How Israel's war intensified Gaza's water and public health crises

Although Gaza's water crisis predated Israel's current war, the last ten months have worsened the situation to unprecedented levels.

"Prior to the 7th of October… in Gaza, people got 83 litres per person per day; their neighbours (Israel) enjoyed 250 litres per person per day," Lama Abdul Samad, a water and sanitisation specialist at Oxfam, said during a panel organised by the Center for Strategic and International Studies (CSIS) on Friday.

Fast-forward to post-7th of October, "Water availability to the population is less than 5 litres per person per day. That is a small amount of water, a severe reduction from what it used to be… That water is the quantity of a toilet flush. That's what people have to drink, cook, bathe and do everything."

She noted that the reason for that was Israel's decision on the 9th of October, 2023, to cut off fuel, electricity, and food from Gaza.

"That resulted in a massive reduction of water. No more than 20 percent of the capacity of the Macarot lines were supplied over those seven months (until the end of May)," she said, adding that the amount of water available is also not clean.

She also highlighted that essential water infrastructure—such as reservoirs, desalination units, and other facilities—has been destroyed by Israel. Despite these sites being deconflicted and their GPS coordinates provided to Israel, northern Gaza and Gaza City now face an acute shortage of water production.

Israel's imposed restrictions on entries of supplies to Gaza also played a role in escalating the crisis. Abdul Samad said that some of their supplies and units have been at the border for six months and never made it to the enclave despite being partially cleared.

"Even when the ceasefire is achieved… it wouldn't be irrational if we thought that people would continue to die due to public health risks," she said.

Public health ramifications

It's worth noting that Israel's carnage in Gaza not only escalated the water crisis, but also caused a widespread of diseases, including the recently discovered Poliovirus.

"Unavailability or access to clean water is extremely favourable for Polio viral transmission," Hamid Jafari, Director of Polio Eradication Operations and Research at the World Health Organization, said during the panel.

"When you put together the overcrowding, the internal displacement, lack of access to clean water for handwashing, toilet hygiene, personal hygiene, and constant exposure to sewage, this is as bad as it can get," Jafari added.

Poliovirus is a life-threatening disease that can affect the brain and the spinal cord, and it can sometimes cause paralysis or even death.

Jafari stated that the primary challenge ahead is for health workers to actively search for cases of paralytic polio exacerbated by the conflict. She emphasised the need for an alternative strategy to effectively carry out these crucial searches.

"That would, of course, require — ideally — peace. If not peace, at least, from what the programme has experienced in other countries, historically of days of tranquillity, when there is a cessation of hostilities, so that children can be vaccinated," he said.

What needs to be done?

While all panellists agreed on the necessity of a ceasefire, Natasha Hall, Senior Fellow with the Middle East Program at CSIS, urged the US policymakers to understand the "tectonic plates that are shifting."

"If the United States is seen as not doing enough to stop a lot of the horrific and humanitarian catastrophe that we've been witnessing over the past nearly ten months, this will be used by US adversaries for the foreseeable future. They will exploit this trauma, and they will have audiences for it," Hall said.

"Certainly, even US allies will use this as example for the US having to support them, no matter what kind of human rights violations or suspected war crimes they commit… I think there are larger strategic ramifications if something isn't done over the long term for Palestinians."

Michelle Strucke, director for the Humanitarian Agenda and the Human Rights Initiative at CSIS, said that regional leaders need to cooperate to fix the contaminated water crisis — from a place of self-interest — as it wouldn't only affect Palestinians, but could also affect neighbouring countries, including Israel.

She echoed Hall's sentiment, urging US policymakers to take a firm stand and set clear boundaries.

"These are choices. War doesn't have to be fought this way. And these are policy choices that they should be able to put pressure on, to intervene and draw lines to say when this is just unacceptable," Strucke said.