Infectious Diseases and Antimicrobial Resistance in the Gaza Strip: Epidemiological Drivers, Health System Disruptions, and Global Implications: A Narrative Review

Background and Aims: The Gaza Strip has faced prolonged blockade, recurrent military conflicts, and systemic infrastructure collapse since October 2023, resulting in an unprecedented public health crisis characterized by surging infectious diseases and antimicrobial resistance (AMR). This narrative review aims to synthesize the available evidence to elucidate the epidemiological drivers, health system disruptions, and environmental determinants underlying this crisis. Methods: A comprehensive narrative review was conducted using peer-reviewed literature, WHO and UNRWA reports, Gaza Ministry of Health field data (2023-2025), and surveillance summaries. Relevant studies and institutional reports were thematically analyzed to identify key trends in infectious diseases, AMR dynamics, and health system vulnerabilities in conflict-affected settings. Results: . Over 200,000 diarrheal cases, half among children under five, reflect the collapse of water, sanitation, and hygiene (WASH) systems, with 97% of groundwater deemed unfit for consumption. Structural damage to health infrastructure, shortages of sterile supplies, and disrupted supply chains have severely impaired infection control and antibiotic stewardship. Environmental degradation, including 23 million tons of debris and untreated sewage, further amplifies the disease transmission risks. Conclusion: Gaza's infectious disease and AMR crisis stems from the convergence of environmental degradation, infrastructural collapse, and health system disruption. Immediate evidence-based interventions, including WASH rehabilitation, decentralized AMR diagnostics, and emergency immunization, are urgently needed. These findings underscore the necessity of sustained, coordinated global health responses to prevent wider regional transmission and mitigate mortality in conflict settings.