(Photo by U.S. Environmental Protection Agency Images via Free Malaysia Today/CC BY 4.0 DEED)
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The war that has been ravaging Gaza for more than a year has decimated healthcare infrastructure and public sanitation systems, claimed at least 42,600 lives, and injured almost 100,000 others. Israel has been targeting hospitals and medical workers, rendering it nearly impossible for Gazans to access healthcare, which the UN considers to be a war crime amounting to ‘extermination.’ The destruction of hospitals and public sanitation systems not only means that the wounded cannot be treated for their injuries, but it also allows diseases to run rampant in Gaza.
Israeli forces have destroyed nearly all of Gaza’s water treatment centres and obliterated water production and desalination. Their actions reduced Gazans’ daily water consumption to 4.74 liters per day—one-third of the recommended minimum amount during emergencies. Dehydration and contact with contaminated water, coupled with a near complete lack of vital medication and cleaning products, risk enabling otherwise treatable diseases to claim thousands of lives. This catastrophe, however, is not likely to stay within the confines of Gaza, as disease does not know borders.
Disease in Gaza
The majority of the diseases present in Gaza are preventable and water-based. Due to the contamination of water—both drinking water and bodies of water—with raw sewage, people are coming into contact with diseases like Hepatitis A, Polio, and myriad skin conditions like impetigo, scabies, and lice.
Cases of Hepatitis A, a viral disease that damages the liver, have skyrocketed in Gaza. Numbers have increased from 85 cases from October 2022 to July 2023 to roughly 40,000 since the war began.
The cases, combined with more than 100,000 cases of acute jaundice, a symptom of liver failure and Hepatitis A, are alarming. Hepatitis A is contagious, especially during the first weeks when the patient is asymptomatic. As a result, the disease can spread unchecked in the overcrowded and unsanitary conditions of Gaza.
Meningitis, a deadly infection that affects the nervous system and leads to swelling of the brain, has also been recorded in the territory, with an uptick in cases since the outbreak of the war. There is concern for the spread of the meningococcal disease, which can lead to sepsis, due to overcrowding.
Resurgence of Polio
A major concern is the registration of the first confirmed case of Polio in Gaza in mid-August, when a 10-month-old baby was left paralyzed due to the disease. Gaza had been polio-free for 25 years, but the virus has been detected in wastewater, confirming an outbreak.
Polio is an extremely contagious and dangerous disease because there is no cure. The majority of cases are asymptomatic, but those who do show symptoms can be left paralyzed or dead. For each symptomatic case, an average of 200 people are infected but do not show severe symptoms, making it extremely difficult to register and control the spread of the disease.
Since Polio does not have a treatment plan, the only way to combat it is through vaccination. However, since the war broke out, more than 50,000 children have been born, with many of them unable to access vaccines. There are also thousands of children whose vaccination schedules have been interrupted by Israeli violence. As a result, Gaza’s vaccination rate against polio has dropped from 99% in 2022 to below 90%.
To combat this, the WHO has organized an emergency vaccination campaign in the region. Efforts to halt the spread of Polio require a 95% vaccination rate with two doses of the vaccine. The successful completion of the first round of the campaign produced “encouraging” results. Yet, it will still be nearly impossible to guarantee the immunity needed in a warzone, especially when considering the current Israeli ground offensive in northern Gaza.
Health Risks Beyond Gaza
Gaza, under these conditions, is a breeding ground for infectious diseases, and these diseases are not going to remain in the territory simply because the borders are closed. There are several fronts on which the spread of these illnesses is the highest risk for regional spillover.
Egypt
The Rafah crossing between Egypt and Gaza has been closed since early May when Israel invaded and took control of the Palestinian side of the border. However, before then, over 100,000 Palestinians crossed the border by using the services of Hala Consulting and Tourism, a firm charging people for passage out of Gaza. These come at an excessive price, up to $5,000 per person, with no guarantees or infrastructure for them once they arrive. As they are unable to register as refugees, they are also unable to access aid and adequate healthcare.
The process puts them in a very risky position where they are completely reliant on the goodwill of others—goodwill strained by the economic crisis and the rampant inflation currently in Egypt. As a result, the living conditions of those who have crossed the border and potentially brought illnesses with them are difficult, and access to basic medical care is limited.
Furthermore, the strain of Polio found in Gaza was first identified in Egypt in 2023. Because the population immunity in Egypt was sufficiently high, the virus did not circulate significantly then. Still, it remained in the population long enough to cross over to Gaza and could easily cross back over.
Israel
The damage the Israeli military has inflicted on Gaza is likely to have consequences on its public health. A large community of Jewish people in Israel are Ultra-Orthodox Jews, or Haredim, and skeptical of vaccines, which puts them at risk of Vaccine-Preventable Diseases (VPD). In an attempt to secure the vote of this influential group, Netanyahu exempted hundreds of thousands of Haredim from his polio and measles vaccination programs, leaving them exposed to potential infection.
This risk of disease spread has increased since the Israeli High Court ruling that removed the exemption for Haredim to be drafted for the Israel Defense Forces (IDF). In July, the IDF sent out the first letters. The IDF recommends but does not require vaccination, meaning that many are sent into Gaza unprotected. It makes the re-introduction of polio into Haredim communities nearly inevitable upon their return.
In addition to the polio cases that returning soldiers will likely introduce to the Israeli population, there is also a risk that the “autumn rains will carry contaminated water to an aquifer that supplies Israel, Egypt, and Jordan.”
Lebanon
The increasing number of attacks on Lebanon is putting the healthcare systems in the country under strain as well. Israel seems to be adopting a similar approach of targeting hospitals as it is in Gaza, rendering access to medical care limited. Hospitals in the South are being evacuated, while the Northern provinces and Beirut must accommodate the 1.2 million displaced people.
Lebanon already housed a high number of displaced people. The country has the most refugees per capita in the world, and the current violence is only worsening the already risky humanitarian situation. Almost all of Lebanon’s displacement shelters are currently full, leaving many people sleeping on the streets or in parks. Therefore, sanitary conditions are also less than desirable, and the risk of diseases like Hepatitis A, acute watery diarrhea, and other VPDs is very high.
A Grim Outcome
The violence in Gaza and Lebanon poses a great threat, not only due to the direct injuries and deaths they cause but also through the diseases that these countries are unable to combat without proper healthcare and sanitation systems. Once these illnesses are present in a population, their spread is incredibly difficult to halt and will not stop simply due to national borders. From an epidemiological standpoint, the consequences of Israel’s war on Gaza are vast and likely to become even more apparent.
Edited by Lubaba Mahmud
