A review ties Gaza's disease surge to collapsed water and sanitation

A narrative review published in Health Science Reports on 9 May draws together what the health record says about infectious disease in the Gaza Strip since October 2023, using peer-reviewed literature, WHO and UNRWA reports, Gaza Ministry of Health field data from 2023 to 2025, and surveillance summaries [s1]. Its central claim is not about any single disease but about a mechanism: that the pattern of illness tracks the failure of water, sanitation and health infrastructure [s1].

This is a review of existing data, not new fieldwork. It inherits the limits of the sources it synthesises, several of which are themselves field estimates gathered under conflict conditions. What it offers is a structured account of which diseases the reporting bodies have flagged, and why.

What the review reports

The authors describe the re-emergence of hepatitis A, acute respiratory infections, and poliovirus that had previously been eliminated locally [s1]. They also report the proliferation of multidrug-resistant pathogens, naming carbapenem-resistant Acinetobacter baumannii — a hospital organism that is difficult to treat because it resists the class of antibiotics usually held in reserve for severe infection [s1].

The diarrhoeal-disease figure is the review's most concrete number. It cites more than 200,000 diarrhoeal cases, half of them among children under five [s1]. The authors attribute this to the collapse of water, sanitation and hygiene systems, reporting that 97% of groundwater is deemed unfit for consumption [s1].

Why the environment sits at the centre

The review's argument is that the disease picture cannot be separated from the physical state of the territory. It reports 23 million tons of debris and untreated sewage as amplifiers of transmission risk [s1]. Structural damage to health facilities, shortages of sterile supplies, and disrupted supply chains have, in the authors' account, impaired both infection control and the careful use of antibiotics that keeps resistance in check [s1].

That last point connects the two halves of the review. Antimicrobial resistance is not only a laboratory phenomenon; it is driven in part by antibiotics used without diagnostics, without reliable supply, and without the isolation capacity that stops resistant organisms spreading in a ward. A health system under those conditions is one in which resistance is expected to rise.

Carbapenem-resistant Acinetobacter baumannii, the organism the review names, is a case in point. It is a hardy environmental bacterium that colonises wounds and the equipment around critically ill patients, and it is notoriously difficult to clear from a hospital once established. Blast and crush injuries, of which there are many in this setting, create exactly the deep contaminated wounds it exploits — and when the carbapenems that would normally treat it no longer work, the options that remain are older, more toxic, or simply unavailable. The review's pairing of war-wound trauma with a drug-resistant wound pathogen describes a compounding problem, not two separate ones [s1].

The link to malnutrition

Infectious disease and undernutrition compound each other, and the review sits alongside a separate, primary surveillance study that quantifies the nutrition side. That study, published in The Lancet on 8 October 2025, reported 265,974 mid-upper arm circumference measurements from children aged 6 to 59 months across Gaza between 1 January 2024 and 15 August 2025 [s2]. Children were screened by mid-upper arm circumference, with a reading under 125 mm triggering enrolment into therapeutic feeding [s2].

A malnourished child is more susceptible to infection, and repeated infection worsens malnutrition. Neither dataset was designed to measure that interaction directly, but each documents one side of a loop that the humanitarian-health literature treats as well established.

What is uncertain

The review's numbers carry the uncertainty of their origins. Case counts assembled during active conflict rest on surveillance systems that are themselves damaged, and undercounting is the usual direction of error in such settings. The re-emergence of locally eliminated poliovirus is reported on the basis of the cited surveillance; the review does not present independent confirmation of transmission chains within its own text [s1]. Health Newspapers is reporting these as findings the review attributes to WHO, UNRWA and ministry sources, and is not independently verifying the underlying field data.

What to watch

The review frames its findings as a case for specific interventions: rehabilitation of water and sanitation systems, decentralised diagnostics for antimicrobial resistance, and emergency immunisation [s1]. Whether the diarrhoeal and vaccine-preventable-disease figures rise or fall is, on the review's own logic, less a medical question than a question of whether water, sanitation and supply chains are restored. Those are the indicators the reporting bodies will be able to track.