The War Has Made Gaza a Hotspot for Infectious Diseases, and Israel Isn’t Immune

Palestinians gather to fill water jugs near one of the strip’s few functioning desalination plants in Deir al-Balah, Gaza Strip, June.Credit: Abdel Kareem Hana, AP

It also stepped-up monitoring for polio and other causes of infectious disease in Israel’s sewage system. At the same time, the military has begun a vaccination campaign for soldiers serving in Gaza against polio, hepatitis A and tetanus.

In his weekly briefing on Wednesday, WHO’s director general, Tedros Adhanom Ghebreyesus, said his organization is prepared in the coming weeks to vaccinate 600,000 children in Gaza under the age of 8 against polio. The vaccine, which WHO is providing, is administered in two doses given a month apart.

“The detection of polio in wastewater in Gaza is a telltale sign that the virus has been circulating in the community, putting unvaccinated children at risk,” the WHO director tweeted. “We need absolute freedom of movement for health workers and medical equipment to carry out these complex operations safely and effectively. A cease-fire, or at least ‘days of tranquility’ during preparation and delivery of the vaccination campaigns, are required to protect children in Gaza from polio.”

Polio is just one of a long list of viruses, bacteria and other disease-causing pathogens threatening Gazan residents. The passage of time and the ongoing humanitarian crisis there is making the situation worse for Gazans, particularly during a period of extreme summer heat. Living conditions and the absence of healthcare infrastructure also provide fertile ground for an epidemiological crisis.

The collapse of infrastructure and the chaos reigning in the coastal enclave also make it difficult to get a full, reliable picture of the scope and severity of the presence of disease. Any assessment must rely on partial information from organizations, volunteers and accounts on the ground.

“We’re on the brink of a healthcare disaster on top of the humanitarian and environmental disasters,” Dr. Majed Abu Ramadan, the health minister of the Palestinian Authority, based in the West Bank, said this week. “This is mainly due to the spread of diseases and infections via respiratory tracts and from water sources.”

Abu Ramadan said the number of hepatitis A cases in Gaza has topped 100,000, compared to a historic annual rate of 85. He also noted the spread of skin diseases like scabies.

“If you take a million people or more and put them in tents in an area with limited access to services, water for drinking and bathing and food, with open sewage and extreme heat, you’re creating a Petri dish that grows almost any possible pathogen or cause of disease,” said epidemiologist Prof. Manfred Green of the University of Haifa, who is on the Health Ministry’s advisory committee on vaccinations and the head of its subcommittee on polio, measles and rubella.

“We don’t know what the quality of the drinking water is and whether there’s enough water for bathing and a basic ability to maintain hygiene,” Green said. “In addition, when you don’t have an orderly sewage system, it’s a recipe for disaster. And when people talk about the [Israeli] hostages, who in any event are living in a hell, the prevailing conditions also horribly damage their health as time passes.”

The collapse of monitoring systems and testing labs in Gaza also make the medical situation in Gaza unclear, but the living conditions on the ground leave no doubt when it comes to the potential for disease and a humanitarian disaster in Gaza.

Last month, Dutch peace organization PAX released a report entitled “War and Garbage in Gaza.” The detailed report is based on an analysis of satellite photos, using means to remotely identify various uses of land and the burial of garbage. It also used open-source information, both official and otherwise, including social media, regarding Gaza waste sites.

“Young children scavenging for food in hills of rotting waste. Once-buzzing markets and large agricultural fields turned into endless garbage lands. The waste is everywhere in Gaza with makeshift waste sites even becoming the target of airstrikes,” the report states, adding that there are at least 225 waste disposal sites and informal landfills around Gaza.

Absent a functioning garbage collection system, hundreds of thousands of tons of solid waste have already piled up around the enclave. PAX notes that, on June 10, UNRWA, the UN Refugee and Works Agency for Palestine Refugees, reported that over 330,000 tons had accumulated in Gaza over a six-month period, enough to fill more than 150 soccer fields. Considering that an additional 2,000 tons is generated daily, it can be assumed that the current figure is even larger.

“Whether in non-evacuated urban areas in the North or makeshift camps for internally displaced people in the South, the problem of waste is pervasive,” the PAX report states. “And though it might not seem like a priority in a conflict zone, the combination of high temperatures and a destroyed sanitary infrastructure with a population weakened by food insecurity and the lack of medical attention, this ‘silent threat’ is critical for the public health and the environment people are depending on.”

“There are huge quantities of garbage there, providing fertile ground for infectious human diseases and animal diseases,” said Prof. Nadav Davidovitch, director of the public health school at Ben-Gurion University and head of health policy at the Taub Center for Social Policy Studies. “The extreme summer heat is also of critical significance, particularly regarding food sanitation and the transmission of intestinal diseases, which are more prevalent during the summer.”

“Even before the discovery of polio [in the sewage] in the Strip, there was very great difficulty monitoring viruses, bacteria and [other] diseases because the healthcare system there has rather collapsed. A monitoring system requires systematic and consistent sampling by skilled people and that’s something that’s very difficult to carry out during wartime,” Davidovitch said.

The difficulty in tracking disease outbreaks and contamination goes beyond sewage samples to systemic testing, from labs that were shut down to clinical testing that is barely available. There are still no known polio cases in Gaza, but that doesn’t mean it doesn’t exist. “Identifying polio cases happens through testing of patients presenting with acute flaccid paralysis, which in most cases isn’t caused by polio.

However, the moment one sees such cases, polio testing is necessary,” Davidovitch said. “Moreover, a rise in AFP is one of the indications of a polio outbreak. This entire system barely exists in Gaza, so there are no reported cases. We can’t know if there are clinical cases beyond the presence of the virus.

The most bothersome thing now is polio. However, the general situation in Gaza, as well as malnutrition, which leads to many diseases, is conducive to the outbreak of diseases like hepatitis A, infectious diseases, intestinal disease and respiratory diseases like measles and whooping cough.”

“The health system in Gaza isn’t functioning. There’s no active monitoring, no information, no labs,” says Prof. Dorit Nitzan, director of the master’s program in emergency medicine at Ben-Gurion University’s School of Public Health. “So, the picture is partial and unorganized. It relies on partial information from the Hamas health ministry, UNRWA and other NGOs there. It’s hard to say it’s scientifically based information.”

She said that Israel is exposed at one level or another to spillover from pathogens in Gaza. “The moment we have polio in the sewage, we understand that its entry into Israel is a matter of time,” she said. “One soldier with boots contaminated by Gaza sewage is sufficient.” But it’s not only polio or sewage water.

Dust, water, blood, clothes, plants, anything entering Israel can carry pathogens, including animals. Garbage attracts animals with fungi, animals and standing water attracting mosquitos.” Still, she doesn’t see a real danger to Israel of disease from Gaza. “Israel has a robust, active and accessible healthcare system,” she said. “There’s also close collaboration between the organizations and the Coordinator of Government Activities in the Territories to provide humanitarian health assistance.”

The Health Ministry stated: “The Health Ministry is monitoring the disease and the situational risk to soldiers and Israeli citizens. It is in contact with various bodies, including the World Health Organization. The ministry does everything necessary to ensure public health, including halting water pumping in areas with a potential for contamination, expansion of monitoring of relevant contaminants, recommending vaccinations.”

The IDF spokesperson stated: “The security establishment is actively and continuously engaged in boosting the medical response in the Gaza Strip, according to cabinet police and in close collaboration with the World Health Organization, humanitarian aid organizations specializing in health services and donor nations.”

The IDF spokesperson added: “Regarding claims about discovering cases of polio in Gaza, we note that WHO conducted sample tests in various areas in which the polio virus was detected. Let it be stressed that in the wake of the tests that the virus is found only in samples, and that there is no fear of the virus breaking out in the community, as 95 percent of the population was vaccinated against polio before the war erupted.

Regarding the health of soldiers, in the wake of reports about the presence of the polio virus in Gaza, and after the Health Ministry informed the IDF about the presence of strands of the virus, it was decided to vaccinate forces operating in Gaza.”

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