Hepatitis A virus transmission among children in displaced households in the Gaza Strip: impact of conflict on WASH and healthcare access

ABSTRACT This study aimed to assess the prevalence of HAV and examine the demographic, environmental, and healthcare-related factors among displaced populations in Gaza. A cross-sectional survey of 1,440 households in 30 shelters across Gaza was conducted using a structured questionnaire based on WHO guidelines. HAV cases were defined as either laboratory-confirmed or self-reported by caregivers, with 32% of cases laboratory-confirmed. Overall, 26.7% of households reported at least one HAV case, with 55% of households with 2–3 children and 63% of households with ≥4 children affected. Larger household size (≥4 children, AOR = 9.1, 95% CI: 6.5–12.6), prolonged displacement (>3 months, AOR = 7.5, 95% CI: 5.0–11.2), overcrowded shelters (≥7 persons, AOR = 3.1, 95% CI: 2.4–4.1), poor sanitation, limited access to clean water (<1 time/week, AOR = 18.2, 95% CI: 11.9–27.9), unmaintained facilities, lack of vaccination, and absence of hygiene awareness campaigns were significantly associated with HAV infection (p < 0.001). Post-war, 78% of healthcare providers reported more than 100 HAV cases, compared to 14% pre-war. These findings highlight the urgent need for immediate WASH interventions, expanded vaccination, and strengthened healthcare support, alongside medium- and long-term strategies to rebuild resilient public health infrastructure in Gaza.