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Epidemiology of Diseases in the context of the war in Gaza Written by Prof. Dr. Ahmad Amro

Posted On: 25-03-2024 | Opinion
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The ongoing war in the Gaza Strip presents unique challenges beyond immediate military and security concerns, including increased risk of disease outbreaks due to disruption or complete destruction of health system infrastructure, overcrowded living conditions in shelters, and limited access to primary health care. Therefore, understanding the epidemiology of potential diseases in such circumstances is crucial to implement immediate and effective preventive measures and provide timely medical interventions to prevent health and humanitarian disasters from occurring or at least to reduce their collective impact.

I present this article as part of a successive series of articles about diseases where they spread and possible ways to deal with them in the context of war.

First: Infectious and communicable diseases:

Waterborne diseases: Among the waterborne diseases that may spread dangerously in such conditions are cholera, typhoid fever, and hepatitis, especially type A. This is due to damage ofthe waterpipes network and infrastructures, contamination of its sources, and poor sanitation. Once the main water sources are contaminated and the infrastructure is disrupted, these diseases can spread quickly, especially in places with high population density, as is the case in sheltering canters and tents in the refugee camps, such as the one witnessed in Rafah Governorate, which is now inhabited by more than one and a half million people. Here, immediate and effective measures must be taken to limit the spread of these diseases. Ensuring the immediate repair and maintenance of infrastructure and repairing damage to water and sanitation networks as quickly as possible is crucial to ensure the delivery of clean and healthy water to the population. The minimum immediate measures that can limit the spread of water-borne diseases include disinfecting contaminated water using effective disinfection processes such as using chlorine or direct boiling to kill germs, and providing alternative water sources such as bottled water and portable tanks. In addition, educating residents about the importance of boiling water before using it for drinking or cooking, cleaning hands regularly to prevent waterborne diseases, and providing immediate healthcare for people with water-borne diseases, including giving fluids and appropriate medical treatment.

Given the damage and contamination of water infrastructure, a rapid and integrated response to combat water-borne diseases is vital and requires the cooperation of local and international humanitarian organizations with local authorities and the local community in providing the necessary assistance and preserving the health of the population in light of the difficult circumstances they face.

Vector-borne diseases: Stagnant water and inadequate waste sewage management create fertile breeding grounds for disease vectors such as mosquitoes, increasing the risk of vector-borne diseases such as malaria, dengue, cutaneous leishmaniasis and Rift Valley fever (RVF). Although there are no vectors of these diseases and they were not previously reported in the Gaza Strip, the accumulation of stagnant water and sewage, such as what we witness near the tents of the displaced populations in Al-Mawasi, Khan Yunis, and Rafah, the accumulation of waste, and the collapse of the primary health care and vaccination against these diseases, are considered among the risk factors that lead to an increase in the occurrence of these diseases, especially with the onset of summer. Add to that other skin diseases such as scabies, fungal infections (dermatophytes), smallpox, lice and mice infestation, and many other diseases that we will mention in details in later articles. Perhaps the most important steps that can be taken to reduce the possibility of the emergence of these diseases and prevent their occurrence are health awareness about the importance of personal hygiene and providing prevention, especially the use of skin mosquito repellents such as castor oil, wearing long clothes, and using nets to reduce the possibility of mosquito bites.

Upper-respiratory tract infections: Overcrowding in shelteringcenters and tents and lack of ventilation lead to increased transmission of respiratory infections such as influenza, colds, sore throat, bronchitis, and inflammation of the lungs. These diseases can be caused by several factors such as viral, bacterial or fungal infections. It is recommended to follow preventive measures such as washing hands regularly and covering the mouth and nose when coughing or sneezing to reduce transmission of infection. Individuals experiencing symptoms of respiratory infections should remain isolated from others and seek medical care when necessary.

Foodborne infections: Interruptions in the food supply and inappropriate storage may lead to contamination of these foods, leading to outbreaks of diseases such as salmonellosis (bacterial food poisoning), viral and fungal food poisoning, and helminthic parasitic poisoning such as amoebic dysentery and tapeworms, which can be transmitted by eating contaminated foods with parasitic eggs or contaminated water. Add to this poisoning by chemicals and environmental pollutants such as mercury poisoning or pesticides.

These are some examples of foodborne diseases, and proper prevention and food hygiene measures that can be implementedto reduce the risk of contracting these diseases, such as washing fruits and vegetables well before eating or cocking them, cooking meat sufficiently, and storing foods at an appropriate temperature, especially when summer arrives.

Second: Non-communicable diseases:

Mental health disorders: During periods of war, difficult circumstances and psychological pressures on individuals and groups are exacerbated, leading to an increased prevalence of mental health disorders and exacerbation of anxiety and depression. Perhaps the most important of these disorders is Post-Traumatic Stress Disorder (PTSD), which can result from individuals being exposed to horrific events such as those occurring now in the Gaza Strip, including direct fighting or the loss of loved ones and family members. This disorder is characterized by persistent fear and painful memories of traumatic events, and can be accompanied by insomnia, panicattacks, and social isolation. Anxiety and depression can increase during periods of war due to uncertainty and constant threats.

Sleep disorders are also significant, since traumatic events and psychological pressures during wars can affect individuals’ sleep, leading to sleep problems such as insomnia and nightmares. This is accompanied by eating disorders, especially in light of the starvation and hunger that threaten the population. The reports of international organizations on the impending famine in Gaza are no secret to every reader. Some may resort to unhealthy eating behaviors such as starvation or overeating as a way to deal with psychological stress during war.

Chronic diseases: Interruption of health care services and lack of medications pose challenges for individuals with chronic diseases such as diabetes, high blood pressure, cancer, kidney and cardiovascular diseases.

Preventive measures

Water and hygiene:

Establishing clean water sources and promoting hygiene practices such as hand washing can prevent waterborne diseasesand decreases its burden. Implementing appropriate waste management systems and sanitation facilities is one of the most important needs to reduce the risk of disease transmission. Chlorinating water sources and distributing water purification tablets can help ensure access to safe drinking water.

Vector control:

Conducting vector control and implementing mosquito control measures, such as spraying insecticides and constant ventilation in shelter centers, especially in the city of Rafah, where more than a million and a half refugees reside in tents and shelter centers, in order to reduce the habitats of the larvae.

Health education and health promotion:

Health education about disease preventive measures is one of the most effective methods, including vaccination campaigns and proper food handling. As well as promoting awareness of mental health and providing psychological and social support services to treat the psychological impact resulting from war.

Access to health care:

Ensuring access to primary health care services, including vaccines, medicines for communicable and infectious diseases, and antibiotics, is crucial for treating and controlling diseases. Supporting healthcare facilities with medical supplies, staff and infrastructure enhances the healthcare system's ability to respond to disease outbreaks.

In conclusion, let us mention that, in the context of this bloody war in Gaza, and according to successive international reports about the threat of famine, the spread of diseases, and the collapse of the health system and health services, this constitutes a source of great concern and an imminent alarm bell. This critical stage requires addressing disease epidemiology and a comprehensive approach that includes preventive measures, access to health care, and community engagement. By implementing strategies to protect against infectious diseases, mitigate the impact of non-communicable diseases, and enhance public health and care for the population. Cooperation between local authorities, humanitarian organizations and international agencies is essential to effectively meet the health needs of Gaza's population during and after the war.


Prof. Dr. Ahmad Amro 

Dean of the Faculty of Pharmacy

Al-Quds University

Mob 00970599205307

[email protected]

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