Sara, 24, is four months pregnant with her third child and living with at least 50 other people in a house in Gaza. This location is supposedly in a safe area — in Rafah, on the border with Egypt. But this city too is being bombed now.

In Bethlehem, Occupied West Bank, the Lutheran Church decided that its Christmas nativity scene this year would be different by placing the symbolic Baby Jesus in a manger of rubble and destruction to reflect the reality of Palestinian children living and being born today.

This young woman’s plight, and that of the estimated 50,000 pregnant women in Gaza, evokes the nativity story depicted in Christmas pageants at churches around the world this time of year. Some 5,500 Gazan women are expected to give birth during Advent.

Sara is from Al Shuja’iya, a neighborhood of Gaza City less than 50 miles southwest of Bethlehem. She and her family complied with Israeli orders to evacuate to the southern part of the Gaza Strip, traveling by car and foot, and also by donkey cart as if it were Biblical times. They had to pick their way over rubble-strewn roads congested with more than 1 million other exhausted and frightened travelers.

When Sara’s family left their home, they first found refuge at her parents’ house, but were forced by the chaos to move another six times, several of them during intense bombardment. Their current location has no electricity, running water or heat and only an open fire for cooking. With the intensifying combat, the situation is extremely stressful, which increases risk for miscarriage, preterm labor and a low-birth-weight infant.

In the Gospel story, once Mary and Joseph arrived in Bethlehem from Nazareth, they could find nowhere to stay until an innkeeper offered them the use of his stable. For many pregnant women in Gaza, there is literally “no room at the inn.” They are giving birth in cars and on the street.

For now, Sara is considered one of the lucky ones. She’s had a single maternal care visit so far, at the Al-Helal Emirati maternity hospital in Rafah. It was crowded with about 50 other women seeking attention, but she was able to meet with a doctor, who gave her a bottle of prescription vitamins. Her family has been able to find food for her to eat — oranges, cucumber, tomatoes, nuts and canned food — but the market shelves are increasingly depleted and prices have skyrocketed.

It’s unclear where Sara will be in May when her baby is due and whether bombs will still be falling. For women giving birth in Gaza this Advent, the odds are narrow that they can obtain a hospital bed, since so many healthcare facilities are in shambles. Many will give birth in Al-Mawasi, a narrow patch along the coast that Israel designated as a safe zone — barren land with a chaotically improvised tent camp and no infrastructure.

Regardless of where these women are, they are likely to give birth in an unsafe environment, putting them at risk for infection, uncontrolled hemorrhage and damage to their reproductive systems. Lack of postnatal care increases the risk of brain damage and death for the baby, while the hostile environment can interfere with the mother-infant bond.

In well-loved hymns passed down through the generations, the night of Jesus’ birth was silent, and the sky was filled with brightly shining stars, guiding shepherds and the three wise men to the manger in Bethlehem.

In Gaza, the night is not silent. The bombs and shelling continue unabated, underscored by the buzzing of drones. The sky is bright with explosions, but toxic smoke obscures the stars. Should wise people such as international human rights monitors wish to check on the conditions of new mothers, they cannot, because Israel has denied them entry. Journalists cannot conduct interviews with such women, either, because they’re forbidden to be in Gaza unless embedded with Israel’s army. Shepherds will not be anywhere near, as they have had to abandon their flocks.

Today, Gazan families are pressed against Egypt’s border. It’s possible Sara and her family could be forced into exile in the Sinai Desert. But she fervently hopes a cease-fire will be called before a mass exodus of Palestinians could happen.

For Sara, her faith in God’s will remains unshakable: “I trust he will always be there for me.”

In this moment of war, may heavenly peace come for the newborns of Gaza.