The war in Gaza is creating a health crisis that will span decades

The situation in Gaza is rapidly evolving into the worst humanitarian crisis in modern memory, and international health organizations have no long-term plan to address the territory’s post-war needs.

More than three-quarters of Gaza’s 2.2 million residents, half of whom are children, are internally displaced, trapped in one of the world’s most densely populated areas with minimal access to food, water or health care. Since Hamas militants from Gaza invaded Israel on October 7 and killed more than 1,000 civilians, Israel has conducted heavy bombing of the enclave, hampering the flow of humanitarian aid and destroying civilian infrastructure. According to the United Nations, more than 30,000 Palestinians have been killed in the Gaza Strip, mostly women and children, and more than 72,000 have been injured.

However, these numbers only mark the beginning of the public health disaster. Those who survive the war face lifelong health effects. Thousands of Palestinians will face missing limbs, compromised immunity, mental illness and other chronic conditions. Meeting their health needs will be a decades-long task that global aid organizations have not adequately planned for.

The World Health Organization, World Food Program, UNICEF, Palestinian Red Crescent Society, CARE and Médecins Sans Frontières all lack specific long-term plans to address Gaza’s health needs, according to information shared by the organizations. new scientists. Save the Children and the International Committee of the Red Cross did not respond to questions about their long-term plans.

unprecedented humanitarian disaster

The lack of planning for health care needs in the coming decades is partly due to the severity of the current humanitarian crisis. Most people in Gaza live in crowded conditions with no sewage treatment or garbage removal. On average, people have less than 1 liter of clean water per day. As a result, infectious diseases are rampant.

A survey of a limited number of shelters in December and January found that at least 90% of children Among children under 5 years of age who have one or more infectious diseases, 70% have had diarrhea in the past two weeks. “This does not take into account the hundreds of thousands of people who are not in refugee shelters,” said Margaret Harris in the World Health Organization.

Hunger is also common. Nearly two-thirds of households live on just one meal a day, and a quarter of the population faces looming hunger and extreme malnutrition. Surveys show the situation is most dire in northern Gaza, with one in six children suffering from malnutrition.The Gaza Ministry of Health reported on March 7 that including 15 children, died of malnutrition and dehydration. Poor monitoring means these numbers are likely much higher.

“The problem with malnutrition in children is that it leads to more disease,” said Tanya Haji-Hasan of Médecins Sans Frontières. Malnourished children are more susceptible to infections, which can wear down the lining of the intestines, making them Difficulty absorbing nutrients. “So they become more malnourished, they become more immunocompromised, and it creates a vicious cycle that essentially snowballs to death,” she said.

The bombing made much of the area unsafe.UNICEF found that as of December, more than 1000 children They have lost one or both legs since the conflict began – on average more than 10 children lose a leg every day. There are few options for caring for these injured: as of February 21, only 18 of Gaza’s 40 hospitals were still operating at reduced capacity. “They don’t have drugs. They don’t have machines. They don’t have power. They may have a couple of doctors who run emergency rooms. So, there’s really no functioning health system.” selena victor Humanitarian organization Mercy Corps is delivering emergency food in Gaza.

The overwhelming humanitarian crisis has put health organizations in a difficult position. “Never in modern history have we seen this level of violence, terror, fear and deprivation inflicted on any population,” Harris said. “In a sense, we are charting uncharted territory.”

Gaza’s looming public health crisis

Even if the war ended tomorrow, survivors would face lifelong health consequences. Many people will have physical disabilities. Others will suffer from severe mental illness. Harris said some people may develop chronic lung disease, heart disease and cancer from chemical contaminants in bombs and destroyed buildings.

For children, the effects are most severe. Sustained malnutrition early in life can stunt growth and impair brain development, leading to cognitive, memory, motor function and intellectual deficits, Haji-Hasan said. It can also weaken children’s immune systems, making them susceptible to illness. Research shows that poor nutrition during pregnancy increases the baby’s risk of obesity, high blood pressure, heart disease and type 2 diabetes. A February report The international aid group Project Hope found that one in five pregnant women treated in Gaza clinics was malnourished, as were one in 10 children there.

However, Harris said the most widespread harm would be the impact on mental health. “Imagine what it must be like for the people who are relentlessly going through this every day. They have a terrible sense of uncertainty – not knowing where they are going, what will happen next, where the next bit of food will come from, “she says. Such traumatic experiences are associated with depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal thoughts. In children, such trauma can disrupt brain and organ development and increase the risk of learning disabilities and mental health problems. Without early intervention, these problems may persist into adulthood. “We are going to see a huge burden of mental illness and it will be extremely difficult to deal with,” Harris said.

Adults who experienced childhood adversity also have 12 times risk Develop alcohol and drug abuse disorders and attempt suicide. They are also more likely to have physical health problems, such as heart disease or cancer. Young people who survive conflict are almost three times more likely to develop serious mental disorders, such as psychosis, than those who have not experienced war.

Current post-war plans are not enough

Given these consequences, a long-term health plan for Gaza must be developed. Such plans must address rebuilding infrastructure, developing mental and physical rehabilitation programs, and conducting regular disease screenings.

“It seems ridiculous to talk about what municipalities will look like when people are struggling to get a handful of bread for their families. It just won’t calculate,” Victor said. “But we need to think about it.”

However, most organizations are just beginning to do so. The few institutions that have made agreements – including the Palestinian Red Crescent Society and CARE International – will solve the problem in the next year or two, but not decades from now. The World Health Organization is developing plans to meet health needs from April 2024 to the end of the year. “We’re dealing with a few different scenarios. The best-case scenario is a ceasefire, which helps us really think about (long-term planning),” Harris said. Another possibility is that the war continues.

This uncertainty, coupled with the looming question of who will govern Gaza after the conflict, makes preparations for the future extremely difficult. “Why we desperately want to see not just a ceasefire but a peaceful resolution is because until we have a ceasefire, any plans, even anything that we consider, is just pie in the sky,” Harris said.

Israel restricts aid organizations’ access to the area, leaving Gaza’s few workers unable to operate safely. “Half the time they can’t do anything. They can’t move around safely. Basic functions like communication are constantly being shut down,” Victor said. Many of them have passed away.For example, a 29-year-old member of the World Health Organization’s limb reconstruction team in Gaza named Dima Abdullatif Mohamed AlhajiHarris said she was killed in an Israeli airstrike along with her 6-month-old baby, two brothers and husband.

These dangers and obstacles complicate long-term planning. “You can make any plan you like, but if you don’t know what the needs are, you’re not going to make a very useful plan,” Victor said.