Occupational hazards and health risks among sanitation workers in Palestine: a cross-sectional study on injuries and skin conditions

Sanitation workers face multiple occupational hazards, injuries, and skin conditions, particularly where safety measures are limited. This cross-sectional study, conducted in 2024, assessed exposures, personal protective equipment (PPE) use, work-related injuries, and skin symptoms among 381 sanitation workers across four West Bank governorates, Palestine. Participants completed an interviewer-administered questionnaire covering sociodemographics, health practices, PPE use, occupational hazards and injuries, and the Occupational Skin Disease Exposure Scale (OSDES-16). Most participants were male (99.0%), 17.6% lacked health insurance, and 18.9% had no regular vaccinations. Despite variable PPE use, 55.1% reported not receiving training. Common exposures included prolonged standing (78.9%), sun exposure (85.0%), and high temperatures (34.9%). Work-related injuries affected 53.5%, primarily from sharp tools (25.0%), falls (22.5%), and direct blows (18.6%). Skin erythema (10.2%), itching (11.5%), and dryness (6.8%) were the most reported symptoms. OSDES-16 scores were weakly correlated with work duration (ρ = 0.176, p < 0.001). These findings highlight substantial gaps in occupational safety and the need for targeted interventions to reduce hazards, improve PPE provision, and address occupational health risks. Policies should account for the social, economic, and political context of sanitation work in Palestine.