estimated that more than half the population is out of work, with nearly 60% living on under $2 a day, according to a recent report by Johns Hopkins University. 

Making babies - even at a high relative cost to the potential parents - seems to be an industry that is unaffected by the economic and political situation.

There are two IVF clinics in the Gaza Strip, and three in the West Bank.

According to Dr Baha al-Ghalayini, director of Gaza’s first IVF clinic established in 1998, initial estimates indicate that over 20% of infertile couples seek IVF treatment here.   

“And I think after we complete the survey we’re conducting we’ll discover that the numbers are even higher than that,” said Ghalayini.

Ghalayini says he treats on average of 40 to 50 patients a month, with one in three coming back for repeat trials. It is not unheard of though for patients to go through eight or nine cycles before getting pregnant.

So far, the success rate for his clinic - or the number of babies that are carried to term and delivered, is at about 30%. 

Pregnant at any cost

Most patients, says Ghalayini, are poor and can hardly afford to sustain themselves and their families, let alone think about being treated for infertility. Therefore, it might come as a surprise to discover such high rates of people seeking treatment, almost at any cost. 

“They don’t allow anything to get in their way. If they don’t have money, they’ll borrow money, if they can’t borrow money, they’ll sell their things, and if they don’t have things to sell they’ll apply for a medical assistance grant from the Palestinian Authority,” said Ghalayini.

More than half of the patients that visit the IVF clinics here, says Ghalayini, are paid for by the Palestinian authority, and the numbers have only risen during the Intifada.

Ghalayini meets a would-be mum
A standard letter from the Ministry of Health is issued to the patient authorising her transfer to a private IVF clinic. The doctor then uses this letter as a check to cash in the money via the Ministry of Health. 

Ghalayini says Shaikh Ahmad Yasin, Hamas’s spiritual leader, also sends subsidised cases his way, as do Fatah and the PFLP. 

“All these groups have a social role as well as a political role.”

The desire to conceive, says Ghalayini, is human nature. But according to Dr Mona al-Farra, physician and social activist with the Union of Health Work Committees, there are many more factors at work in Gaza. 

Paradoxically, the same factors may cause an outside observer to conclude that IVF is not a feasible option for the infertile poor in Gaza - the economy and the political situation - play a key role in encouraging people to seek out the treatment. 
 
“The political situation has created a feeling of instability and insecurity here. So people have many children to make up for this lack of security,” said al-Farra.

“Many patients come and tell me they had a son who was martyred and want to replace him with another son” 

Dr Baha al-Ghalayini,
director of Gaza’s first IVF clinic
 

Al-Farra says there is almost a kind of stigma associated with not having children in Palestinian society. Children are a man’s claim to pride, honour, and standing in society, especially when all else is absent.   

“In addition, we remain an agrarian society with a village mentality, even in the city. People feel it is important to have as many kids as possible - especially boys - to help out, and as soon as possible.”

According to Ghalayini, it is not unusual to find newly married couples coming in for treatment. 

“Of course, I turn them away and explain they have to wait at least a year.”

Ghalayini says he believes there is also a psychological stimulus at work. 

“Many patients come and tell me they had a son who was martyred and want to replace him with another son.” 

“There is also the economic factor,” added al-Farra. “We are a poor society, so people have had a tendency to compensate their economic losses with education and procreation.”    

No alternative

Ghalayini says when he first opened the clinic it took time for people to adjust to the idea. 

“A lot of religious questions were raised, people were afraid this might not be something permissible, Islamically speaking.”

“What can I tell you? I’m really embarrassed. I practically had to beg for money from people. But even if I had to sell my house, I’d do so just to get a chance to come here and get treated”

Sabah,
patient seeking IVF treatment

IVF Clinics can be found all over the Middle East, and the treatment itself has been accepted as a legitimate means of conception by Islamic scholars.

There are however strict guidelines to be followed. The sperm and egg, for example, must come from a properly married couple. The majority of Muslim scholars are virtually unanimous in their ruling that the use of donated eggs or sperm is tantamount to zinna, or adultery.

The range of options for infertile Muslim couples is thus limited in comparison with their Western counterparts. IVF has become their only alternative.

Some cases, like that of Umm Ahmad and her husband, is normal by most standards. They came all the way from Rafah in the southern Gaza Strip to seek treatment in Dr Ghalayini’s clinic after five years of marriage and no children. 

Umm Ahmad sat patiently in the waiting area for over four hours. Dr Ghalayini, it seems, is extremely busy and overworked - even in Ramadan - when he often misses the breaking of the fast in the evening. 

Others are more typical of the kinds of cases Ghalayini is used to seeing: women who come from families unable to find food to eat.

Sabah, from Gaza’s Beach Refugee Camp, has been married for eight years now, and has been unable to conceive. Advertising is virtually non-existent here in Gaza; Sabah says she heard about the clinic from her neighbour. She is struggling to make ends meet. 

“What can I tell you? I’m really embarrassed. I practically had to beg for money from people,” she said, while waiting impatiently for her name to be called.

“But even if I had to sell my house, I’d do so just to get a chance to come here and get treated.”