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Epidemic risk rising as Rafah invasion compounds lethal cocktail of over-crowding, sewage and hunger


Israeli attacks since October caused at least $210m worth of damage to Gaza's water and sanitation infrastructure

The destruction of critical water and sanitation infrastructure by the Israeli forces along with severe over-crowding, malnutrition and heat is pushing Gaza to the brink of a deadly epidemic outbreak, Oxfam warned today.

The situation is further compounded by the Israeli invasion of Rafah which has forced over 350,000 people to flee to already overcrowded shelters and camps, and food and fuel are running out with the closure of border crossings. The international aid agency said at least five of its life-saving water and sanitation projects in the Gaza Strip had been severely damaged or destroyed in the Israeli attacks since October 7.

Oxfam staff in Gaza have described piles of human waste and rivers of sewage in the streets, which people are having to jump between. They also reported people having to drink dirty water and children being bitten by insects swarming around the sewage. Conditions are ripe for the outbreak of epidemics including Hepatitis A and cholera, which thrive in overcrowded places lacking proper sanitation. Soaring temperatures are also increasing health risks.

Oxfam’s Middle East Director, Sally Abi Khalil, said: “The situation is desperate, with so many people in Gaza living in fear and being forced to endure inhumane and unsanitary conditions caused by sustained Israeli bombardment. One colleague told me there was so much human waste in the streets, it literally smelt like disease.

“Israel’s military assault on Rafah could be devastating, not only because of the risk of mass civilian casualties, but also the repercussions of vast numbers of people being forced to move. With the infrastructure already beyond breaking point, little or no healthcare available, and widespread malnutrition this could quickly escalate into a major epidemic.”

One the local organizations Oxfam works with in Gaza, Juzoor for Health and Social Development – which is operating in more than 50 shelters and numerous health points across North Gaza and serving hundreds of thousands of people - said they’ve seen a worrying rise in disease outbreaks.

Celine Maayeh, Advocacy and Research Officer for Juzoor, said: “Unfortunately, all of our shelters lack proper sanitation and sewage systems, and just a few days ago we started hearing reports of areas in Gaza being infested with bugs and flies. Our health teams have been dealing with skin infections and cases of watery diarrhea for months now; and we’ve recently detected thousands of cases of hepatitis A and other gastrointestinal and respiratory diseases. While we’ve managed to treat them, the rising temperatures and accumulating waste and sewage are creating the perfect recipe for a health catastrophe that our health teams alone cannot tackle.”

UNICEF analysis of satellite images found that in Gaza Governorate 87 percent of critical water and sanitation facilities have been destroyed or severely damaged. Across Gaza, at least five of Oxfam’s projects – three wells, a desalination plant and a sewage pumping station have been destroyed or severely damaged that served over 180,700 people a day. A further seven Oxfam water or sanitation projects are also believed to have sustained some degree of damage.

Israeli airstrikes also destroyed the warehouse of one of Oxfam’s local suppliers with the loss of an estimated $60,000 worth of Oxfam latrine blocks – purpose-built toilet and shower facilities, which were due to help improve sanitary conditions for thousands of people.

Attacks which target civilian infrastructure are illegal under the Geneva Conventions. The extensive damage to water and sanitation infrastructure is one example of Israel's relentless assault on Gaza, which according to UN experts, may amount to breaches of International Humanitarian Law.

The Coastal Municipalities Water Utility (CMWU), which is responsible for water and sanitation in Gaza and with whom Oxfam works, estimates the overall damage to Gaza’s water and sanitation infrastructure to be at least $210 million. This is based on assessments where their technical staff were able carry out field surveys and does not include damage in areas which cannot be reached due to the ongoing fighting or Israeli military restrictions. The estimate also does not account for all of the ‘unseen damage’ which is likely to have been caused by the Israeli military’s use of tanks, bombs and rockets.

Monther Shoblaq, CEO of CMWU said: “The entire water supply and sewage management systems are nearing total collapse because the damage is so extensive. There is no power to operate the water wells, desalination plants and the remaining wastewater treatment plants and the sewage is overflowing. We are doing all we can, but the situation is desperate.”

Despite the extremely hostile conditions, Oxfam and local partners have been able to carry out quick fix repairs on some badly damaged water and wastewater pipelines in Rafah, Khan Younis and Deir Al-Balah governorates, providing 50,000 people with clean water and sanitation. In one area of Rafah, before the invasion, over 200 yards of new pipelines were fitted. Oxfam and partners have also installed five desalination units to provide clean drinking water, and three more units have finally been given permission to enter Gaza, after long and repeated attempts. Life-saving water has been trucked to people in makeshift shelters in Rafah and Khan Younis and Oxfam is hoping to expand this to reach more people in the North. To date, Oxfam's work on water and sanitation has helped over 133,000 people and more funding is needed to continue.

Sally Abi Khalil, said: “The Israeli army has continued to destroy every aspect of life in Gaza through military attacks and siege, ruining what little civilian infrastructure remains and preventing humanitarian aid from getting in. We urgently need an immediate and permanent ceasefire to end the death and destruction, to allow more aid into Gaza and to ensure the release of the hostages and illegally detained Palestinian prisoners.”


Notes to editors:

  • A UNOSAT satellite imagery analysis released in mid-January, carried out by UNICEF on behalf of the Water and Sanitation Cluster, shows that 87 per cent of WASH facilities in Gaza governorate were either destroyed or sustained some level of damage, according to OCHA.
  • According to UNRWA, almost 360,000 people have fled Rafah since the first evacuation order a week ago.
  • According to an assessment carried out by The Coastal Municipalities Water Utility – using field surveys and data collected from technical staff in 25 municipal areas who made a preliminary recording of visible and urgent damage in areas they have been able to access – the cost of repairs, as of April 2024, would be at least $210 million. Cost estimates may increase due un-seen damages under the mass debris.
  • Juzoor’s teams of health professionals have been monitoring the situation in the North of Gaza and utilizing the WHO’s diagnosis kits and treatment protocols. Juzoor medical points have been able to successfully handle 99 percent of cases that present with recognizable symptoms, ensuring optimal care. For severe cases, Juzoor refer individuals to secondary treatment facilities and arrange for hospital admission.

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