The World Health Organization is concerned about the spread of infectious diseases in the Palestinian enclave, given the health conditions in which the displaced people live.
Since her departure from Khan Younes in early December, Samah al-Farra and her children have been sleeping on the floor in the middle of a camp for displaced people in Rafah, southern Gaza. The family has no choice but to drink the water they normally use for washing. “When I wash my hands, I feel like they are getting dirtier and dirtier,” the 46-year-old Palestinian told the New York Times. This mother, like all her children, suffers from fever, diarrhea and vomiting. “We’re all sick.”
The Gaza Strip, embroiled in war since the Israeli army's response to the Hamas terrorist attacks on October 7, “is already experiencing a sharp increase in epidemics of infectious diseases,” the director general of the World Health Organization warned on Wednesday, December 20 ( WHO). For Tedros Adhanom Ghebreyesus, Gaza's population suffers from “a toxic mix of disease, hunger, poor hygiene and sanitation” in an area where humanitarian aid is lacking. A health disaster that, according to the WHO, could be even deadlier than the conflict between Israel and Hamas.
“Many families continue to come”
Almost three months after hostilities began, the Palestinian enclave is now home to nearly 1.9 million displaced people, according to the latest report from the UN Office for the Coordination of Humanitarian Affairs (Ocha). Almost 85% of the population lives far from home and its resources, often in dire health conditions. The vast majority of these displaced people (1.4 million) are accommodated in the 155 shelters run by the UN Agency for Palestine Refugees in the Near East (UNRWA). “That’s eight to nine times what we had planned. Our capacity is stretched to the limit,” warns Juliette Touma, UNRWA Communications Director. She recently visited an agency shelter in Khan Younes, which houses an average of 12,400 displaced people.
A school run by the UN Agency for Palestine Refugees in the Middle East (UNRWA) in Deir al-Balah in the Gaza Strip, December 17, 2023. (ASHRAF AMRA / ANADOLU / AFP)
In the Khan Younès reception center, “people were literally lying on top of each other, it was extremely crowded,” describes Juliette Touma. The first arrivals are being housed in former classrooms, but “many families continue to come” as the conflict stalls. Some sleep on the ground or in their cars, others seek shelter in simple huts covered with plastic sheeting. In such a context, “the sanitary conditions are appalling”. The situation of displaced people who have their periods is therefore critical, emphasizes the UNRWA communications director. Since there are no sanitary pads or tampons, “some mothers use old fabrics and make diapers for their daughters.”
“There is not enough soap, not enough clean water. The conditions in the toilets and showers are appalling. There is one toilet for 400 people. An elderly person told me that she had to wait two to three o'clock to go to the toilet. “Toilet.”
Juliette Touma, UNRWA Communications Director
at franceinfo
The observation of Helena Ranchal, head of international operations at Médecins du Monde, is similar. “Sanitation facilities are not guaranteed,” she emphasizes. People drink poor quality water and have to defecate in places where there is no sanitation, sometimes outside. Humanitarian aid workers are not doing any better, emphasizes Helena Ranchal. In the Gaza Strip, some of his colleagues are sleeping “on the beach, others are 17 in a room of 10 or 15 square meters.” Doctors of the World employees have already waited five hours to find water and “many have drunk salt water.”
Palestinians near a truck distributing drinking water bottles in Khan Younes, southern Gaza Strip, on November 21, 2023. (ABED ZAGOUT / ANADOLU / AFP)
Between contaminated water, the immense need for hygiene products and the overcrowding of emergency shelters, “we have a perfect environment for the future development of all epidemic diseases,” warns Helena Ranchal. Added to this are the weather conditions, which become increasingly difficult at the beginning of winter. At night the cold sets in and rain falls on the countless makeshift shelters of the displaced people. With the arrival of winter, humanitarian workers are concerned about the spread of respiratory viruses, facilitated by the high population density in these emergency areas.
Hundreds of thousands of cases of infection
The situation for the refugee population in hospitals is equally precarious, continues Guillemette Thomas, medical coordinator of the Doctors Without Borders (MSF) mission in Palestine in France. In these centers, which have become refuges, “we cannot move, there are hundreds and hundreds of people in a very small space,” describes the humanitarian worker. So much so that “we can no longer identify who the patients and the displaced are” in hospitals where hygiene measures are lacking due to the lack of access to essential products. “With such promiscuity, skin infections occur. The smallest wound becomes infected,” emphasizes Guillemette Thomas.
For those displaced in Rafah, MSF continues to provide basic care at the al-Shaboura clinic. In this health center, “we see that there are many infectious diseases, many cases of diarrhea, respiratory infections and skin diseases,” observes Guillemette Thomas. The humanitarian also fears cases of hepatitis A. “People have to defecate outdoors and that’s how it gets transmitted. It contaminates the wastewater,” she explains. The local example of a reality that is deteriorating in the Palestinian enclave.
“All of these diseases are linked to the precarious conditions in Gaza. There are a large number of cases, cases that we would not see at this time of year if there was no war in Gaza.”
Guillemette Thomas, coordinator at Doctors Without Borders France
at franceinfo
During a press conference on Thursday, the WHO reported at least 170,000 respiratory infections and more than 125,000 cases of diarrhea in the enclave. According to the WHO, there were 45 times fewer cases of diarrhea among Gazans between 2021 and 2022. Children under 5 years of age are particularly affected. The agency is also concerned about cases of chickenpox, jaundice and meningitis. So many diseases are spreading in Gaza.
A spread of disease in a healthcare system on its knees
If the war continues, the spread and severity of diseases will only increase over the next three months, warn researchers at the London School of Hygiene and Tropical Medicine. For these specialists, a lack of vaccinations and malnutrition as the Gaza conflict descends into conflict are accelerating epidemics.
Displaced Palestinians in Deir al-Balah in the Gaza Strip, December 12, 2023. (MAJDI FATHI / NURPHOTO / AFP)
The food insecurity figures are already very alarming: in the north of the Gaza Strip, 48% of the population suffers from severe hunger, according to the World Food Program, as do 38% of the displaced people in the south. Almost all families in the north do not eat enough, as do 83% of displaced people in the south of the enclave. “Our colleagues tell us that when they eat, they eat once a day,” says Helena Ranchal. The people of Gaza, already weakened by the shock of the fighting and forced departures, are losing their immunity because they eat too little every day. This means they are more exposed to the viruses, often without being able to take care of them.
“These infections are extremely contagious, in a health system where everything is stopped. It’s very, very complicated to treat these people.”
Helena Ranchal from Doctors of the World
at franceinfo
UNRWA shelters have medical teams, but the Gaza Strip's overall health system has been devastated by the conflict. According to the WHO, only nine of the 36 health centers in the Gaza Strip are still partially operational. In this context, overwhelmed hospitals “take care of very serious cases,” emphasizes Helena Ranchal, and can hardly treat those suffering from infections or chronic diseases. Even the most serious injuries cannot be treated properly, leading to “popular infections”.
“We cannot do anything under the current conditions with this number of injured, sick and destitute people,” denounces Helena Ranchal. In response to the “dramatic” situations she is experiencing, the humanitarian worker is calling for a ceasefire. “That has to stop.”