Massive Rise in Infectious Diseases in Gaza as Water Supplies and Sanitation Collapse
Palestinian civil defence responders search the rubble of a building  for survivors in the aftermath of an Israeli air strike in the Gaza Strip.

There has been a massive rise in diarrhoea, respiratory infections and skin conditions and in Gaza since Israel’s siege and bombing of the territory began in early October, disrupting supplies of clean water, sanitation, food, fuel and leaving thousands homeless.

Since mid-October, over 33,551 cases of diarrhoea have been reported in the area, over half affecting children under age five, according to the World Health Organization’s (WHO) Eastern Mediterranean Region (EMRO). During 2021-2022, the average number of diarrhoea cases in children under five was around 2,000 a month.

Almost 55,000 people have been diagnosed with upper respiratory tract infections, over 12,600 with rashes, almost 9,000 with scabies and over 1000 with chicken pox.

United Nations (UN) aid agencies have also warned of cholera, typhoid and measles outbreaks as many people lack access to clean water, food and shelter.

No water in Gaza

In northern Gaza, the two main sources of drinking water, a desalination plant and a water connection from Israel, have been shut down for “several weeks”, while on 4 and 5 November, seven water facilities across the Gaza Strip were directly hit and sustained major damage, including three sewage pipelines in Gaza city, two water reservoirs (in Rafah and Jabalia refugee camp) and two water wells in Rafah, according to the UN’s Office for the Coordination of Human Affairs (OCHA).

OCHA said that by Thursday, all of the Gaza Strip’s 120 municipal water wells were expected to shut down as fuel to pump water is depleted. Israel said last week that it had restored supplies from two pipes into southern and central Gaza, one of which was damaged in the fighting. It is unlikely those supplies can reach the embattled north. 

Israel has blamed Hamas’s monopolization of scarce resources such as food, fuel and water for its own military purposes for the escalating humanitarian crisis in Gaza. But the daily volume of drinking water Israel has allowed to cross the Gazan border with Egypt is enough to serve just 4% of Gaza’s population, OCHA said in its daily update on Wednesday.

WHO EMRO reports that “lack of fuel has led to the shutting down of desalination plants, significantly increasing the risk of bacterial infections like diarrhoea spreading as people consume contaminated water” and has “also disrupted all solid waste collection, creating an environment conducive to the rapid and widespread proliferation of insects and rodents that can carry and transmit diseases”.

It added that “damaged water and sanitation systems, and dwindling cleaning supplies” have made it almost impossible for health facilities to maintain basic infection prevention and control measures. 

“These developments substantially increase the risk of infections arising from trauma, surgery, wound care and childbirth,” it added. An estimated 50,000 women are pregnant in Gaza.

Emergency Medical Teams (EMTs) have been deployed to support Shifa, Aqsa, and Abu Yousuf Al Najjar hospitals in expanding their emergency departments’ capacity.

‘Disastrous conditions’ at biggest hospital

Meanwhile, the medical conditions at Al-Shifa, the largest hospital in the Gaza Strip and one of the oldest Palestinian health institutions, are “disastrous”, according to a joint statement by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and WHO. 

Fierce fighting between Israel and Hamas has reportedly been raging for the past several days in the vicinity of the hospital, an area Israel has described as a major Hamas command and control centre.

“There are currently almost two patients for every bed available. The emergency department and wards are overflowing, requiring doctors and medical workers to treat wounded and sick patients in the corridors, on the floor, and outdoors.”

“The number of wounded increases by the hour while patients are undergoing immense and unnecessary pain as medicines and anaesthetics are running out,” they added.

Dr Marwan Abusada, the hospital’s head of surgery, told The Guardian that they have “zero capacity”. 

“We have 153 patients at the ER. All the beds are occupied. We have no space for patients to go after they undergo surgery. We have a type of worms [in] the wounds after the surgery. Most injuries and surgeries have no follow-ups as the medical teams cannot cope with the influx of injuries every hour,” said Abusada.

On Wednesday, the UNRWA facilitated the delivery of WHO’s emergency medical supplies and medicines to Al-Shifa Hospital in Gaza City,” only the second delivery of lifesaving supplies to the hospital since the escalation of hostilities and the total siege of Gaza began”.

Out of almost 1.5 million displaced people, nearly 725,000 are in 149 UNRWA facilities, while 122,000 are sheltering in hospitals, churches, and other public buildings, and about 131,134 in 94 non-UNRWA schools, while others are living on the streets near hospitals.

Shelters run by UNRWA are so overcrowded that an average of 160 people are sharing a toilet and there is one shower for every 700 people, according to the agency.

France hosts Gaza conference

Delegations from over 80 countries and organisations met on Thursday at the International Humanitarian Conference for the Civilian Population in Gaza hosted by France on the eve of its annual Paris Peace Conference.

United Nations (UN) Under-Secretary-General for Humanitarian Affairs Martin Griffiths told the conference that the UN “cannot be part of a unilateral proposal to push hundreds of thousands of desperate civilians in Gaza into so-called safe zones”  if there is no agreement between all the parties on the establishment of these zones.

Calling for an immediate humanitarian ceasefire, he also expressed concern that “satisfactory conditions do not exist anywhere in Gaza to ensure adequate shelter, food, water, sanitation and health”.

Meanwhile, International Rescue Committee President David Miliband told CNN on Wednesday that a humanitarian ceasefire in Gaza needed to last for an “absolute minimum” of five days to allow aid agencies to do their work. Israel gave people in northern Gaza four hours to leave the territory on Wednesday before it intensified its attacks again.

“There needs to be a massive scale-up of the aid flows – that’s medicines, that’s non-food items, that is food, that is water, the basics of life and the fuel to get those goods around the Gaza Strip,” said Miliband.

“Second, you can’t deliver aid without aid workers,” he added, but it was unsafe for them to operate. 

“Thirdly — essential — we’ve got to be able to have safety for civilians who come to receive aid when they bring their kids when they bring their wounded, they’ve got to be able to be safe in a health centre,” added Miliband, warning of the threat of cholera, measles and typhoid.

No end in sight as war enters second month 

A Palestinian Civil Defense vehicle was struck by an Israeli air strike on 21 October. The strike killed between 6 and 10 civilians, according to Airwars.

As the brutal war between Israel and Hamas presses on into its second month, over 10,569 people – one in every 190 Palestinians living in Gaza – are dead, according to the Gaza Health Ministry. The Ministry does not distinguish between combatants and civilians.

Nearly 1,400 Israelis and foreign nationals have been killed in Israel, the vast majority on 7 October, according to Israeli authorities. Some 240 men, women and children kidnapped by Hamas and other militias on the day of the attack continue to be held hostage. Their locations within Gaza and the number still alive are unknown.

UN Secretary-General Antonio Guterres strongly condemned both Hamas’s brutal and deadly assault on thousands of Israeli civilians on 7 October, as well as its war tactics of embedding military facilities into critical civilian infrastructure and using civilians as “human shields,” in an interview with Reuters on Wednesday.

Hamas has fired over 9,500 missiles into Israeli cities since its 7 October incursion into 22 Israeli communities where civilians  were shot and burnt to death in their homes. Hamas-aligned militias in southern Lebanon have also stepped up their missile attacks into northern Israeli cities, reaching as far as the outskirts of Haifa.

Guterres also emphasised the deadly toll the massive Israeli airstrike campaign is inflicting on civilians in Gaza: “When one looks at the number of civilians that were killed with the military operations, there is something that is clearly wrong.”

The first 19 days of the war saw Israel conduct over 7,000 airstrikes on Gaza, killing an estimated 6,500 people. The 7,000 bombs dropped on Gaza – a territory half the size of New York City – in under three weeks outpaced even the most intense month of the bombing campaign by the US-led coalition against the Islamic State in Iraq and Syria (ISIS), according to Airwars.

The rate at which Israeli airstrikes are hitting Gaza ranks as one of the most intense campaigns of the 21st century. The deadly toll on humanitarian, medical and media workers has been unprecedented.

The war in Gaza is already the deadliest conflict for journalists since the Committee to Protect Journalists (CPJ) began gathering data in 1992. As of 9 November, 39 journalists – 34 Palestinian, four Israeli and one Lebanese – were confirmed dead, according to the CPJ. This accounts for 70% of journalists who have lost their lives reporting since the start of 2023.

The situation for humanitarian workers is even more dire. UNRWA announced on Wednesday that two members of its staff had been killed in the preceding 24 hours. Seven more UNRWA staffers were confirmed dead by the time the agency’s Commissioner General, Philippe Lazzarini, spoke at the international conference on Gaza in Paris on Thursday.

The 99 UNRWA staffers killed since the onset of the war is “the highest number of United Nations aid workers killed in a conflict in the history of the United Nations,” the agency said.

Civilian lives buried beneath a war of numbers 

The deaths in Gaza include at least 2,550 women and 4,237 children, with another 25,956 people injured, Gaza’s Health Ministry has said. A further 2,260 people are reported missing, many presumed to be buried beneath the rubble left behind by Israeli air strikes, including 1,270 children. The Gaza Health Ministry is controlled by Hamas. 

More than 1.5 million Palestinians – three-quarters of the population of Gaza – have been displaced since the start of Israel’s military operations in the enclave. The flow of aid on which Gazans depend has slowed to a trickle. In peacetime, around 500 trucks transporting humanitarian aid and commercial goods entered Gaza every day. But a month after the Hamas attack on Israel, just 650 trucks had been allowed to enter the enclave. 

One out of every 19 people in Gaza are either injured, missing, or dead, according to Gaza Health Ministry figures. Hamas is estimated to have a fighting force of between 20,000 and 30,000 combatants – 1.5% of the population of Gaza. Children, meanwhile, make up around 47% of Gaza’s population, according to UNICEF. 

“We need to distinguish – Hamas is one thing, the Palestinian people (are) another,” said Guterres. “If we don’t make that distinction, I think it’s humanity itself that will lose its meaning.”

Gilad Erdan, Israel’s Ambassador to the United Nations, shot back at the UN chief, stating that Israel is working to limit civilian casualties and has opened an evacuation corridor to South Gaza, while Hamas targets Israeli civilians. 

“Would the Secretary-General dare say that since the number of German civilian casualties during World War II was higher than American or British civilian casualties, it meant that something was ‘wrong’ with the US and UK military operations when fighting a genocidal regime?” Erdan told Reuters, adding that the death toll provided by the Gaza Health Ministry should not be trusted. 

Israeli officials have repeatedly disputed the casualty figures provided by the Gaza Health Ministry, citing its lack of distinction between civilian and military casualties and influence exerted by Hamas over death tolls. US President Joe Biden has voiced similar scepticism, stating on October 27 that he had “no confidence in the number that the Palestinians are using”. 

However, the Gaza Health Ministry’s death tolls from previous wars with Israel have proven reliable. The numbers provided by the Ministry during clashes with Israel in 2008, 2014 and 2021 all matched – with small discrepancies – the post-war tallies reached by UN, independent, and even Israeli investigations. 

“The numbers may not be perfectly accurate on a minute-to-minute basis,” Michael Ryan, head of the WHO’s Health Emergencies Program said of the Gaza Health Ministry figures. “But they largely reflect the level of death and injury.”

Children dying at an unprecedented rate 

The estimated 4,237 children killed in Gaza account for 40% of all deaths since the war began, a staggering rate with few precedents. 

Three weeks into the war, Save the Children revealed the number of children killed in Gaza was greater than the total number of children who lost their lives in all global conflicts since 2019. A further 980 children in Gaza have been confirmed dead since that report. 

“An average of about 160 children are killed every day based on the figures of the [Gaza] Ministry of Health,” WHO spokesperson Christian Lindmeier said at a media briefing on Tuesday.

Seven years into the ongoing Yemeni civil war, a conflict in which both sides have employed child soldiers and notorious for its high rate of child casualties, 3,773 children – fewer than in just one month of the war in Gaza – have died, according to the UN. The deadliest conflict for children in recent decades is the Syrian civil war, in which 27,126 children were killed in over 10 years of fighting. 

If child deaths continue to proceed at the current rate, the number of children killed in Gaza would match that of more than 10 years of Syria’s civil war in around seven months.

The historic rate at which children are losing their lives in Gaza is transforming the enclave into “a graveyard for children”, Guterres said on Monday. 

“Every year, the highest number of killings of children by any of the actors in all the conflicts that we witness is the maximum in the hundreds,” said Guterres in an interview with Reuters on Wednesday. 

“We have in a few days in Gaza thousands and thousands of children killed, which means there is also something clearly wrong in the way military operations are being done,” he stated.

Hamas’s bloody calculation

Flames and smoke billow during Israeli strikes in Gaza, which have caused an unprecedented level of destruction since the 7 October Hamas incursion into Israel.

To Hamas leadership, the deaths and displacement of Palestinian civilians are not a surprising or unwanted outcome, but a pivotal part of a bloody calculation, according to new reporting based on interviews with its senior leadership in Doha, Qatar. 

“We succeeded in putting the Palestinian issue back on the table, and no one in the region is experiencing calm,” Khalil al-Hayya, a high-ranking member of Hamas’s leadership, told the New York Times of the largest massacre of Jews since the Holocaust.

“What could change the equation was a great act, and without a doubt, it was known that the reaction to this great act would be big,” al-Hayya added when asked about the scale of civilian deaths in Gaza.

The terror group’s leaders have repeatedly declined to express any remorse for the brutal actions of its fighters in the raid on Israel and its citizens that left 1,400 dead and more than 200 taken hostage.

“We had to tell people that the Palestinian cause would not die,” al-Hayya concluded, regarding the thousands of Palestinian and Israeli lives lost since the Hamas attack on 7 October.  

On Thursday, Palestinian terror group Islamic Jihad released a video of two hostages, offering their release. The captives include a 77-year-old woman and a 13-year-old boy, abducted with his brother, father and partner, from Kibbutz Nir Oz.

Negotiations are reportedly underway in Doha between Israel, the United States and Qatari mediators over the possibility of the release of 10 to 15 hostages in exchange for a one-two-day humanitarian pause, Reuters reported.  

“Israel is a country that has no place on our land,” declared Hamas official Gazi Hamad in a Lebanese TV interview last week. “The existence of Israel is illogical….7 October, 10 October, 1 million October, it is justified.”

Elaine Ruth Fletcher contributed to this report. 

Image Credits: Airwars, WHO EMRO.

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