The collapse of water, sanitation, and hygiene systems in Gaza: Public health implications and global security perspectives

Tika Pustika Fersari; Jana Abu Salha

doi:10.56744/irchum.v4i2.98

Authors

Tika Pustika Fersari Puskesmas Pangkalbalam Kota Pangkalpinang
Jana Abu Salha Universitas Pertahanan Republik Indonesia

DOI:

https://doi.org/10.56744/irchum.v4i2.98

Keywords:

Armed Conflict, Global Health Security, Humanitarian Infrastructure, Public Health Crisis, Water Sanitation and Hygiene (WASH)

Abstract

Since the escalation of large-scale conflict in October 2023, severe destruction of civilian infrastructure has occurred in the Gaza Strip, including the collapse of Water, Sanitation, and Hygiene (WASH) systems. This breakdown has rapidly triggered a public health emergency with short-, medium-, and long-term consequences. Short-term impacts included marked increases in infectious diseases such as diarrhea and hepatitis A, acute malnutrition, and elevated risks to maternal and child health. Medium-term impacts involved ecological degradation through groundwater contamination and sanitation system failure, which in turn contributed to rising clean-water prices and widening socio-economic inequalities, disproportionately affecting women and children. Long-term impacts generated intergenerational risks, including the potential emergence of a “lost generation” due to stunting and increased global health security concerns associated with transboundary disease spread. Comparative evidence from Yemen, Syria, Sub-Saharan Africa, and Indonesia (Aceh and Papua) indicates similar epidemiological patterns, in which WASH destruction is associated with cyclical epidemics, malnutrition, and deepening structural vulnerability. Using a descriptive qualitative approach based on a review of academic literature, international organizational reports, policy documents, and credible media sources, this study systematically examines the implications of WASH system collapse for public health in Gaza during the ongoing genocide. The analysis develops a conceptual framework that positions the WASH crisis not only as a humanitarian concern but also as a public health emergency with regional and global ramifications. On this basis, the study concludes that effective WASH reconstruction should be prioritized as a humanitarian and global health security strategy and integrated with nutrition, maternal–child health, and social protection programs. The findings also underscore the need for comprehensive international policy responses and reinforce arguments for recognizing the protection of WASH infrastructure as a fundamental human right in armed conflict.

Downloads

Download data is not yet available.

References

Abuawad, A., Griffiths, M., Edwards, G. H., Eftekhari, A., Al Ebweini, M., Al-Najar, H., Butmeh, A., Dayyeh, R. A., El-Shewy, M., & Aker, A. (2025). The Ongoing Environmental Destruction and Degradation of Gaza: The Resulting Public Health Crisis. A Publication of the American Public Health Association, 115(7), 1053-1061. https://doi.org/10.2105/AJPH.2025.308140.

Al-Khishawi, Y., & Abed, M. (2024). Gaza: Kurangnya Air Bersih Mendatangkan Penyakit dan Penderitaan. Doctorwithoutborders-apac.org. https://doctorswithoutborders-apac.org/id/gaza-kurangnya-air-bersih-mendatangkan-penyakit-dan-penderitaan.

Anera. (2024). Water, Sanitation and Hygiene Infrastructure Under Attack in Gaza. Reliefweb.int. https://reliefweb.int/report/occupied-palestinian-territory/water-sanitation-and-hygiene-infrastructure-under-attack-gaza.

Astuti, Y. R. (2022). Pengaruh Sanitasi dan Air Minum Terhadap Stunting di Papua dan Papua Barat. Poltekita: Jurnal Ilmu Kesehatan, 16(3), 261-267. https://doi.org/10.33860/jik.v16i3.1470.

Camacho, A., Bouhenia, M., Alyusfi, R., Alkohlani, A., Naji, M. A. M, Radiguès, X. D., Abubakar, A. M., Almoalmi, A., Seguin, C., Sagrado, M. J., Poncin, M., McRae, M., Musoke, M., Rakesh, A., Porten, K., Haskew, C., Atkins, K. E, Eggo, R. M., Azman, A. S., Broekhuijsen, M., Saatcioglu, M. A., Pezzoli, L., Quilici, M. L., Al-Mesbahy, A. R., Zagaria, N., Luquero, F. J. (2018). Cholera Epidemic in Yemen, 2016-18: An Analysis of Surveillance Data. Lancet Global Health, 6(6), e680-e690. https://doi.org/10.1016/s2214-109x(18)30230-4.

Checchi, F., Gayer, M., Grais, R. F., & Mills, E. J. (2007). Public Health in Crisis Affected Populations a Practical Guide for Decision-Makers. London, United Kingdom: Humanitarian Pratice Network (HPN).

Christine., Politon, F. V. M., & Hafid, F. (2022). Sanitasi rumah dan stunting di Wilayah Kerja Puskesmas Labuan Kabupaten Donggala. AcTion: Aceh Nutrition Journal, 7(2). http://dx.doi.org/10.30867/action.v7i2.536.

Creswell, J. W., & Poth, C. N. (2024). Qualitative Inquiry and Research Design: Choosing Among Five Approaches (5th ed.). SAGE Publications.

Cronin, A. A., Shrestha, D., Spiegel, P., & Gore, F. (2009). Quantifying the Burden of Disease Associated with Inadequate Provision of Water and Sanitation in Selected Sub-Saharan Refugee Camps. Journal of Water and Health, 7(4), 557-568. http://dx.doi.org/10.2166/wh.2009.089.

Curtis, J., & Davey, A. T. (2025). International Mine Awareness Day: New Study Evidences the Impact of Humanitarian Mine Action on Resilience, Peace and Development. Drc.ngo. https://drc.ngo/resources/news/new-study-evidences-the-impact-of-humanitarian-mine-action-on-resilience-peace-and-development/.

Efron, S., Fischbach, J. R., Blum, I., Karimov, R. I, & Moore, M. (2019). The Public Health Impacts of Gaza's Water Crisis: Analysis and Policy Options. Santa Monica, Calif: RAND Corporation.

Eneh, S. C., Admad, S., Nazir, A., Onukansi, F. O., Oluwatobi, A., Innocent, D. C., & Ojo, T. O. (2023). Cholera Outbreak in Syria Amid Humanitarian Crisis: The Epidemic Threat, Future Health Implications, and Response Strategy - A Review. Pront Public Health, 20(11), 1161936. https://doi.org/10.3389/fpubh.2023.1161936.

Groot, C. D., Alhaffar, M. B. A., & Eriksson, A. Societies at Risk: The Correlation Between Intensity of Armed Conflict and Child Health During the Civil War in South Sudan. Archives of Public Health, 83(45). https://doi.org/10.1186/s13690-025-01523-5.

Hall, N., Kirschenbaum, A., & Michael, D. (2024). The Siege of Gaza’s Water. Csis.org. https://www.csis.org/analysis/siege-gazas-water.

Hamamra, B., Mahamid, F., & Mayaleh, A. Childhood under siege: battling malnutrition, disease, and despair during genocide in Gaza. Journal Health, Population and Nutrition, 44, 321. https://doi.org/10.1186/s41043-025-00948-6.

Hasyim, A. (2025). PBB: Tujuh Puluh Persen Sistem Air dan Sanitasi di Gaza Rusak atau Hancur. SerambiNews.com. https://aceh.tribunnews.com/2025/05/24/pbb-tujuh-puluh-persen-sistem-air-dan-sanitasi-di-gaza-rusak-atau-hancur.

Hsieh, H. F., & Shannon, S. E. (2021). Three Approaches to Qualitative Content Analysis. Qualitative Health Research, 15(9), 1277-1288. http://dx.doi.org/10.1177/1049732305276687.

Idrus, P. (2025). OCHA: 96 Persen Rumah Di Gaza Alami Krisis Air, Sistem Sanitasi Nyaris Runtuh. Gazamedia.net. https://gazamedia.net/ocha-96-persen-rumah-di-gaza-alami-krisis-air-sistem-sanitasi-nyaris-runtuh/.

Kann, R. S., Snyder, J. S., Victor, C., Cumbe, Z. A., Garn, J. V., McGunegill, S., Nala, R., Freeman, M. C., & Levy, K. (2024). Water, Sanitation, And Hygiene Insecurity and Disease Prevention Behaviors During The COVID-19 Pandemic in Low-Income Neighborhoods of Beira, Mozambique. PLoS ONE, 19(11), e0310490. https://doi.org/10.1371/journal.pone.0310490.

Kementerian Kesehatan Republik Indonesia. (2023). Buku Profil Penanggulangan Krisis Kesehatan 2023. Jakarta: Kementerian Kesehatan RI. https://penanggulangankrisis.kemkes.go.id/__pub/Final_Buku_Tinjauan_Tahun_2023.pdf.

Kusumandari, S. A., & Kurniawan, A. (2023). Pengungsi Internal di Papua Hadapi Kerentanan Berlapis - 3 Langkah Mengoptimalkan Perlindungan Sosial bagi Mereka. Smeru.or.id. https://smeru.or.id/id/article-id/pengungsi-internal-di-papua-hadapi-kerentanan-berlapis-3-langkah-mengoptimalkan.

Miller, J. D., Young, S. L., Bryan, E., & Ringler, C. (2024). Water Insecurity is Associated with Greater Food Insecurity and Lower Dietary Diversity: Panel Data from Sub-Saharan Africa During The COVID-19 Pandemic. Food Security, 16, 149-160. https://doi.org/10.1007/s12571-023-01412-1.

Musfira. (2019). Rancangan Model Pengelolaan Air Bersih di Kota Jayapura. Jurnal DINAMIS, 17(1).111-125. https://ojs.ustj.ac.id/dinamis/article/download/341/262/.

Nongbri, R. W., Sarkar, A., & Mandal, S. K. (2025). Impact of Temperature Shocks on Household Water Poverty in India. Science Reports, 15(1), 16618. https://doi.org/10.1038/s41598-025-01732-6.

Perlman, B., Collins, S. M, Hoek, J. V. D. (2025). Public Health Implications of Satellite-Detected Widespread Damage to WASH Infrastructure in The Gaza Strip. PLOS Global Public Health, 5(2), e0004221. https://doi.org/10.1371/journal.pgph.0004221.

Phiri, S. S., George, N. S., & Iseghehi, L. (2024). Protecting the Health of the Most Vulnerable in the Overlooked Democratic Republic of Congo Crisis. Health Science Reports, 7(8), e70011. https://doi.org/10.1002/hsr2.70011.

Sari, D. P., Yusuf, S., Andid, R., Darussalam, D., Dimiati, H., & Amna, E. Y. (2024). Water, Sanitation, And Hygiene (WASH) Factors Associated with Stunting Among Under-Fives: A Hospital-Based Cross-Sectional Study in Banda Aceh. AcTion: Aceh Nutrition Journal, 9(3), http://dx.doi.org/10.30867/action.v9i3.2022.

Satriani, S., Ilma, I. S., & Daniel, D. (2022). Trends of Water, Sanitation, and Hygiene (WASH) Research in Indonesia: A Systematic Review. International Journal Environmental, Research and Public Health, 19(3), 1617. International Journal of Environmental Research and Public Health. 2022; 19(3):1617. https://doi.org/10.3390/ijerph19031617

Sufri, S., Nurhasanah, Jannah, M., Dewi, T. P., Sirasa, F., & Bakri, S. (2023). Child Stunting Reduction in Aceh Province: Challenges and a Way Ahead. Matern Child Health, 27(5), 888-901. https://doi.org/10.1007/s10995-023-03601-y.

Tarnas, M. C., Karah, N., Almhawish, N., Aladhan, I., Alobaid, R., & Abbara, A. (2023). Politicization of Water, Humanitarian Response, and Health in Syria as a Contributor to The Ongoing Cholera Outbreak. International Society for Infectious Diseases, 131, P115-118. https://doi.org/10.1016/j.ijid.2023.03.042.

UNICEF. (2022). Syria: Water Crisis and Disease Outbreaks. Unicef.org. https://www.unicef.org/press-releases/syria-water-crisis-disease.

Wandik, H., Sitorus, Y., & Musfira, M. (2025). Partisipasi Masyarakat Pada Mitigasi Bencana Banjir di Kampung Doyo Baru, Distrik Waibu, Kabupaten Jayapura. Jurnal Median Arsitektur dan Planologi, 14(2), 79-89. https://doi.org/10.58839/jmap.v14i02.1470.

WHO (2023). Disease Outbreak News: Geographical Expansion of Cases of Dengue and Chikungunya Beyond the Historical Areas of Transmission in the Region of the Americas. Who.int. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON448.

Wisner, B., Gaillard, J.C., & Kelman, I. (2012). Handbook of Disaster Risk Reduction. London: Routledge.

Wulandari, R. D., Laksono, A. D., Kusrini, I., & Tahangnacca, M. (2022). The Targets for Stunting Prevention Policies in Papua, Indonesia: What Mothers’ Characteristics Matter?. Nutrients, 14(3), 549. https://doi.org/10.3390/nu14030549.

Zinszer, K., & Abuzerr, S. (2024). Water, Sanitation, and Hygiene Insecurity and Infectious Disease Outbreaks Among Internally Displaced Populations in Gaza: Implications of Conflict-Driven Displacement on Public Health. Journal of Water, Sanitation and Hygiene for Development, 14 (11), 1182-1192. https://doi.org/10.2166/washdev.2024.361.