The World Health Organization is concerned about the spread of infectious diseases in the Palestinian enclave, given the health conditions in which the displaced live.
Since their departure from Khan Younes at the beginning of December, Samah al-Farra and her children have been sleeping on the ground, in the heart of a camp for displaced people in Rafah, in the south of the Gaza Strip. The family has no choice but to drink the water they usually use for washing. “When I wash my hands, I feel like they get dirtier,” described in New York Times the 46-year-old Palestinian woman. This mother suffers from fever, diarrhea and vomiting, like all of her children. “We are all sick.”
Plunged into war since the Israeli army’s response to the Hamas terrorist attacks of October 7, the Gaza Strip “already experiencing a sharp increase in infectious disease epidemics”, warned the Director General of the World Health Organization (WHO) on Wednesday, December 20. For Tedros Adhanom Ghebreyesus, the Gazan population suffers “a toxic mix of disease, hunger, lack of hygiene and sanitation”, in a territory where humanitarian aid is lacking. A health disaster which, in the opinion of the WHO, could prove even more deadly than the conflict between Israel and Hamas.
“Many families continue to arrive”
Almost three months after the start of hostilities, the Palestinian enclave now has nearly 1.9 million displaced people, according to the latest report from the UN Office for the Coordination of Humanitarian Affairs (Ocha). Nearly 85% of the population lives far from home and its resources, in often disastrous health conditions. The vast majority of these displaced people (1.4 million) are hosted in the 155 shelters of the UN agency for Palestinian refugees in the Middle East (UNRWA). “This represents eight to nine times what we had planned. Our capacities are pushed to the extreme,” alert Juliette Touma, UNRWA communications director. She recently visited an agency shelter in Khan Younes, which hosts an average of 12,400 displaced people.
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In the Khan Younès reception center, “people were literally on top of each other, it was extremely crowded,” describes Juliette Touma. The first arrivals are housed in old classrooms, but “many families continue to arrive” as the conflict gets bogged down. Some sleep on the ground or in their cars, others take shelter in basic huts, covered with plastic sheeting. In such a context, “the sanitary conditions are terrible”. The situation of displaced people having their periods is therefore critical, points out the UNRWA communications director. Lack of sanitary napkins or tampons, “some mothers use old fabrics and make napkins 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 at three o’clock to go to the toilet.”
Juliette Touma, UNRWA communications directorat franceinfo
The observation of Helena Ranchal, director of international operations at Médecins du monde, is similar. “Sanitation is not ensuredshe points out. People drink poor quality water, they have to relieve themselves in places where there is no wastewater management“, sometimes outside. Humanitarians are not better off, underlines Helena Ranchal. In the Gaza Strip,some of his colleagues “sleep 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 drank salt water.”
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Between contaminated water, the immense need for hygiene products and overcrowding in shelters, “we have perfect terrain for all epidemic diseases to develop in the future”, warns Helena Ranchal. Added to this are the weather conditions, which are increasingly difficult at the start of winter. The cold sets in at night and the rain falls on the countless makeshift shelters of the displaced. With the arrival of winter, humanitarians are concerned about the circulation of respiratory viruses, facilitated by the density of the population crowded into these emergency reception areas.
Hundreds of thousands of cases of infections
The situation is just as precarious for refugee populations in hospitals, continues Guillemette Thomas, medical coordinator of the mission in Palestine of Médecins sans frontières (MSF) France. In these centers that have become refuges, “we can’t move around, you have hundreds and hundreds of people in very small spaces”, depicts the humanitarian. To the extent that “we can no longer discern who the patients and the displaced people are”, in hospitals where hygiene measures are lacking, lack of access to essential products. “With such promiscuity, you have skin infections. The slightest wound becomes infected”underlines Guillemette Thomas.
For the displaced in Rafah, MSF continues to provide primary care in the al-Shaboura clinic. In this health center, “we see that there are a lot of infectious diseases, a lot of cases of diarrhea, respiratory infections and skin diseases,” observes Guillemette Thomas. Humanitarians also fear cases of hepatitis A. “People have to relieve themselves outside and that’s how it’s transmitted. It contaminates the wastewater,” she explains. The local illustration of a reality which is worsening in the Palestinian enclave.
“All of these illnesses are linked to the precarious conditions in Gaza. There are a huge number of cases, cases that we should not see at this time of year if the Gaza Strip was not at war. “
Guillemette Thomas, coordinator at Médecins sans frontières Franceat franceinfo
During’a press conference on Thursday, the WHO reported at least 170,000 respiratory infections and more than 125,000 cases of diarrhea recorded in the enclave. Between 2021 and 2022, cases of diarrhea among Gazans were 45 times fewer, according to the WHO. Children under 5 are particularly affected. The agency is also concerned about cases of chickenpox, jaundice and meningitis. So many diseases are gaining ground in Gaza.
A spread of diseases 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 from the London School of Hygiene and Tropical Medicine. Because for these specialists, the lack of vaccination and malnutrition, as Gaza descends into conflict, are accelerators of epidemics.
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The food insecurity figures are already very alarming: in the north of the Gaza Strip, 48% of the population suffers from severe hunger, like 38% of displaced people in the south, according to the World Food Program. Almost all families in the north do not eat enough, like 83% of displaced people in the south of the enclave. “Our colleagues tell us that they eat once a day, when they eat,” supports Helena Ranchal. Gazans, already very weakened by the shock of fighting and forced departures, are losing immunity by eating too little each day. They are thus more exposed to viruses… often without being able to be taken care of.
“These infections are extremely contagious, in a health system where everything is stopped. It is very, very complicated to treat these people.”
Helena Ranchal, from Doctors of the Worldat franceinfo
UNRWA shelters have medical teams, but the Gaza healthcare system as a whole is devastated by the conflict. According to WHO, only 9 of Gaza’s 36 health centers remain partially operational. In this context, overwhelmed hospitals “deal with very serious cases”points Helena Ranchal, and can hardly treat those who suffer from infections or chronic illnesses. Even the most serious injuries cannot be properly treated, leading to “generalized infections”.
“We cannot do anything in the current conditions with this magnitude of injured, sick and without means. denounces Helena Ranchal. The aid worker calls for a ceasefire, in response to the situations “dramatic” that she notices. “This has to stop.”