https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01531-4/fulltext
The environmental impacts of war
Often overlooked as a dimension of the health effects of war, the impacts of conflict on the environment are gaining increasing attention. Rebecca Sers reports.
Armed conflicts pose unprecedented challenges for public health. Inevitably, much of the focus in these contexts falls on acute health needs. But modern warfighting causes conflict pollution and environmental harm leading to potentially important, more chronic, health risks. Doug Weir of the Conflict and Environmental Observatory told The Lancet that while “there is more awareness of this environmental damage, most of that is about the immediate impacts of the things that are burning, the things that are exploding, and the things that are destroyed. Less consideration is given to the consequences for environmental governance which can last decades potentially, and the almost inevitable public health legacies.” As the number of countries and people affected by conflict continues to rise—according to the 2025 Global Peace Index there are currently more conflicts globally than at any time since World War Two—the importance of documenting what Richard Sullivan has termed “covert threats to health” will only grow.
Conflict pollution can affect health by contaminating the environment—water, soil, and air resources and ecosystems—with heavy metals and chemicals. These toxic remnants of war are both a direct result of combat activities and a reverberating consequence of the disruption to state institutions, infrastructure, and services. Conflict debris is one of the most ubiquitous effects. The UN Environment Programme (UNEP) told The Lancet that in Gaza, military activities have generated 53 million tonnes of conflict debris from damaged buildings and infrastructure. The contamination risk is most significant “at a localised level— such as industrial sites or older buildings containing hazardous materials like asbestos”. Debris often contains unexploded ordnance and human remains. “Asbestos primarily poses serious long-term health risks—such as asbestosis, lung cancer, and mesothelioma—through chronic exposure. It may take a generation for the full impacts to become visible. Heavy metals can cause acute poisoning at high doses and long-term damage to the nervous system and kidneys and may also increase cancer risk.”
No conflict has the same environmental footprint. As Syria emerges from 14 years of war, Wim Zwijnenburg, Humanitarian Disarmament Project Leader for Dutch non-governmental organisation PAX, told The Lancet that the “ripple effects of conflict-driven pollution and large-scale environmental degradation are already causing health impacts in localised pollution hotspots”. In June, 2025, PAX outlined how intense fighting—cities bombed to rubble, nature reserves razed, oil infrastructure targeted—has contributed to “deep environmental scars” in the country.
In the densely populated Gaza Strip, decades of war and occupation exacerbated by the dramatic escalation of conflict since October, 2023, have resulted in severe environmental degradation, leading the UN Trade and Development to warn that Gaza was becoming “uninhabitable”. The UNEP 2024 report Environmental Impact of the Conflict in Gaza outlined this destruction and the collapse of waste management systems, as well as less visible harms including the contamination of land, water resources, and the air by munitions debris and unexploded ordnance. The UNEP told The Lancet that “Gaza’s environmental and public health crises are deeply intertwined, each amplifying the other, [with] the cumulative consequences of these multiple environmental hazards posing a major public health burden.”
According to Weir, the “very high environmental profile” of the war in Ukraine is explained by factors including “the scale of the 2022 invasion with the number of different components of the environment being harmed; intensive mechanised warfare across a very long frontline; and, one-off, high-profile incidents including the occupation of the Zaporizhzhia Nuclear Power Plant which is completely unprecedented in terms of conflict, and the destruction of the Nova Kakhovka Dam’.’
The most intense combat has taken place in the eastern oblasts, in areas which were, or remain, under occupation. The widespread destruction of settlements, industrial facilities (many of which are located close to urban areas), the natural landscape, and freshwater and coastal environments mean that no part of the country is untouched. In June, 2025, the Minister of Environmental Protection and Natural Resources confirmed that the government has documented more than 8000 cases of environmental damage with total losses to nature exceeding US$94 billion since 2022.
Environmental governance is key to managing conflict pollution and its health effects. Context matters here. Weir told The Lancet that “the Palestinian Environment Quality Authority has for years been trying to navigate environmental protection and advocacy within the context of occupation; however, it has less of a platform and audience than the Ukrainian government, which has been extremely active in its environmental advocacy around the conflict”. The latter is pursuing a post-conflict Green Recovery with support from international partners and seeking accountability for environmental damage. About 250 cases of environmental war crimes and ecocide are being investigated by the Office of the Prosecutor General. According to Donna Cline, Environmental Mobile Justice Team Lead at Global Rights Compliance, because “there has never been a prosecution for environmental harm before one of the international criminal tribunals, there is no precedent. The Ukrainian investigators and prosecutors are some of the only people in the world who have investigated and prosecuted environmental war crimes.”
Underlining the importance accorded to the health implications of environmental harm in its “strategic cooperation” with the government, Jarno Habicht, WHO Representative in Ukraine, told The Lancet that “within and anchored to the broader process of institutional/governance reform, we regularly engage with national stakeholders, [and] communicate with the Ministry of Environment and other partners to see how to assess health implications of environmental harm”. Over the longer term, “environmental damage and degradation of ecosystems will have long-term consequences for human health, which are further exacerbated by climate change. For this reason, WHO is cooperating with national authorities to strengthen their ability to undertake a climate vulnerability assessment that would consider the unique context of the country, including by factoring in increased risks caused by the war.”
Against the backdrop of conflict, documenting causation of the downstream health risks and their correlation with disease outcomes is challenging. According to Daniel Hryhorczuk, Professor Emeritus of Public Health at the University of Illinois, for “many environmental toxins, it has taken decades of research to discover the association between these exposures and their health effects, and even then, many more years to implement effective policy. The causes of illness and death are multifactorial, especially in times of conflict.” In fragile, conflict-affected settings, the data are imperfect and it is not clear what level of evidence is feasible. Although the application of open-source intelligence is becoming increasingly important, the full extent of the damage can be assessed only when hostilities have ceased. Richard Sullivan, Professor of Cancer and Global Health at King’s College London, told The Lancet that “Expecting every conflict to be covered is not realistic but a more systematic analysis, which would likely involve civil-security actors, is needed to understand wider impacts.”
The challenges confronting fragile health-care systems in these settings are likewise immense. According to Richard Fuller of the Global Alliance on Health and Pollution, “the legacy of toxins has a downstream impact that can kill for decades. The degree of suffering may be as large as that caused by the conflict itself, especially in modern wars.” More research is necessary to broaden the understanding of exactly how conflict pollution can impact health in exposed populations, and to support resource prioritisation to meet these needs. This is not straightforward. Aula Abbara, consultant in infectious diseases at Imperial College London and co-founder of the Syria Public Health Network, told The Lancet that the “pressure on health systems globally but particularly in areas at risk of conflict and humanitarian crisis is already very high. [In Syria], the resilience of these different systems and communities and emergency response preparedness to deal with these health challenges is therefore lower.” Sullivan told The Lancet that in Gaza and Syria currently there “are more pressing problems. For Gaza its continued survival is at stake with the ongoing genocide and for Syria there are acute issues that mean resources are going to only the most urgent frontline public health and infrastructure priorities.”
According to Habicht, “War is always bad for public health.” Yet until recently, the long-term, cumulative health impacts of conflict pollution have been largely overlooked. Even today, in many long-running conflicts—Sudan, Myanmar, and the Democratic Republic of the Congo—this toxic legacy passes well below the international radar. Managing the environmental impacts of conflict is today’s challenge. Since 2022, the pace of technological change signals a new era of warfare in which the capacity for environmental harm will probably increase. Zwijnenburg has warned that alongside conflict pollution in Syria other environmental pressures such as climate-linked water shortages, wildfires, and deforestation “are not just long-term concerns—they are converging into an acute crisis”. Despite the difficulties of assessing the health consequences of the toxic remnants of war, bringing them to the forefront of global health policy and humanitarian action is now an urgent task.
The history of land and water in Palestine, a mirror of the fate of its people
The tragic fate of water in the region is the key to the Zionist capital system.
Just eighteen months after the 1967 invasion, Israel handed over all the water resources of the region and Palestine to the Israeli army, declaring that all water resources were national and belonged to Israel and that Palestinians could not exploit them without permission. Then, whenever Palestinians went for permission, it most often did not allow them to exploit or dig wells or dig shallow and dry wells. And only after that, in 1982, the Israeli government transferred all the water in the region to the Israeli company Mekorot, of course under the laws and control of the Israeli government. In total, in the entire region, Israelis have access to 89.5% and Palestinians to 10.5% of the available groundwater, with an almost equal population. The groundwater has a total of eight basins, four in Israel and four in the occupied territories. The Palestinians do not have access to the Jordan River or any other river of surface water. Israel annually extracts 90% of the “mountain” aquifer water for its own citizens, while the Palestinians can only have 10%. It diverts the only surface water source in the region, the Jordan River, which flows through the West Bank, and does not allow the Palestinians to use it. The Jordan River flows into two different places along this border: the northern part, which produces the largest source of fresh water, flows into the Sea of Galilee, which is itself fresh water, and the lower part, which flows into the very salty Dead Sea. Israel pumps a large amount of water from the Jordan River for itself and Jordan and sends the rest through canals to its national waterways before reaching the West Bank (see the attached map, marked in red). The Jordan River is generally exploited by Syria, Israel, and Jordan, and does not reach the Palestinians. Israel also diverts the Torza River, or Wadi al-Fara’a, in the West Bank, which is fed by seasonal rainfall, and sends it to the Torza reservoirs for Israeli farmers to use for their crops. In September 2019, Netanyahu also promised to occupy and annex the “Fertile Jordan Valley” to Israel during his election campaign. Between 2009 and 2019, the Israelis destroyed or reduced 547 Palestinian water structures. Ultimately, Palestinians are forced to buy water from the Mekoro-Rot company. In 2009, the World Bank reported that each Israeli uses four times as much water as a Palestinian living in the same area. In 2017, Amnesty International produced a report showing how Palestinian farmers have been forced to grow limited crops that use less water. Israel’s history since 1967 shows a steady advance and occupation of Palestinian land and water resources. Israel itself sends water from the north of its occupied territories to the south, but Palestinians are not allowed to transfer water from the West Bank to Gaza. Before October 7, 2023, about 90 percent of Gaza’s water came from the coastal aquifer, which flows from the Mediterranean to Gaza and then to Israel. Israel’s excessive withdrawal of these aquifers caused saltwater to infiltrate the water, making it tasteless and brackish. It also became unfit for human consumption because of the leaching of sewage and chemicals into the water. The remaining 10 percent was supplied through three large pipes from Israel at high tariffs and a small desalination plant, which were cut off after the war. In parts of Gaza where there was no piped water, residents, who made up about two-thirds of the population, bought their water from Israeli tankers carrying poor quality water at a high price of five to six times the price of piped water, between US$4 and US$10 per cubic meter. (Some families paid between 40% and 50% of their income for water.) Israel even pumps water from springs into Jewish settlements, and Palestinian villages are facing dry springs (Amnesty International 2017 report).
One of two Mekorot pumping stations outside the village of Bardala. These pumping stations have caused springs in the villages of Ein al-Beida and Bardala to dry up completely, forcing the Palestinian community to be entirely reliant on the Israeli state-owned company for their domestic and agricultural water provision. © Amnesty International
Since Israeli authorities do not recognise the right of many Palestinian communities to live in Area C and refuse to allow them the necessary infrastructure, these families have no access to running water even though a Mekorot pipeline runs along the side of the highway less than 100 meters from their land. To get water they must go twice a day to the local water filling point run by the Mekorot company. © Amnesty International
Before October 7, 26% of illnesses in Gaza were water-borne. These included diarrhea, viral hypoxia, kidney and liver disease, blue baby syndrome (a condition in which the blood does not carry oxygen, with rapid, shallow breathing and bluish skin that can lead to death), and severe anemia, as well as intellectual disabilities. The United Nations has found more than 96% of Gaza’s water unfit for human consumption. Gaza’s water has an average of more than 100 colonies of bacteria per square inch. In the United States and most developed countries, drinking water, whether from municipal facilities or wells, must be absolutely free of these bacteria. For example, in the United States, if they find a slight drop in pressure or any minor problem in the water distribution pipes, the government immediately recommends that all consumers boil their water.
The Siege of Gaza’s Water
Gaza’s water was 85% unsafe in 1998, and by 2018, this percentage had risen to 97%. As a collective punishment, on October 9, 2023, the Israeli government ordered the closure of all vital resources, including water, food, medicine, and fuel, to the people of Gaza, and then, as in previous wars, including the 2014 war, it began bombing Gaza’s vital facilities, including water supplies, water and sewage treatment plants, and power generation facilities. Very quickly, the people of Gaza lost 95% of their water supplies, and after the destruction of the sewage treatment plants, sewage flowed into the streets. According to a United Nations report, the people of Gaza now live on a daily ration of three liters of water, which is far below the internationally established emergency ration of fifteen liters per day. According to a 2009 World Bank report, each Israeli used an average of 300 liters of water per day (Israelis have beautiful gardens and swimming pools). Experts predict an outbreak of cholera and other diseases caused by contaminated water and dehydration in Gaza, where there are now no clinics reporting such illnesses.
According to Amnesty International’s 2017 report, the average Palestinian consumed 73 liters of water per day, and in some areas of the West Bank, even 20 liters per day, compared to the Organization for the Coordination of Humanitarian Affairs’ estimate of 100 liters per person per day. In the same area, the average Israeli consumed 300 liters per day. Amnesty International reports photos of lush Israeli gardens and swimming pools next to Palestinians deprived of adequate water.
On the other hand, tens of millions of gallons of sewage are now dumped into the Mediterranean Sea every day, from which some of the drinking water is taken, and there are no more clinics in Gaza to treat diseases caused by this pollution. For example, in 2016 and 2017, after the 2015 wars in the crises in Iraq, Kuwait, Syria, and Bahrain and the region, after heavy rains, sewage flowed into the streets and cholera broke out. Two million people were infected with cholera and 3,500 people died. In total, according to UNICEF, in wars, children under five die twenty times more often from diarrhea than from direct attacks by war.
Now, the American national television, Public Television, has produced a report on the displaced people of Gaza in their tents, which shows that the tents are full of scorpions, cockroaches, insects, mosquitoes, flies, and rats, and the stench of sewage makes breathing unbearable. One of the reasons for this is the destruction of all water purification systems and the lack of fuel for the few remaining water purification pumps. Israel is absolutely preventing fuel from reaching Gaza.
Israeli industrial establishments in the occupied Palestinian territories are more than just family settlers. These establishments forcibly seize Palestinian natural resources, including stone quarries in the West Bank, which the so-called Palestinian Authority apparently administers, in violation of the Hague Convention. In 2016, Human Rights Watch prepared a detailed report on this matter. It should be noted that Israel recently decided to build Jewish settlements in the Golan Heights, which it illegally occupied from Syria, and the United Nations has declared the occupation of these heights illegal and condemned this decision. Israel continuously first seizes Palestinian lands and then begins to build settlements, and then immediately, in addition to building houses, it builds various urban service centers, and then a flood of various establishments flows into the new village. Interestingly, Israel is opening more than usual archaeological sites, which we have heard of sometimes making discoveries about their ancestors going back thousands of years and that the land belongs to the Jews. In the occupied territories, Palestinians are under Israeli military rule and there is complete Israeli surveillance throughout the territory.
The Israeli authorities also restrict Palestinians’ access to water by denying or restricting their access to large parts of the West Bank. Many parts of the West Bank have been declared “closed military areas”, which Palestinians may not enter, because they are close to Israeli settlements, close to roads used by Israeli settlers, used for Israeli military training or protected nature reserves.
Israeli settlers living alongside Palestinians in the West Bank – in some cases just a few hundred meters away – face no such restrictions and water shortages and can enjoy and capitalize on well-irrigated farmlands and swimming pools.
In Gaza, some 90-95 per cent of the water supply is contaminated and unfit for human consumption. Israel does not allow water to be transferred from the West Bank to Gaza, and Gaza’s only freshwater resource, the Coastal Aquifer, is insufficient for the needs of the population and is being increasingly depleted by over-extraction and contaminated by sewage and seawater infiltration.
The resulting disparity in access to water between Israelis and Palestinians is truly staggering. Water consumption by Israelis is at least four times that of Palestinians living in the OPT. Palestinians consume on average 73 litres of water a day per person, which is well below the World Health Organization’s (WHO) recommended daily minimum of 100 litres per capita. In many herding communities in the West Bank, the water consumption for thousands of Palestinians is as low as 20 litres per person a day, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). By contrast, an average Israeli consumes approximately 300 litres of water a day.
50 years on, it is time for the Israeli authorities to put an end to policies and practices which discriminate against Palestinians in the OPT and to address their desperate need for water security. The Israeli authorities must lift the restrictions currently in place which deny millions of Palestinians access to sufficient water to meet their personal and domestic needs as well as to enjoy their rights to water, food, health, work and an adequate standard of living.
Devastating toll on communities in the Jordan valley
In September 2017 Amnesty International researchers met with residents of the Jordan Valley and witnessed first-hand the catastrophic impact the water restrictions have had on people’s daily lives.
Ihab Saleh, a squash and cucumber farmer living in Ein al-Beida, a Palestinian village of about 1,600 people located in the northern part of the West Bank, is one of hundreds of thousands of people whose lives and livelihoods have been destroyed by Israeli water restrictions. Over the past 25 years he has seen the local spring gradually dry up after the Israeli company Mekorot drilled two wells near the neighbouring Palestinian community of Bardala, to serve Mehola, an Israeli settlement. The amount of water the Israeli authorities allocate to the village has been decreasing over the years, he says, and has been fully cut off on numerous occasions. Despite an agreement to compensate the Palestinian villages of Bardala and Ein al-Beida, since the mid-1970s, Israel has significantly reduced the amount of water available to both communities.
In addition to the farming villages, many Bedouin communities in the Jordan Valley face severe restrictions as a consequence of Israel’s control of Palestinian natural water resources. Often the land they live on is designated by Israel as a “closed military area”. Not only is their access to water limited, they also live under the constant threat of forced evictions through demolition orders on their homes and properties.
Two families living beside highway 90 near the village of Ein Al-Beida have had their houses and property destroyed twice in the last two years. Most recently, in December 2016, the Israeli army destroyed two home structures and all of the water tanks belonging to the families.
In al-Auja, a village of about 5,200 people, 10 kilometres north of Jericho in the Jordan Valley, the situation is much the same. In 1972, Mekorot sunk a well and established a pumping station, close to the Wadi Auja spring. According to residents, the spring used to provide a plentiful supply of water to the village and surrounding agricultural land via a series of irrigation channels.
Even the Palestinian Authority does not realize that this used to be a centre for agriculture… People are left with no options. In 1967, when they [the Israeli authorities] started taking the water it was like a sickness in a body… slowly the land dried up.
Issa Nijoum speaking to Amnesty International, Al-Auja.
Due to water shortages, farmers in Al-Auja were forced to diversify from their traditional livelihoods and now grow crops that are less water-intensive and also less profitable. While in the past they grew mainly citrus fruit and were capable of exporting them, they rely now on less water intensive vegetable crops such as zucchini, cucumber and squash, which can sustain a cultivation period of three to four months through the winter season. Many residents of Al-Auja have also been forced to find work in farms located in three neighbouring Israeli settlements, which have unrestricted access to water.
Israeli settlements’ access to water
Swimming Pool in Ma’ale Adumim. With water supply roughly four times greater than that provided to Palestinian communities, Israeli settlements such as Ma’ale Adumim stand in stark contrast to their Palestinian neighbours. © Amnesty International
Lush vegetation in the Israeli settlement of Ma’ale Adumim. With a population of 37,670, the settlement is one of the largest in the Occupied Palestinian Territories. © Amnesty International
Grape harvest in the Israeli settlement of Psagot, July 2017. The winery at Psagot was founded in 2003 and according to its official website, produces around 350,000 bottles of wine a year, 70 percent of which is exported internationally. Grapes are high value, water intensive crops. © David Silverman/Getty Images
An Israeli settlement date farm close to the village of Al-Auja, in the Jordan Valley, 21 September 2017. Hundreds of millions of dollars’ worth of goods produced in Israeli settlements built on occupied Palestinian land are exported internationally each year, despite the fact that the vast majority of states have officially condemned the settlements as illegal under international law. © Amnesty International
A water filling point on the outskirts of the village of Al-Auja in the Jordan Valley. For Palestinians with no access to running water the situation is dire. To meet their basic needs, they have no choice but to purchase additional water from tankers, usually twice a day. The water is often of dubious quality and is more expensive than that supplied through the water network. © Amnesty International
Qais Nasaran a store owner from Al-Jiftlik, a village with an estimated population of approximately 4,700, located in the northern Jordan Valley, used to farm a small plot of land. After his well dried up, he has been forced to find a new way to make a living. He now runs a grocery store.
The store is located in an old pump house for a well which was sunk in 1966 with permission from the Jordanian authorities who controlled the West Bank at the time. A year later, after Israel occupied the Palestinian territories, the Israeli authorities stopped Qais Nasaran’s family from using it. There was water in the well until 2014 when it finally dried up. Qais explained how, each year, when the well was full, the Israeli military would check to see no one was using it.
Qais still owns a cistern on his land but cannot always afford to fill it as it costs around 8,000 NIS (approximately 2,278 USD). He buys his water from a landowner in the Jordan Valley.
For Mustafa Al-Farawi, a date farmer from Al-Jiftlik, the situation is similar. The amount of water available from the well on his land has been decreasing steadily over the years.
He explains that, in the 1980’s, the well would provide enough water to irrigate an area of 1,000 acres, and provide water for the animals, as well as supporting the family. Now the majority of water used for his date farm has to be bought and transported with a water tank from a spring 7km away, which is the only spring that can still be accessed by Palestinians.
We have not enough water and no control of it. The Israeli authorities’ tactic is to slowly decrease the water, so we have to leave the land.
Mustafa Al-Farawi, Al-Jiftlik
In recent years, Mustafa wanted to sink a new well at a different location that would guarantee more water. He says that an engineer came to check and there was water closer to ground level on another part of the farm’s land. He applied for drilling rights, but the Israeli authorities denied the application. Eventually he decided to sink the well anyway without permission, but the Israeli army came and prevented him from doing so. He was told that sinking the well was against Israeli military orders and the construction was halted.
The village of Furush Beit Dajan, in the northern West Bank with a population of about 930, used to be a producer of citrus fruit. From the mid 1990’s, farmers have had to diversify their crops due to insufficient water supplies.
The villagers say that they used to have an abundance of water but in recent years the wells have been supplying less and less. Residents of the village mentioned that the aquifer is being exhausted by Israeli wells used to supply the neighbouring Israeli settlements of Hamra and Mehora. According to Azim Mifleh, a farmer from the village, Israeli wells started pumping in the vicinity of the village in the 1970’s and slowly the local wells lost their efficiency. Since the Oslo Accords signed between Israel and the Palestine Liberation Organization (PLO) in 1995, Israel has extracted far in excess of the agreed quantity of water from the Eastern Aquifer.
Azim Mifleh, a farmer and coordinator for the Agricultural Development Association (PARC) from Furush Bei Dajan, says he used to have 800 trees on his land; mostly lemon and grapefruit. Now he only has two trees left next to the house.
Azim Mifleh had to diversify and grow crops in greenhouses. Most of the crops he now grows, including cucumbers, tomatoes and squash, can only be cultivated in the winter and spring seasons.
The land is occupied and the [Israeli] occupiers should be looking after the people…Israel should be doing what they are supposed to; they have to pay the price for occupying, and act in the best interest of the occupied people.
Azim Mifleh, Furush Beit Dajan
There are five water wells in the vicinity of Furush Beit Dajan village- all are privately owned by Palestinians. According to residents from the village, they have suffered drastic decreases in their output of water due to Israeli wells being sunk in the area to supply the settlement of Hamra, which farms an extensive area of land. The settlement of Hamra has a 100 acre date farm and also harvests water-intensive crops such as bananas and citrus fruits.
Palestinian tourists from Nablus pray in an abandoned lido near the Dead Sea in the Jordan Valley. Since 1967, the Israeli authorities have denied Palestinians access to the Jordan River has been restricted entirely along its whole course through the West bank. Water levels in the Dead Sea have fallen dramatically over the past 50 years due to diversion of the river Jordan up stream by Israel as well as Jordan and Syria. The Dead Sea now lies around half a kilometre away from the lido when once it surrounded it.
The Siege of Gaza’s Water
Commentary by Natasha Hall, Anita Kirschenbaum, and David Michel
Published January 12, 2024
On October 9, in response to the October 7 assault by Hamas militants, Israel’s defense minister ordered a “complete siege” on the Gaza Strip, including the halting of electricity, food, water, and fuel sent to Gaza from Israel. Clean water is unavailable for most living in Gaza, and Israeli airstrikes are destroying water infrastructure and wells—in potential violation of international humanitarian law—in addition to taking thousands of lives and displacing almost two million Gazans. Even more lives are at risk as the threat of disease increases. Improving water access in Gaza is essential to preventing further loss of life and livelihoods and to rebuilding a secure and sustainable future when the present conflict ceases.
A Water Crisis Worsened by War
Gazans struggled to access adequate safe water even before the current crisis. About 90 percent of Gaza’s water supply comes from the Coastal Aquifer Basin, which runs along the eastern Mediterranean coast from Egypt through Gaza and into Israel. However, the water is brackish and contaminated due to seawater intrusion, overextraction, and sewage and chemical infiltration. Consequently, Gazans rely on small-scale desalination units and unregulated private water tankers, which can be costly and pose additional health risks. The remaining 10 percent of water not pumped from the Coastal Aquifer comes primarily from three Israeli pipelines and from small-scale seawater desalination plants.
As a result of Israel’s siege, Gazans’ access to water from all sources, including desalination and external Israeli sources, quickly dropped by 95 percent after October 9. The United Nations estimates that the average Gazan is living on only 3 liters of water per day for all needs—well below the United Nation’s emergency standard of 15 liters. Without energy, all five of Gaza’s wastewater treatment plants and most of its 65 sewage pumping stations were forced to shut down by mid-November. Some small desalination plants in southern Gaza may be operating at a much reduced capacity, but plants in northern Gaza are not functional. As many as 70 percent of Gazans now resort to drinking salty and contaminated water straight from wells.
The ongoing violence after October 7, 2023, further exacerbates the crisis. The Applied Research Institute in Jerusalem estimated that of 581 key water and sanitation facilities, 37 were destroyed and 226 had suspected damage by November 14. Daily bombardments restrict civilians’ ability to collect water, render farming impossible, endanger staff operating water plants, and limit circulation of water tankers.
Airstrikes and Israeli evacuation orders have driven much of the population from their homes seeking safety. Some 1.9 million Gazans—nearly 93 percent of Gaza’s population—have been displaced since Israel’s invasion. The staggering number of internally displaced people (IDPs) increases water stress in Southern Gaza, with water systems in the south ill-equipped to meet the rising demand. Constantly moving populations complicate delivery of water supplies, and the crowding in southern Gaza has led to the spread of waterborne illness and disease stemming from lack of hygiene. By November 9, humanitarian organizations warned that outbreaks of cholera and typhoid were imminent.
Israel’s control over Gaza’s borders has inhibited aid agencies’ ability to fill the gaps. When aid trucks were finally allowed to enter Gaza through the Rafah crossing on October 21, the United Nations Children’s Fund (UNICEF) delivered over 44,000 bottles of drinking water as part of the 20-truck convoy—only one day’s supply of water for 22,000. The November 24 truce temporarily allowed for the UN Relief and Works Agency for Palestine Refugees and UNICEF to supply fuel to Gaza’s main water utility, which in turn distributed it to water and sanitation facilities in the south, but aid agencies remained unable to improve access to water in the north.
The Resulting Public Health Disaster
A long-expected health crisis has now surged. Inadequate water quality and quantity can lead to decreased water consumption and associated unsafe hygiene practices related to contaminated food, hands, and utensils. By November 29, 2023the World Health Organization reported more than 75,000 documented cases of diarrhea since mid-October with children under age five accounting for around half the cases. By comparison, in 2021 and 2022, Gaza averaged 2,000 diarrhea cases a month among young children. Without access to clean water, doctors are resorting to chemical disinfectants to sterilize instruments. Coupled with the unavailability of iodine to clean wounds, hospitals struggle to provide sufficient care. Medical experts also fear the collapse of water and wastewater treatment services, together with overcrowding in hospitals, makeshift camps, and shelters, could fuel the spread of infections resistant to antimicrobial treatment.
The breakdown of Gaza’s water systems risks prolonging a deepening social and public health disaster even after the conflict ends. Before October 7, 26 percent of diseases observed in Gaza were water-related, stemming from reliance on the contaminated and brackish Coastal Aquifer Basin in conjunction with inadequate and under-resourced water services. Now, damage to sanitation infrastructure is causing untreated wastewater and sewage to overflow into the streets and the sea. Over time, wastes can leach into the groundwater supplies, polluting wells and nearby agricultural areas. Common diseases caused by contaminated water include diarrhea, viral hepatitis, liver and kidney diseases, methemoglobinemia (blue baby syndrome), and anemia. The wars in Syria, Yemen, Ukraine, and Iraq For example, the conflict in Yemen that began in 2015 damaged or destroyed critical water infrastructure. In 2016 and 2017, two devastating cholera outbreaks flared after heavy rainfalls overwhelmed compromised sewage and stormwater systems, resulting in over two million recorded cases and 3,500 related deaths. In some cases, damage to water infrastructure in conflict zones can pose greater health risks than the violence itself. UNICEF reports that during protracted conflicts, children under five are over 20 times more likely to die from diarrheal diseases linked to unsafe water and sanitation than from violence.
These health concerns do not just endanger Gaza but can travel across borders through sewage and water systems. Without functioning treatment plants in Gaza, tens of millions of gallons of raw sewage are discharged daily into the Mediterranean Sea, renewing pollution threats to the intake of desalination plants in Israel. And while prior to the current siege Gaza’s health clinics were able to detect waterborne diseases, Gaza’s overwhelmed health practitioners have limited capacity for disease containment. Were an epidemic to arise, disruption and mass displacement could spread diseases to neighboring countries, as it did in 2015, when a cholera outbreak exacerbated by instability in Iraq widened to Syria, Kuwait, and Bahrain.
Gaza’s Collapsing Water Systems and Infrastructure
Even more destructive than previous conflicts in Gaza, the current violence impairs an already brittle water sector. Years of clashes between Hamas and Israel have severely deteriorated Gaza’s water and sanitation services. The 2014 war alone caused $34 million in damage to these systems. During the May 2021 escalation, 290 water infrastructure “objects” were damaged, inflicting $10–15 million in damages. At the same time, the denial of humanitarian access and the blockade on Gaza significantly slowed repairs and restoration of water services, leaving them vulnerable to further degradation. Following the 2021 conflict, untreated sewage flowed into the streets, lakes, and sea from damaged wastewater infrastructure. With the destruction still incompletely repaired months later, severe storms in 2022 led to flash flooding worsened by damaged pipes and stormwater drains clogged with untreated waste.
Israel, worried that piping could be used to make weapons, has restricted the equipment needed to enhance Gaza’s water services. These restrictions, combined with frequent bouts of conflict and repeated destruction of critical infrastructure, have made donors wary of investing in Gaza’s water sector. By 2016, around 79 percent of the desalination plants were unlicensed, and 38 percent of the water they produced was contaminated. Such challenges forced the authorities into a reactive cycle of rebuilding damaged water infrastructure and abandoning more forward-looking plans for resilient systems, such as artificial aquifer recharge. Instead, donors and aid agencies have invested in decentralized wastewater and desalination plants, solar panels, and other dispersed facilities to mitigate the consequences of the blockade and recurrent violence.
However, according to a recent study, many of these installations have been destroyed. Humanitarian aid organizations reported to CSIS that NICEF and EU-funded desalination plant in northern Gaza that provided 10,000 cubic meters of drinkable water per day, which makes up 14 percent of Gaza’s potable water, has been damaged, as well as the beach well where the plant extracted water. The Gaza Central Wastewater Plant was also severely damaged. Opened in April 2021 with an additional solar panel field providing electricity, the facility treated the sewage of over half of Gaza’s population. The solar field, meant to increase the resilience of a blockaded Gaza, has been destroyed.
While the violence continues, many uncertainties will remain as to the conflict’s scope and long-term impact. Yet the damage to Gaza’s infrastructure will eventually need to be assessed in hopes of reconstruction and water systems will need to be restored, raising several important considerations.
Barriers to Reconstruction
Many challenges have hindered past post-conflict reconstruction efforts, including inadequate financing, import restrictions, lengthy approval processes, and difficulties ensuring that Hamas will not benefit from the aid provided. This has rendered previous recovery efforts far too slow and limited Gaza’s ability both to establish more resilient water systems and prevent the impending collapse of the Coastal Aquifer. Reconstruction efforts after Israel’s May 2021 offensive only began four months after the ceasefire, with rebuilding estimated to cost up to $485 million over the first two years. In comparison, UNICEF now calculates immediate costs of $53.4 million to meet urgent water and sanitation needs. The ultimate price of reconstruction will be colossal. One analysis estimates the cost of rebuilding decimated housing stocks alone at $3.5 billion.
Past reconstruction has primarily focused on the immediate requirements of the region, not long-term solutions. Given the persistent threat of conflict in the region, it is imperative to support resilient water systems and infrastructure that can meet the needs of civilians in times of crisis. This requires much faster and greater levels of funding, agreements enabling imports of critical supplies for essential infrastructure, and an increased focus on improving the delivery of safe water services to conflict-affected and displaced communities.
Protecting Water in Times of war
The near complete blockade on water in Gaza is unprecedented. During times of conflict, international humanitarian law prohibits attacking or destroying “objects indispensable to the survival of the civilian population,” such as water infrastructure and drinking water installations. International law also forbids depriving civilians of access to water and requires parties to conflict to allow safe passage for humanitarian relief. In Gaza, water infrastructure has been destroyed and the delivery of clean water and fuel to operate water treatment plants has also been impeded. The protection of water under international humanitarian law needs to be strengthened and upheld, and greater allowances made for the importation of critical supplies, in addition to the prioritization of long-term and resilient solutions.
Yet no solution can be achieved by Gaza or Israel in isolation. All the region’s water and wastewater sources cross into Israel, the West Bank, and Gaza alike. Both populations have an interest in tackling the crisis before it further undermines environmental and public health.
Palestinians are surrounded by sewage and garbage as summer Gaza heat continues
DEIR AL-BALAH, Gaza (AP) — Children in sandals trudge through water contaminated with sewage and scale growing mounds of garbage in Gaza’s crowded tent camps for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.
In the stifling summer heat, Palestinians say the odor and filth surrounding them is just another inescapable reality of war — like pangs of hunger or sounds of bombing.
The territory’s ability to dispose of garbage, treat sewage and deliver clean water has been virtually decimated by eight brutal months of war between Israel and Hamas. This has made grim living conditions worse and raised health risks for hundreds of thousands of people deprived of adequate shelter, food and medicine, aid groups say.
Hepatitis A cases are on the rise, and doctors fear that as warmer weather arrives, an outbreak of cholera is increasingly likely without dramatic changes to living conditions. The U.N., aid groups and local officials are scrambling to build latrines, repair water lines and bring desalination plants back online.
COGAT, the Israeli military body coordinating humanitarian aid efforts, said it’s engaging in efforts to improve the “hygiene situation.” But relief can’t come soon enough.
“Flies are in our food,” said Adel Dalloul, a 21-year-old whose family settled in a beach tent camp near the central Gaza city of Nuseirat. They wound up there after fleeing the southern city of Rafah, where they landed after leaving their northern Gaza home. “If you try to sleep, flies, insects and cockroaches are all over you.”
Over a million Palestinians had been living in hastily assembled tent camps in Rafah before Israel invaded in May. Since fleeing Rafah, many have taken shelter in even more crowded and unsanitary areas across southern and central Gaza that doctors describe as breeding grounds for disease — especially as temperatures regularly reach 90 degrees Fahrenheit (32 degrees Celsius).
“The stench in Gaza is enough to make you kind of immediately nauseous,” said Sam Rose, a director at the U.N. agency for Palestinian refugees.
Conditions are exacting an emotional toll, too.
Anwar al-Hurkali, who lives with his family in a tent camp in the central Gazan city of Deir al-Balah, said he can’t sleep for fear of scorpions and rodents. He doesn’t let his children leave their tent, he said, worrying they’ll get sick from pollution and mosquitoes.
“We cannot stand the smell of sewage,” he said. “It is killing us.”
Basic services breakdown
The U.N. estimates nearly 70% of Gaza’s water and sanitation plants have been destroyed or damaged by Israel’s heavy bombardment. That includes all five of the territory’s wastewater treatment facilities, plus water desalination plants, sewage pumping stations, wells and reservoirs.
The employees who once managed municipal water and waste systems have been displaced, and some killed, officials say. This month, an Israeli strike in Gaza City killed five government employees repairing water wells, the city said.
Despite staffing shortages and damaged equipment, some desalination plants and sewage pumps are working, but they’re hampered by lack of fuel, aid workers say.
A U.N. assessment of two Deir al-Balah tent camps found in early June that people’s daily water consumption — including drinking, washing and cooking — averaged under 2 liters (about 67 ounces), far lower than the recommended 15 liters a day.
COGAT said it’s coordinating with the UN to repair sewage facilities and Gaza’s water system. Israel has opened three water lines “pumping millions of liters daily” into Gaza, it said.
But people often wait hours in line to collect potable water from delivery trucks, hauling back to their families whatever they can carry. The scarcity means families often wash with dirty water.
This week, Dalloul said, he lined up for water from a vendor. “We discovered that it was salty, polluted, and full of germs. We found worms in the water. I had been drinking from it,” he said. “I had gastrointestinal problems and diarrhea, and my stomach hurts until this moment.”
The World Health Organization declared an outbreak of Hepatitis A that, as of early June, had led to 81,700 reported cases of jaundice — a common symptom. The disease spreads primarily when uninfected people consume water or food contaminated with fecal matter.
Because wastewater treatment plants have shut down, untreated sewage is seeping into the ground or being pumped into the Mediterranean Sea, where tides move north toward Israel.
“If there are bad water conditions and polluted groundwater in Gaza, then this is an issue for Israel,” said Rose, of the U.N. agency for Palestinian refugees. “It has in the past prompted actions by Israel to try and ameliorate the situation.”
COGAT said it’s working on “improving waste management processes” and examining proposals to establish new dumps and allow more garbage trucks into Gaza.
Where can garbage go?
Standing barefoot on a street in the Nuseirat refugee camp, 62-year-old Abu Shadi Afana compared the pile of garbage next to him to a “waterfall.” He said trucks continue to dump rubbish even though families live in tents nearby.
“There is no one to provide us with a tent, food, or drink, and on top of all of this, we live in garbage?” Afana said. Trash attracts bugs he’s never seen before in Gaza — small insects that stick to his skin. When he lies down, he said, he feels like they’re “eating his face.”
There are few other places for the garbage to go. When Israel’s military took control of a 1-kilometer (0.6-mile) buffer zone along its border with Gaza, two main landfills east of the cities of Khan Younis and Gaza City became off-limits.
In their absence, informal landfills have developed. Displaced Palestinians running out of areas to shelter say they’ve had little choice but to pitch tents near trash piles.
Satellite images from Planet Labs analyzed by The Associated Press show that an informal landfill in Khan Younis that sprung up after Oct. 7 appears to have doubled in length since January. Since the Rafah evacuation, a tent city has sprung up around the landfill, with Palestinians living between piles of garbage.
Cholera fears
Doctors in Gaza fear cholera may be on the horizon.
“The crowded conditions, the lack of water, the heat, the poor sanitation — these are the preconditions of cholera,” said Joanne Perry, a doctor working in southern Gaza with Doctors Without Borders.
Most patients have illnesses or infections caused by poor sanitation, she said. Scabies, gastrointestinal illnesses and rashes are common. Over 485,000 diarrhea cases have been reported since the war’s start, WHO says.
“When we go to the hospital to ask for medicine for diarrhea, they tell us it is not available, and I go to buy it outside the hospital,” al-Hurkali said. “But where do I get the money?”
COGAT says it’s coordinating delivery of vaccines and medical supplies and is in daily contact with Gaza health officials. COGAT is “unaware of any authentic, verified report of unusual illnesses other than viral illnesses,” it said.
With efforts stalled to broker a cease-fire between Israel and Hamas, Dalloul says he’s lost hope that help is on the way.
“I am 21 years old. I am supposed to start my life,” he said. “Now I just live in front of the garbage.”
Frankel reported from Jerusalem. AP journalists Jack Jeffery in Ramallah, West Bank, and Michael Biesecker in Washington contributed to this report.
The fate of children, the elderly, and the disabled in the war against Gaza.
According to Human Rights Watch, the recent war against the Palestinian masses has left more than 41,000 dead (46,376 by the end of December 2024), more than 16,750 of whom are children, and thousands of thousands disabled, with a large proportion of them children and adolescents. As of last September, there are about 95,500 war-wounded people among the missing, more than 22,500 of whom are permanently disabled according to World Health Organization statistics. According to UNICEF, thousands of these injured are children who have lost one or two limbs. At the end of 2023, the UN Secretary-General published the annual “List of Shame,” an annual report on armed conflict and child casualties, and added Israel to the list for the first time. According to the report, Israel committed 5,698 horrific attacks in 2023 that killed and maimed children, including attacks on schools and hospitals. The last major medical center in Gaza, Kamal Adwan Hospital, was set on fire by Israel on Friday, December 27, 2024. Humanitarian organizations considered it a systematic destruction of hospitals and medical centers. Isn’t this genocide? The World Health Organization had recognized this hospital as the last major medical center in northern Gaza. Al Jazeera has prepared a shocking report on the evacuation and bombing of this hospital.
About 1.9 million people, or 90 percent of the population of Gaza, have been displaced or made homeless (according to Human Rights Watch). This homelessness has had a double and more frightening impact on disabled or handicapped children, the elderly, and other physically disabled Palestinians, which also include children, because this group of the population has difficulty leaving their residential area and moving around in general. Especially since such children need special equipment, food, and various daily medications. These problems have been exacerbated by Israel’s prevention of medical and food aid from reaching them to an unbelievable extent. According to the report, these children are more vulnerable to physical attacks by Israeli military forces, and when Israel gives the people of Gaza effective or ineffective warnings and short notice before bombing, the disabled are more affected than others. Handicapped children or those with serious illnesses have suffered a lot due to the long absence of the equipment and medications they need. Let’s not forget that all the surviving children in this war were also psychologically damaged, but disabled children have been more traumatized than other children for many reasons.
It should be noted that out of the 1.9 million war refugees, one million are children, of whom at least 19,000 have lost their parents and entire families and are completely homeless. The Israeli government is preventing the refugees from receiving food, medicine and other aid, and according to Human Rights Watch, 38 people have died of hunger as of September 2024, most of whom are children. In June, UNICEF reported that 3,000 Palestinian children are at risk of dying from hunger. Israel is using starvation and dehydration as a tactic of war, which is also prohibited under international law.
If the journalists had survived and reported the news from Gaza to the outside world, a great tragedy of humanity would have been recorded. One of the millions of events during the Nazi era and World War II is a true story that Albert Camus also told in his speech when he came to New York, the story of a mother who was forced by the Nazis to choose between her two sons to not be executed or to execute the other. Imagine the mental hell that mother would live in after making this decision for the rest of her life! Every moment, a new incident like this happens in Gaza that is often not reported anywhere, including the story of a pregnant mother named Reem Ajour who, on the orders of Israeli soldiers, left her wounded husband and four-year-old daughter at home and was expelled from her home with her son on the orders and threats of Israeli soldiers, after which their house was blown up.
It should not be forgotten that 2.3 million people in Gaza lived in the most densely populated part of the world in an area measuring 25 by 7.4 kilometers, an open prison closed to the world on all sides. Now Gaza is completely unlivable and there is a famine in northern Gaza, which Israel does not allow the UN to deliver food and other basic necessities. Of course, this displacement and expulsion of the people of Gaza and to the north, and then bombing even the north, is because Israel is trying to expel all the Palestinians living in Gaza from its territory if it can and supposedly send them to Egypt and other countries. Although Egypt has not accepted the migration of even a percentage of the people of Gaza due to its economic situation, it can be predicted that Egypt will be forced to do this by taking a budget and perhaps with a threat in the future. “According to the testimony of history, every five- or six-years Israel launches a series of attacks on the Palestinians under the pretext of reminding them who has authority, this is called mowing the lawn.” Taken from the words of prominent professor and researcher at the University of Chicago, Professor John Mearsheimer.
According to Amnesty International. First of all, we must shed light on the courts, the existing legal authorities of the world, the United Nations, the nature of the civil and social institutions of every country, including the most democratic societies. For the lovers of the ostentatious adornment and decoration of capitalism, all of these are the achievements of the stormy struggles of the masses!! A community that never attributes any value or role to any worker, as soon as it encounters the name of these shrines, forges a mountain of memoirs to connect them to the struggles of the downtrodden!! There is also the opposite of this orientation, some are content with saying that all of these institutions are formalities, they are not the source of goodness, but what is the reality? What do workers need to know? The answer can be summarized in a few points. Whatever institution, authority, court, convention, union, center exists in the world, in the political structure of every country, in the sphere of official international relations, has finally been created and has gained credibility with the agreement of governments.
There is no doubt about this. The question is, why have governments, the capitalist class of the world, or any country, seen themselves obliged to build or accept these shrines in order to solve which problem, to confront which internal problem of their class, in response to which protest of the rebellious and exploited masses, to satisfy which need of capitalist octopus’ relations? This is an important point that must be explored. Capitalism is a volcano of exploitation, separating the vast majority of the earth’s inhabitants from work, the fruits of work, removing them from involvement in determining the fate of work, life, the originator of all forms of oppression, injustice, brutality, genocide, war, apartheid, Holocaust. This system, by its very nature, is full of explosive contradictions. On the one hand, it is the target of violence, struggle, uprising, revolution of the working masses. On the other hand, it is a quagmire of war and conflicts, competition, disputes between different sections of the ruling and opposition bourgeoisie over the distribution of shares of profit, property, power. After the second imperialist war, in order to eliminate the rebellious threat of the global labour movement, resolve the internal conflicts of the world bourgeoisie, and consolidate the foundations of the hegemony of the dominant pole, the United Nations engineered a vast network and subsidiary institutions. It created and fielded the High Commissioner for Refugees, the Commissioner for Human Rights, UNICEF, the Women’s Rights Commission, the Hague Criminal Court, etc. Let us clarify again, there is no doubt that capitalism has established many of these under the pressure of the workers’ campaign. What is being consciously or unconsciously hidden is that the capitalist class and the capitalist state did not create these to solve the problem of the working masses or reduce the pressure of worker exploitation!! Capitalism has consented to the architecture, the establishment of these institutions, the conclusion of these conventions, in order to remove from itself the danger of revolts, uprisings, and struggles of the discontented masses, to extinguish these raging struggles. So that the workers will fall in love with these institutions, consider them miraculous, and abandon their history-making organization against the Soviet power. These have emerged under the pressure of the wave of our struggles, but they play the role of a bulwark of the bourgeoisie in confronting our campaigns and a weapon of capital to suppress our anti-capitalist class struggle. Apart from statesmen and capitalism’s mercenary intellectuals, no fair person free from capitalist brainwashing has any doubts that the criminal attack on Gaza and the massacre of many children in this country was carried out completely and totally by the Netanyahu government and with very shameless support of the United States: s government and its west allied powers. For our part, as always, we ask all workers in the world to campaign against the genocides of the rulers of Israel, America, Germany, England, France in Gaza, the West Bank or elsewhere. Capitalism’s power to kill and oppress and create annihilation must be answered with a united labour movement and international liberation force. The great cursed inhabitants of Gaza and all of Palestine are part of the working class of the world. For 75 years, Israel and predatory capitalist governments have aimed for genocide and annihilation. The release of these people is an urgent and unavoidable issue for the international labour movement, and we, as a cell of this movement, call with the loudest voice to all chained people around the world to stand up against these genocides, holocausts and the holocaust. Stop the wheel of work and production from turning. Stop the cycle of reproduction of global capital. Exercise power and order the liberation of the Palestinian workers as a link in the international chain of the human liberation struggle with the great history-making power.
https://www.csis.org/analysis/siege-gazas-water
War wounds caused by explosive weapons in Gaza: data from a 2024 study by Médecins Sans Frontières
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01531-4/fulltext?
As of July 23, 2025, Israel’s military assault on Gaza has killed over 59 219 Palestinians, wounded an additional 143 045, and displaced nearly all of the 2·1 million people who live there.1 Triangulation and modelling of different data sources estimate even higher mortality estimates.2,3 As of July 31, 2025, almost no humanitarian aid has been allowed to enter Gaza since March 2, 2025—with a total blockade of humanitarian aid from March 2 to May 19, 2025. The state of Israel has resumed using explosive weapons in its attacks on Gaza and its people since breaking the ceasefire agreement on March 18, 2025.4
Following the attacks carried out by Hamas and other armed militant groups on Oct 7, 2023, in which approximately 1200 people were killed and 251 people taken hostage,4 Israeli forces have responded by exerting collective punishment that is perpetuating a campaign consistent with patterns of genocide.5 In a report published by Médecins Sans Frontières (MSF) in December, 2024, we describe how the violence unleashed by the Israeli forces has caused physical and mental damage on a scale that would overwhelm even the best functioning health systems in the world, let alone one already decimated by a continuous offensive and a blockade that has been in place for decades.4,6
In this Correspondence, building on the December, 2024 report,6 we present descriptive results from routinely collected medical data from six of the MSF Operational Centre Brussels supported health facilities in Gaza (Al Aqsa Hospital, Al Mawasi Primary Healthcare Centre [PHC], Al Najar Hospital, Deir el Balah PHC, Khan Younis PHC, and MSF Field Hospital) from Jan 1 to Dec 31, 2024. Routine medical data were collected under tremendously challenging conditions, including the frequent displacement of patients and health-care staff, widespread destruction of medical and data infrastructure, and limited access to electricity to support digital infrastructure and paper to print tally sheets and patient files. Data were collected in a central database originating from different sources (digital and paper) and encoded at a health-facility level. Standard clinical case definitions based on MSF and the Gaza Ministry of Health medical guidelines were used that adhere to international classifications.
In 2024, 207 942 general outpatient department (OPD) consultations were conducted. MSF also supported other health-care services such as operating theatres, emergency rooms, mental health, and antenatal care. 114 368 (55·0%) OPD consultations were for women and 41 588 (20·0%) were for children younger than 5 years. Wound care accounted for 44·8% of all consultations (93 254 of 207 942) which were conducted for 22 637 patients across included health facilities. Almost a third of wound care-related consultations were for women (29 841 [32·0%]) and 27 655 (29.7%) were for children younger than 15 years, of which 9179 (9·8%) were for children younger than 5 years. Violent trauma, including physical violence and directly targeted violence against a person or group of people, presented in nearly half of wound care-related consultations (39 700 [42·6%]; range 13–66% across facilities; table). The remaining wound care-related conditions were injuries due to unsafe living conditions, domestic-related accidents, and road-related accidents.
“The Democracy Camp and Israel’s Right to Self-Defense”
Israel is allowed to maintain hundreds of official settlements and 1,000 Israeli settlements in the area where the Palestinians live. Every breath of protest from any Palestinian child against this crime is terrorism!! It must be choked!! Because “Israel has the right to defend itself”.
Israel has the right to transfer 450,000 of its residents to the West Bank. Every angry look from any old Palestinian woman at this heinous crime is absolute terrorism!! It is an example of violating Israel’s security and the person who looks at it must be shot!! Because “Israel has the right to defend itself”.
Israel is free to bulldoze the residential areas of Palestinian workers and build dozens of Israeli settlements in their place. Every painful voice from any Palestinian resident against this barbaric crime is terrorism!! And it must be answered with a bullet!! Because Israel has the right to defend itself”.
Israel has the full right to settle a number of ultra-Orthodox Jews among the 200,000 Palestinian residents of Hebron. Give each of these uninvited guests a mission to bombard every Palestinian with abuse, insults, humiliation, beatings, garbage, filth, and spit, repeating all these inhumanities moment by moment, and in doing so, they have the support of thousands of armed forces of the Israeli army everywhere. Any Palestinian who protests this intolerable brutality is a terrorist and deserves severe punishment because “Israel has the right to defend itself”!!
Israel is allowed to push and move its border wall 25 kilometers into the West Bank. Any protest against this aggression is a clear example of terrorism and deserves to be shot!! Because “Israel has the right to defend itself”
Israel has the right to prevent the Palestinian working masses from any form of access to the abundant resources of the “Dead Sea” and to respond to any protest against this crime with devastating bombs!! Because “Israel has the right to defend itself”
Israel has the right to reduce the maritime border of Gaza with the Mediterranean from 12 miles to 6 and then 3 miles and continue this reduction. It prevents the Palestinian working population from fishing and delivering a bite of food to their hungry children, calling any voice opposing this crime terrorism and crushing it!! Because “Israel has the right to defend itself”
Israel has the right to destroy the Gaza Strip and the West Bank on the heads of its inhabitants. It burns the fruits of the work of successive generations of Palestinian workers, bomb millions of women and children without interruption. It takes over 100 thousand Palestinians captive in a Holocaust and massacres!! Because “Israel has the right to defend itself”.
Israel is completely free to make tens of thousands of Palestinian children prey to phosphorus bombs and burn them to ashes in the fire of its wrath. Any compassion for these children is called terrorism!! Because “Israel has the right to defend itself”
Israel is free to cut off water and electricity to millions of Palestinians, to block the access of every Palestinian resident to any amount of food, fuel, any form of basic necessities of life because “Israel has the right to defend itself”.
Israel is right to drop thousands of bombs on every hospital, every Palestinian refugee camp. To crush hospitals for days and weeks in a row and make them prey to fire. To kill all the patients, refugees. To hand over a large population of newborns to the death squad!! Because “Israel has the right to defend itself”
The democracy camp considers all the genocides, holocausts and above barbarities to be the inalienable right of the ruling beast of Israel because in the encyclopedia of this camp “Israel has the right to defend itself”
Israel has the right and full authority to use its Jewish ultra-Orthodox to spread racist hatred among Jewish students and teenagers and to repeat all these inhumanities moment by moment, and in all these cases it has the full support of the democracy camp from Biden to Schultz and company, from Giorgio Melanie to Rishi Sunak and Macron. What is the difference between singing the song “We will destroy all the Palestinians in Gaza and return safely” among Israeli children and teenagers and what Adolf Eichmann promoted with the aim of eugenics among the SS youth!?
A summary of the crime in the past 22 months of the criminal regime of Israel with the support of the United States and all European countries (the democracy camp), the silence of all Arab countries against the Palestinians. This is just a corner of the crimes of global capital against humanity. The democracy camp considers all the above genocides, holocausts, and barbarities to be the inalienable right of the ruling brute Israel because, in this camp’s encyclopedia, “Israel has the right to defend itself.”
For the democracy camp and the entire global capitalism, history begins on October 7, 2023. What happened on October 7, which led to a devastating war, should not be seen as a coincidence: “The October 7 operation did not happen in a vacuum. It was the result of 75 years of military occupation of Palestine by Israel, which is the longest occupation in modern history.”
Hassan Abbasi August 2025