In July 2017, five-year-old Mohammad al-Sayis died in the Gaza Strip after ingesting contaminated water while swimming in seawater polluted with sewage. Dozens of others had reportedly been hospitalized after swimming in Gaza’s seawater during the months of July and August 2018, including Mohammad’s brothers. This incident shed light on the severe health risks associated with Gaza’s chronic water and sanitation crisis.

Gaza’s growing water pollution crisis is not limited to the dire state of its seawater. Nearly all of its drinking water is considered unfit for drinking due to sewage contamination or high salinity levels. The lack of clean water for domestic use, the unsafe sanitary conditions, and the ingestion of undrinkable water, pose a serious threat to the public health of the two million Palestinians living in the Gaza Strip.

Gaza’s water crisis is inseparable from its severe energy complications. Electricity and fuel shortages aggravate the current water and sanitation crisis. Water is not properly cleaned, treated, desalinated and restored to homes and hospitals due to the current electricity shortages. Because of this, a UN report deemed the issues of water and sanitation in Gaza of primary concern, and concluded that by 2020 the Gaza Strip will be uninhabitable.

The water issue in Gaza can be attributed to two primary causes: lack of access to plentiful safe water for domestic use, and insufficient wastewater sanitation. Access to safe water in Gaza is extremely limited which has led to a decline in both water consumption and hygiene standards. Approximately half of Gaza’s population receives water suitable for domestic use for only six to eight hours every four days; another third receives water for eight hours every two days.

Gaza’s water problems have been a recurring issue since Israel imposed an air, land, and sea blockade on the coastal enclave in 2007 to squeeze the government set up by Hamas. The restrictions imposed by Israel on the entry of construction materials, spare parts, and equipment into the Gaza Strip make it difficult to repair damaged sewage infrastructures, often leaving them neglected and in poor condition. As many as 23 essential water and sanitation items such as pumps, drilling equipment, and disinfectant chemicals are on the ‘dual use’ list, which means that they are only allowed entry into Gaza on a selective basis. With nowhere else to turn in a water-scarce region, Gaza has been drawing much of its water from the sea while also expelling its sewage into the same source. While Israel is meeting its water needs with desalinated water, building the world’s largest reverse osmosis plant only 30 miles north of Gaza, similar facilities in Gaza lack the electricity to run at full capacity. This leaves the water used by Gazan residents largely untreated. Only around 22% of wells in Gaza produce water with acceptable salt concentrations. The rest are anywhere from two to eight times saltier than global standards, with some wells exceeding the World Health Organization (WHO) official standard. The high salinity puts Gazans in jeopardy of kidney stones and urinary tract problems.

Furthermore, poor wastewater treatment networks increase the likelihood of disease transmission through waterborne pathogens. Due to electricity shortages, some 110 million liters of raw or poorly treated sewage is flowing into the sea every day. The possible risk of developing waterborne diseases increases with the consumption of water contaminated with human or animal feces. Fecal contamination can be a source of pathogenic bacteria (e.g., cholera, salmonella, and shigella) and viruses (e.g., polio). Resulting contaminations can lead to significant diarrheal and other water-related diseases, including stomach cramps, vomiting, fevers and urinary tract infections.

According to UNICEF, Gaza’s contaminated water is responsible for 26% of all diseases in the territory and 50% of Gaza’s children between the age of six months and five years suffer from water-related parasitic infections. Every child in the Gaza Strip is at risk of acquiring waterborne diseases. These infections, along with chronic diarrhea, can drastically affect child growth and development along with the child’s ability to absorb nutrients, consequently leading to a higher incidence of childhood malnutrition.

Moreover, the overall lack and poor condition of water available will have severe implications on the Palestinians’ access to medical services and healthcare and its quality. The high water salinity available in Gaza is adversely affecting healthcare services such as hemodialysis, which depends on pure water.

The recent US decision to cut UNRWA funding is a further setback to solving Gaza’s water crisis. The UNRWA Environmental Health Programme controls the quality of drinking water by providing sanitation and carrying out vector and rodent control in refugee camps, thus reducing the risk of epidemics. During the 2014 conflict, when hostilities destroyed critical facilities, and the flow of water to most of Gaza came to a drastic stop, UNRWA was trucking water twice a day to more than 90 UNRWA schools, where nearly 300,000 Palestinians sought shelter until the violence subdued. When Gazans struggled to access clean water in the summer of 2017, UNRWA responded by teaming with humanitarian aid organization Mercy Corps on a project to provide the 30,000 refugees in the Maghazi camp—which experienced some of the highest incidences of diarrhea—with at least three liters of potable water per day.

According to the Fourth Geneva Convention (GC IV, art. 27-34 and 47-78)  and the 1907 Hague Relations (arts 42-56), Israel, as an occupying power, must be compelled to respect international law and must ensure sufficient hygiene and public health standards, as well as the provision of food and medical care to the population under occupation. The Israeli blockade of the Gaza Strip impedes the entry of construction materials necessary for repairing water distribution networks and the existing sanitation infrastructure. We call upon Israel to allow the access of these materials, along with maintenance equipment and fuel necessary for restoring the damaged water systems and carrying out new projects for wastewater sanitation networks and infrastructure.