The flow of humanitarian aids is the urgency to address food security and health safety in the Gaza Strip: an open call

Dear Editor, Table 1 - Reported communicable diseases in the Gaza Strip population since October 2023. Disease Cases Skin rash 12 635 Upper respiratory infections 54 866 Diarrhea 33 551 Scabies, lice/ticks 8944 Chickenpox 1005 The ongoing armed conflict of Israel-Palestine mainly in the Gaza strip since it broke on October 7, 2023 is a severe threat to the region. A matter of greater concern is the public health in the devastated Gaza city, and the entire area is a humanitarian disaster zone. The deaths and health worries there continue to rise as the war persists for this long. Further, the resulting extreme overcrowding and disrupted health, water and sanitation services intensify the threat perceptions. Reportedly, nearly 725 000 civilians in 149 UNRWA facilities, about 131 134 in 94 non-UNRWA schools and host families, and 122 000 shelter in the hospitals, churches and other public buildings. There is only one shower for every 4500 people and one toilet for every 220 on an average in the Gaza today [1]. Such shabby affairs provide a conducive environment for the inevitable spread of infectious diseases leading to a potentially endemic situation. The situation is gradually becoming grimmer as the infectious diseases rapidly spread among the population in the region. The situation of an increasing infectious disease transmission risk is quite critical for almost the 1.5 million displaced population across Gaza, especially in the hugely crowded shelters with pitiable access to hygiene, sanitation and safe potable water [2]. Eventually, the risk of the spread of bacterial infections like diarrhea may rise due to the regular consumption of the unhealthy contaminated water. This region has reported 12 635 skin rash, 54 866 upper respiratory infections, 33 551 (over half of whom were 5-year old children or younger) diarrhea, 8944 scabies and lice/ticks, and 1005 chickenpox cases since the mid of October 2023[2]. These numbers of confirmed cases are 25 times higher compared to what was reported prior to the war that is still ongoing. Meningitis and hepatitis are also suspected. The timely preventive/therapeutic interventions in shambles and a disrupted routine vaccination programme would likely further complicate the scenario, increase the risk and accelerate the spread of the diseases. Incomplete disease surveillance coverage, limited internet access could further constrain the ability to detect the potential outbreaks early and invoke a timely effective countermeasure[2]. The dwindling fossil fuel availability there has forced the shutting down of desalinization plants and has disrupted solid waste collection, that create a conducive environment for the rapid and widely proliferating disease-carrying insects and rodent pests. The strained supply of cleaning (hygiene and sanitation) products coupled with a devastated potable water supply and sanitation system have made it almost impossible to maintain the basic prevention and control measures for infectious diseases. This could substantially increase the infection risk arising from trauma, surgery, wound care and in childbirth. Worsening the scenario, the lack of personnel protective gears for healthcare workers could lead to especially them acquiring and transmitting nosocomial infections during patient-care[2]. Disrupted management of biomedical wastes at the hospitals would increase the risk of being exposed to hazardous materials and infections. The shortage in the supply of fuel, medical oxygen and other essential medical needs besides the lack of food and water security for patients and the caretakers, the situation in healthcare facilities (like the medicals, clinics and diagnostic labs) seems to be going out of hand. The hospitals rely heavily on the volunteers in the threadbare healthcare and nursing care staff capacity[3]. As a result, respiratory diseases could be a common cause of mortality. It is to note that, 82 000 COVID-19 cases with 400 deaths were reported in Gaza strip in 2022. In the recent time, many SARS-CoV-2 variants are circulating globally[4-6]. This is again making additional health care challenge in the region. The population there will be even more susceptible to contracting communicable diseases as they face issues of food security, malnutrition and inclement cold weather. It is especially of concern for the currently over 50 000 expecting ladies and about 337 000 children under the age of 5 in Gaza. Therefore, fuel, water, food and medical supplies as humanitarian aids for the Gaza Strip public are urgently needed. Nearly 2.2 million civilians in the Gaza Strip were classified in Phase 3 or above (crisis or worse) between 8 December 2023 and 7 February 2024 (Figure 1), as per the IPC’s (Integrated Food Security and Nutrition Phase Classification) Acute Food Insecurity Phase Classification[7]. The essential water, hygiene and sanitation, and health service infrastructure are all damaged or destroyed owing to the ongoing long war, thereby limiting the capacity to address severe malnutrition and infectious disease outbreaks. The UNICEF projects that the most life-threatening malnutrition form in children known as “child wasting” shall affect about 10 000 (a nearly 30% increase from pre-war situation) in the next few weeks among the critically vulnerable 335 000 Gaza children under the age of 5[8].Figure 1.: Classified IPC’s Acute Food Insecurity Phase in Gaza strip (8 December 2023–7 February 2024).[ 7 ] Malnutrition is a person’s imbalanced (deficient or in excess) nutrient-intake. Under-nutrition, inadequate vitamins or minerals intake or overweight/obesity conditions result in diet-related noncommunicable life-style diseases like cardiac diseases (including stroke), diabetes and specific cancers. An estimated 37 million children under 5 years of age were overweight or obese and 149 million suffered from stunting in 2022[9]. Globally, under-nutrition was reportedly the primary cause of nearly 50% deaths in children of 5 years of age or less, mostly occurring in the low- and middle-income countries. Worldwide, every nation has one or more form of malnutrition. A bigger global health concern to address is all the forms of malnutrition, with the women, infants, children and the adolescents particularly at risk. The socio-economically backward community is the more-likely affected population. As per the latest IPC report, the entire Gaza population is in crisis or worse levels of acute food insecurity (the exact figure standing at 2.2 million)[7]. A starving sick or convalescing individual is more likely to be vulnerable to the various forms of life-threatening diseases including the infectious ones. While the Gaza public already suffers from food, water, necessary medication and adequate healthcare insufficiency, and relies heavily on the various humanitarian aids to thrive, a famine shall turn this terrible situation in to a catastrophe. Limited humanitarian assistance have been managed to be delivered in the Gaza strip by the UN, international aids agencies and few non-governmental organizations (including NGOs) so far. However, the supply falls far too short of the need to prevent a lethal hunger, malnutrition and disease combo[8]. Also, humanitarian aids alone could not meet essential needs in the Gaza as the food, clean potable water and medical assistance is particularly severely short in the northern region too. Malnutrition also increases the risk diarrhea, pneumonia and measles in children and the breast-feeding mother, especially in settings that has life-saving health services in shambles. With the risk of a daily rise in famine situation, Gaza faces a “food security catastrophe” that is looming large[7]. With food insecurity and high malnutrition, the entire Gaza population faces rising hunger crisis, most acutely among children, the pregnant, breastfeeding women and the elderly. Dedicated to human wellbeing, the WHO leads and champions global efforts everywhere to care and share with all, with equitable access to safe and healthy life. With its partners, The WHO strives to scale up flexible disease surveillance systems in the numerous shelters and the existing healthcare facilities (that have escaped the war devastation as yet) in the Gaza strip. In such a concerning scenario of the current disease trends, an effective surveillance system with stronger countermeasures as back-ups is suggested for the cause and sake of humanity.