In Gaza, the World Health Organization warns that the disease could kill more people than the Israeli offensive. Infectious diseases are “skyrocketing”, says WHO. More than 100,000 cases of diarrhea have been reported, with rates among young people 25 times higher than before the war.
The war has destroyed Gaza’s health system, adding to its disease surveillance capabilities. That’s why fitness teams and medical professionals around the world are doing everything they can to stumble and avoid flare-ups in a desperate situation.
“It’s about detecting the emergence of diseases that can cause an outbreak very, very, very quickly,” says Rick Brennan, WHO’s regional emergencies director for the Eastern Mediterranean region.
Before the war, despite the Israeli blockade, aid teams say Gaza’s public fitness formula did a pretty smart job. The more than two million Palestinians who live there enjoy physically robust vaccination rates, access to three dozen hospitals and effective disease surveillance.
“There was a pretty effective formula for detecting outbreaks,” Brennan says, “stumbling upon cases of infectious diseases, moving the samples to be tested in the labs, and then applying measures. “
But since the Hamas attack on Oct. 7, this formula — along with the rest of Gaza’s fitness infrastructure — has crumbled under Israel’s bombardment and ground offensive. Israel has accused Hamas of hiding weapons and fighters in and around hospitals, adding in the tunnels underneath, which has put the services in the crosshairs. The WHO says a quarter of Gaza’s hospitals remain partially functional.
Dr. Tahrir Al-Sheikh, a pediatrician in Gaza, has seen that disintegration firsthand. She was working at Al-Nasr Children’s Hospital until the war displaced her to the south where she’s been offering medical help at a school-turned-shelter.
“We used to grow bacteria in Gaza,” he says, and “we prescribe drugs based on the results. Now we can’t grow crops or anything, and infections are spreading. “
Al-Sheikh witnessed brutal diarrhea. ” I took care of a 4-month-old baby who had 20 bowel movements a day,” she recalls.
He also witnessed a torrent of respiratory illnesses. “I’ve had cases that haven’t responded to any treatment,” he says. “But I can’t tell [the shelter if] they have COVID, and I can’t diagnose it because I don’t have the equipment. “
The current scenario in Gaza is accelerating the spread of the disease.
“Wherever there is overcrowding,” says Marwan Al-Homs, director of Rafah’s Mohammed Yousef El-Najar Hospital, “these outbreaks exist: internal shelters, even in small apartments where 35 other people live. “
Juliette Touma, director of communications for UNRWA, the United Nations Relief and Works Agency, visited the Khan Younis Training Center in south Gaza, a shelter intended for 1,000 people but now hosting more than 30,000. “You have 400 people sharing one toilet,” she says. The same goes for showers. “There’s not much water to begin with, whether to wash or to stay clean. There’s not much hygiene supplies.”
Across Gaza, the population’s immune system is weakened. There is also a colder winter, dilapidated hospitals, and a lack of clean water, sanitation and good enough nutrition, things that are difficult to guarantee under Israel’s near-total siege of Gaza.
“It’s a cauldron of possibility of infectious disease,” says Amber Alayyan, deputy program manager for Doctors Without Borders in the Palestinian territories.
“If you don’t have access to antibiotics because you can’t go to the doctor,” he says, “then anything that’s so undeniable to treat can become pretty deadly. It’s an infectious crisis to come. “
Global health groups are racing to ramp up disease surveillance efforts in Gaza before there is widespread illness, which the WHO says could endanger even more lives than the combat.
Last weekend, Ayadil Saparbekov, WHO team lead for health emergencies in the Palestinian territories, traveled from Jerusalem to Gaza to ferry rapid diagnostics for hepatitis and cholera into the enclave.
“I bring the kits to detect and respond in a timely manner to other infectious disease outbreaks,” he said in a video posted on X, the former Twitter site.
UNRWA’s Touma stresses the importance of normal and sustained humanitarian assistance, adding hygiene products, vaccines and chlorine tablets. “All of that probably helps prevent disease,” he says.
WHO is hoping to resuscitate one or two of the local laboratories in Gaza that did pathogen screening before the war, though that will take effort and time.
In addition, they hope to “even bring in a cell lab from the outside,” Brennan says. “And we’re also exploring possibilities to take specimens out of the country, adding them to Egypt, for testing. This has proven to be a bit more complicated than expected. “
While the logistics of these approaches are being negotiated, Brennan says he is relieved that some of the most terrible diseases, such as measles or cholera, have yet to appear in Gaza. This is partly due to pre-war vaccines.
“If we get an influenza outbreak into those massively overcrowded shelters,” says Brennan, “if we’ve got shigella dysentery, that could rip through a community very quickly and really impact the most vulnerable. To be honest, I’m grateful that we’ve got to this point. We’ve got increased rates but we haven’t had a deadly outbreak yet.”
The duration of this clever fortune would possibly depend on disease surveillance to identify early cases of anything sinister, ideally while it can still be contained.