The Israeli war on Gaza over the past three months, leading in some cases to dead bodies strewn across the streets and beneath the debris of demolished homes, as well as the destruction of hospitals and healthcare facilities, is leading to the proliferation of diseases across the Strip.

This has been exacerbated by overcrowding, the contamination of water and food, unhealthy living conditions, and a scarcity of essential medicines and healthcare.

The collapse of the healthcare sector in Gaza has made it difficult to treat patients after the Israel army bombed hospitals using missiles and mortar fire. Israel’s attacks have resulted in the destruction of healthcare facilities and the killing of doctors, nurses, and patients, turning hospitals into mass graves.

The Palestinian Ministry of Health is the primary provider of healthcare services in the Gaza Strip, which is home to 2.3 million people. The UN Relief and Works Agency for Palestine Refugees (UNRWA), non-governmental organisations, and the private sector also contribute to the delivery of healthcare.

Across the Gaza Strip, residents access health services through 35 hospitals, meaning that there are 1.59 such facilities per 100,000 people. This includes 13 government hospitals, 17 non-governmental hospitals, two hospitals affiliated with the Ministry of Interior and National Security, and three private hospitals.

There are 18 hospitals in Gaza City, six in Khan Younis, five in the northern region, and three each in Deir Al-Balah and Rafah.

The World Health Organisation (WHO)has warned about the escalating risk of infectious diseases in the Gaza Strip due to the displacement of Gazans towards the south and the Israeli war. Many families have experienced multiple displacements, with a considerable number seeking refuge in already overcrowded healthcare facilities.

According to the WHO, approximately 180,000 people are suffering from upper respiratory infections. Some 136,400 have reported cases of diarrhea, half of them children under the age of five. There are 4,683 cases of acute jaundice, 55,400 cases of scabies, 5,330 cases of smallpox, and 42,700 cases of different kinds of rashes.

The severe overcrowding is contributing to the rapid spread of these infections.

Estimates from international organisations indicate that the total number of displaced people in the Gaza Strip now stands at 1,900,000. This represents 85 per cent of the total population, with the displaced being dispersed among shelters and the homes of relatives and friends.

“Thousands of displaced families, either in the streets or in overcrowded shelters, are now at risk due to the spread of diseases. Accommodating the approximately 1.3 million displaced people in UNRWA’s 155 shelters in the Strip has become a significant challenge,” Adnan Abu Hasna, a media advisor for UNRWA, told Al-Ahram Weekly.

The number of the displaced surpasses the capacity of UNRWA facilities by more than four-fold in shelters located in the central and southern regions, with an average of 11,480 displaced people per shelter, Abu Hasna said.

UNRWA has deployed over 120 mobile medical units in shelters throughout Gaza in an attempt to curb the spread of disease and provide essential medical care to the displaced population. Some 45 per cent of displaced children are exposed to the risks of contracting infectious diseases.

“UNRWA has warned against the emergence of diseases among the displaced, such as hepatitis and cholera, both of which were previously almost unknown in the Gaza Strip. There is an urgent need to open the border crossings to address the collapsing healthcare situation,”Abu Hasna added.

Aya Hnaideq, a displaced Palestinian woman in Gaza, was visiting the Japanese health clinic in Khan Younis in the south of the Strip when she spoke to the Weekly. “My family, including my three children and myself, have contracted scabies due to inadequate hygiene and the lack of basic necessities,” she said.

“Getting medicine from outpatient pharmacies is difficult, and it is often unavailable at UNRWA clinics. We don’t have the money to buy medicine,” she added.

Hnaideq highlighted the prevalence of rapidly spreading diseases among children in displacement camps, including intestinal infections, sore throats, influenza, pharyngitis, skin rashes, bronchitis, and cholera. These health issues are attributed to the severe overcrowding in camp facilities.

Omar Abdel-Meguid, a doctor working at the medical facility in the Khan Younis displacement centre, attempts to treat hundreds of cases on a daily basis despite the scarcity of medicines and medical supplies.

“The medical teams are worried about the spread of more deadly diseases and epidemics such as cholera and hepatitis due to inadequate health facilities, the lack of proper nutrition, and absence of clean drinking water,” he said.

“The overcrowded living conditions, with more than nine people residing in spaces designed for far fewer, create an environment conducive to the rapid spread of diseases. Many other people live near these centres in poorly equipped shelters, exposing them to adverse weather conditions that contribute to skin diseases, intestinal infections, and respiratory issues,” Abdel-Meguid said, who had volunteered to open a medical unit inside the shelter along with fellow displaced Palestinians.

“Hundreds of children are being reported with severe dehydration, and some are experiencing kidney failure. There has been a notable increase in cases of Hepatitis A, complicated by the fact that the virus incubation period can extend for up to a month,” Ashraf Al-Qudra, a spokesman for the Palestinian Health Ministry in Gaza, told the Weekly.

Al-Qudra attributed the alarming rise in hepatitis cases to factors including “overcrowding, contaminated water, unsafe food, and the sharing of bathrooms.”

“The diseases spreading among patients in the displacement centres, such as skin and respiratory diseases, are highly contagious and propagate rapidly, especially given the cramped conditions,” he said.

The scarcity of clean water and the absence of adequate bathing facilities are significant contributors to the proliferation of skin diseases, he added. Al-Qudra cautioned about the escalating health disaster in the Strip owing to the shortage of medicines required to treat infectious skin conditions.

The UN has also issued warnings about the dire conditions faced by Gaza residents, including the looming threat of deadly diseases and epidemics amidst the challenges of the Israeli bombings, deprivation, and hunger.

Heavy rain has further worsened the already precarious health situation in the Strip. The UN Office for the Coordination of Humanitarian Affairs (OCHA) has warned about flooding in numerous areas, and this has added to additional problems in managing sanitation in densely populated shelters.

These conditions create breeding grounds for insects and vermin, heightening the risk of diseases spreading. Disturbingly, some 360,000 cases of infectious diseases have already been documented in the shelters.

“People are forced to drink unclean water due to limited resources. The lack of desalination is a key issue, as the fuel required to operate the desalination plants is restricted,”Al-Qudra said.

Marwan Al-Hams, head of the Health Emergency Committee in Rafah, painted a grim picture of the city, describing it as disaster-stricken due to the influx of hundreds of thousands of people and the resulting congestion of facilities.

Himself the director of the Abu Youssef Al-Naggar Hospital, the largest in the city, Al-Hams expressed deep concerns about the “severe overcrowding in schools, public facilities, and homes that risk an impending health disaster for which the city lacks the necessary capacity.”

The Abu Youssef Al-Naggar Hospital has seen a surge in the number of cases of diarrhea, fever, bronchitis, and intestinal infections, with a majority of patients being children, women, and the elderly living in shelters, he said.

Hundreds of children and infants are suffering from dehydration and anemia due to malnutrition.

Al-Hams said that unless the Rafah Crossing is opened permanently and a continuous flow of aid and basic humanitarian needs, including relief and medical supplies, is guaranteed, along with the necessary fuel to operate vital facilities, the situation will deteriorate further.

* A version of this article appears in print in the 4 January, 2024 edition of Al-Ahram Weekly