Water quality and its role in waterborne disease outbreaks during the war on the Gaza Strip

Abstract
Background: Contaminated drinking water poses a major threat to public health and well-being worldwide. There are growing concerns about the issue in developing countries, especially in conflict areas like the Gaza Strip. The aim of this study is to assess the quality of water in public supplies, focusing on displaced people’s shelters and healthcare facilities in Khan Younis and the Middle Area in the Gaza Strip, and to understand the role of the Ministry of Health (MoH) in waterborne disease outbreak control during the war on the Gaza Strip.
Methods: In this case study we utilized secondary data obtained from the Health Information Unit at the MoH. The dataset comprises results from both microbial and chemical analyses of water samples collected between May and June 2024. Healthcare facilities and displaced people’s shelters are primary sources of these samples, which were collected from various points, including drinking water and water intended for personal and household hygiene. Microbial testing looked for fecal coliform (FC) and Escherichia coli (E. coli). Chemical analyses were conducted, including measurements of free chlorine levels and total dissolved solids (TDS). The results were compared with the World Health Organization (WHO) guidelines for drinking water quality to assess the overall water safety and identify potential health risks.
Results: The findings indicate a widespread contamination across different water sources in Khan Younis and the Middle Area of the Gaza Strip, with 41% of samples testing positive for FC and 20% for E. coli in public water supplies and shelters. In healthcare facilities, the contamination rates were 39% and 25% for FC and E. coli, respectively. Additionally, chemical tests revealed that 42% of samples did not meet WHO standards for total dissolved solids (TDS) and 79% had critically low levels of free chlorine.
Conclusion: The contamination levels in drinking water in the Gaza Strip exceed the threshold values of the WHO guideline for safe drinking water, and the severe scarcity in the chlorination process further complicates the situation. Therefore, strategies to protect water sources and improve treatment must be implemented immediately. This research highlights the crucial need for international intervention to reinstate safe water access and prevent deterioration in public health.

Keywords: E. coli, fecal coliform, Gaza Strip, microbial contamination, waterborne disease, war impact.