Malnutrition, contaminated water, and post-infectious neuropathies: lessons from the Guillain-Barré syndrome outbreak in Gaza

The cases of malnutrition, water insecurity, and the collapse of the health system, turning into a humanitarian crisis, have been illustrated by the 2025 outbreak of Guillain-Barré syndrome (GBS) in Gaza, which is a form of treatable post-infectious neuropathy. Toward the end of August 2025, there were reports of over 90 cases and at least 10 deaths due to shortages of intravenous immunoglobulin, plasma-exchange filters, and ventilators. GBS-inducing enteric pathogens such as <i>Campylobacter jejuni</i> are likely promoted by chronic food insecurity and fecal contamination of water, but micronutrient deficiencies (e.g., thiamine) can also contribute to or exacerbate polyradiculoneuropathy. Nutritionally deficient patients cannot regenerate as well due to a reduced immune response that limits the ability to fight infections or repair nerve injuries. It is thus important to integrate nutritional surveillance and rehabilitation with the delivery of acute care that includes the administration of immunotherapy, ventilatory support, and the identification of pathogens. The Gaza experience makes it clear that an appropriate response to the outbreak must address both the urgent treatment of patients and the structural factors associated with malnutrition and water insecurity to prevent avoidable deaths and chronic disability from GBS and other post-infectious neuropathies.