‘Perfect storm for disease has begun’ in Gaza, overwhelmed doctors say

A lack of food, clean water and shelter have worn down hundreds of thousands of traumatized people in Gaza and, with a health system on its knees, it's inevitable epidemics will rip through the enclave, 10 doctors and aid workers told Reuters.

"The perfect storm for disease has begun. Now it's about, 'How bad will it get?'" James Elder, chief spokesperson for the UN children's fund (UNICEF), said in an interview on Tuesday.

From Nov. 29 to Dec. 10, cases of diarrhea in children under five jumped 66 per cent to 59,895 cases, and climbed 55 per cent for the rest of the population in the same period, according to data from the World Health Organization (WHO). The UN agency said the numbers were inevitably incomplete due to the meltdown of all systems and services in Gaza because of the war.

All telecommunications and internet services in the Gaza Strip went down again Thursday as a result of "the ongoing aggression," Gaza's main telecommunications companies Paltel and Jawwal said.

The head of the pediatric ward at Nasser Hospital in Khan Younis in southern Gaza, Dr. Ahmed Al-Farra, told Reuters on Tuesday his ward was overrun with children suffering extreme dehydration, causing kidney failure in some cases, while severe diarrhea was four times higher than normal.

He said he was aware of 15 to 30 cases of Hepatitis A in Khan Younis in the past two weeks: "The incubation period of the virus is three weeks to a month, so after a month there will be an explosion in the number of cases of Hepatitis A."

Since the truce between Israel and Hamas collapsed on Dec. 1, hundreds of thousands of people have moved to makeshift shelters — abandoned buildings, schools and tents. Many others are sleeping in the open with little access to toilets or water to bathe, aid workers said.

WATCH | Gaza's southern city of Rafah hit with ongoing airstrikes:

Rafah neighbourhood reeling after Israeli attack

19 hours ago

Duration 0:37

People in Gaza's southern city of Rafah picked through the rubble on Thursday after homes were destroyed by Israeli airstrikes.

At the same time, 21 of the Gaza Strip's 36 hospitals are closed, 11 are partially functional and four are minimally functional, according to WHO figures from Sunday.

Marie-Aure Perreaut, emergency medical co-ordinator for MSF's operations in Gaza, said the medical charity had left a health centre in Khan Younis 10 days ago — because the area was within Israel's evacuation orders — where it had been treating respiratory tract infections, diarrhea and skin infections.

She said two things were now inevitable.

"The first is an epidemic of something like dysentery will spread across Gaza, if we continue at this pace of cases, and the other certainty is that neither the ministry of health nor the humanitarian organizations will be able to support the response to those epidemics," she said.

Medicine 'under attack,' UNRWA says

Academic researchers at the London School of Hygiene & Tropical Medicine warned in a Nov. 6 report — a month after the Hamas attack on Israel triggered the Gaza war — of how the indirect health effects of the conflict would worsen over time.

They said that two months into the war there would be an increased burden of infant malnutrition due to disrupted feeding and care, and the nutrition of mothers would worsen. "With time, increasing chance of introduction of epidemic-prone pathogens. Risk factors: overcrowding, inadequate (water and sanitation)."

Aid workers say what the experts in London predicted is exactly what's playing out now. Three experts said diseases such as dysentery and watery diarrhea could end up killing as many children as Israeli bombardments have done so far.

The UN aid agency for Palestinian refugees (UNRWA) said two months of brutal war combined with a "very tight siege" have forced 1.3 million Gazans out of a population of 2.3 million to seek safety at its sites in the strip of land by the Mediterranean Sea.

"Many of the shelters are overwhelmed with people seeking safety, with four or five times their capacity," said Juliette Touma, UNRWA's director of communications. "Most of the shelters are not equipped with toilets or showers or clean water."

Since the war started, 135 staff of UNRWA have been killed and 70 per cent of staff have fled their homes, two of the reasons why UNRWA is now operating only nine of the 28 primary health clinics it had prior to the war, Touma said.

All told, at least 364 attacks on health-care services have been recorded in Gaza since Oct. 7, UN special rapporteur on the right to health, Tlaleng Mofokeng, said in a Dec. 7 statement.

"The practice of medicine is under attack," she said.

More than 300 Gazan health ministry staff and medics have been killed since Oct. 7, the ministry said on Wednesday.

'Epidemic potential'

Gaza's health ministry said on Wednesday its supplies of childhood vaccines had run out. Overnight on Wednesday, strong winds and heavy rain ripped the flimsy tents at a camp in Rafah and flooded the ground, forcing people to spend the night huddled in the cold on wet sand.

The United Nations is tracking the incidence of 14 diseases with "epidemic potential" and is most concerned about soaring rates of dysentery, watery diarrhea, and acute respiratory infections, according to a list the UN is currently using for Gaza seen by Reuters on Tuesday.

Dr. Paul Spiegel, director of the Center for Humanitarian Health at the John Hopkins Bloomberg School of Public Health, who is in Cairo working on the UN response, said a diarrhea outbreak could happen as soon as tomorrow, unless many more aid trucks were let in and clean water was provided.

He also said the UN plans to start documenting the levels of acute malnutrition among children in Gaza soon by measuring their mid-upper arm circumference, known as a MUAC test.

WATCH | Torrential rain worsens living conditions in Gaza:

Torrential rain soaks Gazans as health crisis unfolds

1 day ago

Duration 2:21

Torrential rains flood the streets of Gaza and worsen already impossible living conditions for people there. The fighting continues as infectious diseases and a predicted public health crisis set in.

"When you have acute malnutrition, which is called wasting, people, they die from that, but then they are also so much more vulnerable to other diseases," said Spiegel.

The UN's World Food Programme said on Monday that 83 per cent of the people who have moved to southern Gaza were not eating enough food.

Children drinking water 'unfit for human consumption'

To avoid epidemics, aid workers said hospitals and health centers would need to be able to treat large numbers of people for such diseases, instead of only the trauma wounds they're already overwhelmed with.

Drinking and bathing water would need to be available at minimum required levels according to emergency humanitarian standards while greater amounts of food and medicine would need to come into the Gaza Strip and safe passage provided for humanitarian convoys to deliver it, the aid workers said.

During the recent truce, about 200 aid trucks a day entered Gaza but that has since dwindled to 100 and fierce fighting has mostly prevented any distribution beyond Rafah.

Doctors at Abu Yousef al-Najjar Hospital in Rafah told Reuters on Tuesday they were overwhelmed with hundreds of patients needing treatment for infections and communicable diseases given the squalid conditions in overcrowded shelters.

"There will be outbreaks of all contagious diseases across Rafah," said Dr. Jamal Al-Hams.

Nasser Hospital's pediatric head Al-Farra said ongoing hostilities had made it impossible for many families to bring their ill children for care in time, which in any case he could not provide adequately due to shortage of medicines.

"Children are (drinking) water that is unfit for human consumption," he said. "There's no fruit, no vegetables, so children have a deficiency in vitamins, in addition to … anemia from malnutrition."

Standing among a sea of tents near Nasser Hospital, Mahmoud Abu Sharkh, who fled northern Gaza early in the war with his three children who are all under three, pointed to the squalid conditions around him in the dusty camp.

"The children get better for two days, and on the third day they are sick again."