Illness caused by water pollution is a leading cause of child mortality in the Gaza Strip, says a study by the RAND Corporation, a copy of which was obtained by Haaretz.

The study shows that water pollution accounts for more than a quarter of illnesses in Gaza and that more than 12 percent of child deaths up until four years ago was linked to gastrointestinal disorders due to water pollution. Since that time these numbers have continued to grow.

Open gallery view

The collapse of water infrastructure has led to a sharp rise in germs and viruses such as rotavirus, cholera and salmonella, the report says.

The data appear in a study by Dr. Shira Efron, a special adviser on Israel and policy researcher at RAND’s Center for Middle East Public Policy; Dr. Jordan Fishbach, co-director of the Water and Climate Resilience Center at RAND; and Dr. Melinda Moore, a senior physician, policy researcher and associate director of the Population Health Program at RAND.

The researchers based their study on previous cases in the world in which wars and instability created a water crisis and hurt infrastructure, such as in Iraq and Yemen, where mortality has been on the rise and other health problems have surfaced. In the period studied, they collected material from various officials in Gaza, the Palestinian Authority, Israel, Jordan and Egypt.

Open gallery view The emergency department at Shifa Hospital, the largest medical facility in Gaza, March 29, 2017. Credit: MOHAMMED SALEM/REUTERS

The RAND Corporation is an apolitical American non-profit that advises governments and international organizations on formulating public policy.

Gaza’s water crisis dates back more than a few years. The Israeli company Mekorot began supplying water to the territory in the 1980s. But since Hamas’ rise to power and the disengagement from Gaza in 2005, and the repetitive fighting since Operation Cast Lead at the turn of 2009 have significantly worsened the situation.

Today 97 percent of drinking water in the Strip is not drinkable by any recognized international standard. Some 90 percent of residents drink water from private purifiers, because the larger installations have been damaged by fighting or have fallen into disuse since they couldn’t be maintained. The current situation, according to the study, is that Gaza is incapable of supplying enough water for its 2 million inhabitants.

The study shows Gaza schools have one toilet per 75 pupils and one sink for washing hands per 80. Most of this water is either recycled or from a reservoir. As a result, the very presence of children in these schools puts them at risk of contracting gastrointestinal diseases. Schools, public buildings and hospitals are only cleaned when necessary in order to conserve water. Hospital staff only wash their hands when it’s essential and not on a regular basis when going from one patient to another, in order to conserve the water for life-saving treatment.

The researchers estimate that within two years, even the isolated sources of water used today will cease to operate without proper maintenance.

Open gallery view A Palestinian man sells drinking water in Khan Younis refugee camp, southern Gaza Strip, April 16, 2016 Credit: AP / Khalil Hamra

“To think that all this is taking place beyond the fences of a water power such as Israel in inconceivable,” Efron says.

The average cost of water use per capita in the West is 0.7 percent of monthly wages, according to the report. In Gaza, a third of monthly wages goes toward the purchase of water. Since unemployment is greater than 57 percent, many residents cannot afford to spend such an amount on water. The few wealthier people in Gaza can purchase bottled mineral water, but most Gaza residents must suffice with the one day a week that the authorities turn on the taps for a few hours.

Another factor in the rise of Gaza’s morbidity is the poor condition of its infrastructure. Sewage, water and electricity infrastructure have been damaged severely in the continual fighting with Israel, particularly in 2014’s Operation Protective Edge, such that hardly any sewage treatment installations remain to purify water before it is dumped into the sea or used for irrigation. Gaza residents collect water independently in their own improvised containers, such as barrels or drains, in order to drain sewage from their homes onto the streets. Funds provided for purifiers by donor nations were given to set them up but not maintain them so that this infrastructure, so vital to the health of Israeli and Gazan residents, has been standing idle like monuments for years.

Efron, who led the research, says the amount of sewage water flowing from Gaza into the sea toward Israel and Egypt on a daily basis equals the contents of 43 Olympic-size swimming pools. She cites it as a key reason that Gaza residents should avoid entering the sea.

A potential humanitarian disaster

Despite the high risk for a cholera outbreak in Gaza due to the polluted sewage system, researchers at first estimated it wasn’t possible to determine when and if such an epidemic would occur, since the residents are immunized. But a short time before they published their findings, the Trump administration announced a halt to funding for UNRWA, reversing these conclusions. UNRWA (United Nations Relief and Works Agency for Palestinian Refugees in the Near East), regularly inoculates 1.3 million residents of Gaza and gets 4 million doctors’ visits in the territory. Efron said that without a proper alternative to UNRWA’s health aid, it’s only a matter of time before an epidemic occurs.

Open gallery view FILE PHOTO: Sewage flows from an outlet into the sea in front of Shati refugee camp in Gaza City, April 12, 2016 Credit: Khalil Hamra / AP

“It may reach the level of a humanitarian disaster,” she said.

In their report, the researchers recommend the urgent establishment of a joint team of Israeli, Egyptian, and Palestinian Authority officials to prepare for the possible outbreak of an epidemic.

They said that while global discourse is focused on difficult illnesses and their long-term ramifications, the real urgency is to deal with infectious disease caused by drinking water and sewage.

“They must think about immediate-term solutions that could stabilize the situation. To think that it will stay on the other side of the fence is to bury your head in the sand,” Efron said.

Zohar by on Scribd

“Gaza sewage is already affecting Israel, viruses traced to Gaza have been diagnosed in Israel in the past,” she said. “If the situation isn’t dealt with, it may unfortunately be just a matter of time before Israel and Egypt find themselves facing a health crisis because of Gaza.”

Efron says this is a resolvable crisis and the obstacles are mainly political. “Although the debate about Gaza turns mainly on mutual recriminations over who is responsible, it’s not in the interest of any player for an epidemic to erupt. It’s a human-made crisis and it has technical solutions, but the obstacles are political.”

Open gallery view Trucks full of goods arriving from Israel depart from the Palestinian side of the Kerem Shalom cargo crossing, in Rafah, southern Gaza Strip, Aug. 15, 2018. Credit: Adel Hana, AP

Therefore, she says, it was important for the team to point out the relatively simple and technical means that could be employed from this moment to avoid a regional health crisis.

With regard to the Gaza electricity crisis, the researches propose the use of solar energy. “It’s a relatively cheap solution, accessible and it could be run from private homes, clinics and schools – and it would not require the continued reliance on diesel fuel,” they wrote.

They also recommended that the diesel fuel that does get into Gaza be supplied straight to the hospitals, where it should be used for examinations and life-saving treatment.

“We are referring to energy solutions, water and the health system which go beyond the assurances of emergency supplies of diesel fuel,” she said. “It’s important in and of itself, but far from sufficient. At the same time, funding and support for large projects involving desalination, sewage purification, electricity lines, and solar energy must be sought, as the international community is trying to do. But while working on projects whose overall costs will be in the billions of dollars, and which will take years to complete, entailing the agreement of all involved parties – who cannot seem to agree on anything – immediate solutions must also be sought.”