Gaza’s sanitation crisis spreads disease

In a vast tent camp in Gaza, Israeli bombs fall so close that you can hear and feel them. But daily life is also a battle against hunger, cold and a growing sanitary crisis.

A lack of sufficient toilets and clean water, as well as open sewage, are issues that displaced Palestinians have struggled with since the early days of Israel’s assault on Gaza.

For two months after Salwa al-Masri, 75, and her family fled to the town of Rafah, at the southern tip of Gaza, to escape Israel’s military offensive, she said she would walk 200 meters to the nearest bathroom reach. If she was lucky, younger women in line would give her a head start. Other times, she might wait an hour to use a dirty toilet she shared with thousands of other people.

“It’s terrible,” Ms al-Masri said recently via WhatsApp from her family’s dilapidated tent, which they had made from wood and plastic sheeting. “I wouldn’t drink water. I would stay thirsty so I wouldn’t have to go to the bathroom. I stopped drinking coffee and tea.”

Many other Gazans, already facing hunger and thirst as a result of Israel’s more than four-month siege of the area, say they too have tried to cut back even more on food and drink to avoid an uncomfortable and unsanitary visit avoid the toilet. .

Recently, Ms al-Masri’s son and other relatives bought a concrete toilet bowl and dug a hole behind their tent, where sewage collects. It’s a closer bathroom and one she shares with fewer people.

But the challenges of obtaining water for washing and the backing up of sewage threaten their health, and the stench of sewage fills their makeshift encampment.

Last month, the World Health Organization reported that cases of hepatitis A had been confirmed in Gaza. It also said that there were several thousand people with jaundice, which is caused, among other things, by hepatitis A. Cases of diarrhea among children has also skyrocketed. According to UNICEF, this is all linked to poor sanitation.

“The inhumane living conditions – hardly any clean water, clean toilets and the ability to keep the environment clean – will allow hepatitis A to spread further,” said WHO Director-General Tedros Adhanom Ghebreyesus. wrote on social media at the time “and highlight how explosively dangerous the environment is for the spread of disease.”

Prominent epidemiologists estimate that an escalation of the war in Gaza could cause up to 85,000 Palestinian deaths from injuries, illness and lack of medical care over the next six months, in addition to the nearly 30,000 reported by local authorities since early October. Their estimate represents “excess deaths” that would not have been expected without the war.

Schools, hospitals, mosques and churches have become crowded shelters for Palestinians seeking safety from Israeli airstrikes. The few available bathrooms have to be shared with hundreds or thousands of people who sometimes wait in line for hours to use them.

Israel’s bombardment of Gaza and its associated ground offensive have pushed Palestinians further south into the overcrowded corner of Gaza around Rafah, forcing them to set up makeshift tents. As a result, access to bathrooms and sanitation has only worsened.

About 1.5 million displaced Palestinians are now in Rafah – more than half of Gaza’s total population of around 2.2 million – as Israel threatens to invade the area.

Following the Hamas-led attacks on Israel on October 7, Israel’s near-total siege of Gaza has prevented most things from entering the area, causing dire shortages of food, water and medicine. In addition, representatives from both UNICEF and the Palestinian Red Crescent said their organizations have tried to bring in portable toilets and materials to build sanitary facilities, but Israeli authorities have prevented this.

“It’s a public health problem,” said Abrassac Kamara, UNICEF manager of the Palestine WASH program, which helps provide safe water and sanitation. “But the second thing is just dignity. It is something we take for granted, but it is actually the way we deprive people of their dignity.”

Israel’s Civil Administration, the bureaucratic arm of its military in the occupied West Bank and Gaza, said restrictions on certain goods entering Gaza prevented the entry of items that could also be used for military purposes.

Hamas “exploits civilian resources to strengthen itself militarily, at the expense of caring for the civilian population,” the civilian administration said, without explaining how portable bathrooms could meet military needs.

UNICEF officials said they have had to resort to building toilets out of wood, concrete and plastic sheeting – materials already available in Gaza – often at great cost. The agency plans to create 500 such toilets in Rafah to help ease traffic congestion.

“Right now, anything considered a building material – mostly metal, but also sandwich panels, nails, rebar – is all banned,” Mr Kamara said. “We’ll make do with it.”

UNICEF planned to build another 500 toilets in the town of Khan Younis in southern Gaza, but had to abandon these efforts when Israel’s ground offensive recently entered the area.

“They will literally put up any kind of privacy protection – plastic on the back of the tent – ​​and just dig and bury when they need to relieve themselves,” Mr Kamara said. “We are back to basic hygiene: digging a hole and covering it.”

In a video Posting on Instagram last month, Bisan Owda, a journalist and documentary filmmaker from Gaza, captured the daily struggle to find a latrine. As she walked past tents on the street with a large jug of water in her hand, she talked about her challenges.

“This is my daily routine,” she said, “almost a 20 to 25 minute walk to reach a bathroom – basically struggling to reach a bathroom.”

Other women have complained about a desperate lack of sanitary pads in the area, and at least one of them told The New York Times that she started taking birth control pills to stop her periods altogether.

Sana Kabariti, 33, a pharmacist from Gaza City, in the north, said she fled with her family to the city of Nuseirat, in central Gaza, as Israeli bombs rained down on their neighborhood in the first few days of the war . She and about 40 members of her extended family, including 10 children, were confined to a small room and shared one bathroom, she said. But there was no water and no toilet paper.

So despite the dangers they returned to their homes.

“As for the toilet, there was no water,” she said. “And this led to the families that were with us returning to Gaza City, and to the danger, because they could not cope with the lack of water and the lack of toilet paper.”

Eventually, the bombings in Gaza City became so intense that she and her family had to flee again. They moved south, first to the city of Deir al Balah and finally to Rafah.

They are better off than many in Rafah because they seek shelter in a room in a house shared with many. But the bathroom is small and they have to make a trip every day to get water to wash and keep the bathroom clean. Showering is a luxury they can rarely afford.

They don’t use toilet paper. Even if they can find it on the market, the price is exorbitant: the Israeli siege has driven up the cost of the few goods still available in Gaza.

Instead, the family cuts scraps of fabric to use, Ms. Kabariti said.

“There are a lot of people who don’t want to go to the toilet more than once a day,” she says.

In her neighborhood, she said she met an older woman who refused to use the bathroom at the center where she was sheltering because it was so dirty and unsanitary. Instead, the neighbors allowed her to use their bathroom.

But because she doesn’t want to impose it, she only uses it once a day – right after sunrise, when she has said her morning prayer. Then she holds out until the next morning.

“After almost four months, I don’t know how long someone’s body can continue like this,” Ms. Kabariti said.

Abu Bakr Bashir reporting contributed.