Refugee shelters in southern Gaza are being disinfected with chemical agents in a bid to prevent a catastrophic outbreak of disease.
Cases of severe diarrhoea are already sweeping through the population and experts fear typhoid and cholera outbreaks could quickly follow.
Israeli bombing has destroyed much of Gaza’s sanitation infrastructure, leaving sewage running through the streets, while shortages of clean water and antibiotics threaten to tip the precarious situation into a health crisis.
“If you don’t get clean water soon, mortality will be very high,” said Professor Francois Balloux, Chair in Computational Biology Systems at UCL.
“It is highly likely that there are cases of typhoid we just don’t know about yet. Although there are no official reports of cholera yet, that does not mean that it isn’t spreading,” he added.
At least 830,000 Gazans now reside in overcrowded shelters, while 70 per cent of people in the enclave’s south have no access to clean water, according to the World Health Organization (WHO).
Overcrowding encourages the spread of disease, while a lack of sanitary water increases the risk of waterborne infections, like diarrhoea, cholera and typhoid – all of which can be deadly without adequate medical care.
Workers from the NGO Anera are toiling to sanitise 55 shelters in southern Gaza with chemical agents in a bid to kill lingering infections.
“Cleaners are working around the clock in 24-hour shifts,” said Sean Carroll, Anera’s president and CEO. “The cleaning team systematically moves from one shelter to another, ten per day.”
However, disinfectant supplies are in short supply due to blockages on the border with Egypt and a lack of fuel.
“There were many times that our staff wondered if we could keep delivering because of it,” said Mr Carroll.
Ahmad Najjar, Anera’s Medical Donations Programme Officer in Gaza, told the Telegraph that dermatological diseases resulting from overcrowding are spreading like wildfire.
“It is related directly to the absence of hygienic tools, mainly water and the very limited numbers of bathrooms,” he told the Telegraph.
“I noticed many water-borne diseases like parasitic infections, some kidney stones, and inflammation due to drinking salty water due to the huge absence of drinking water.”
Mr Najjar added that he expects to see cholera cases in the near future because of unclean water and untreated sewage.
He said that many pregnant women have lost their babies due to the dire conditions.
“I have seen malnutrition for pregnant women, mothers, and their babies due to limited access to all food items,” he said.
The situation is likely to spiral as winter looms, Mr Najjir explained, with humanitarian workers bracing for a spike in respiratory infections as people shelter in canvas tents inadequate for colder conditions.
Since November 10, 10,224 people have been diagnosed with an acute respiratory infection, while scabies and lice have reportedly affected 10,952 individuals, according to figures from Airfinity, a global health monitorer.
A further 8,202 people have been diagnosed with diarrhoea, with 51 per cent of these under the age of five.
“Severe diarrhoea, especially without access to antibiotics, is often lethal for young children,” said Professor Balloux, who was a member at the MRC Centre for Outbreak Analysis and Modelling within the Department of Infectious disease epidemiology at Imperial College London.
“What is likely to occur very soon is outbreaks of typhoid or cholera. That could affect the whole population. If the situation does not improve soon, there will be a cycle of infections.”
Municipal officials in Gaza say sewage is overflowing into the streets because the lack of electricity has caused a “complete halt to sewage pumps”.
Ahmad al Soufi, president of Rafah municipality, said it is “creating a health and environmental abomination”.
“We are now witnessing a deterioration in the environmental situation resulting from the accumulation of waste in the streets, alleys and all neighbourhoods and the spread of diseases and epidemics of all kinds.”
Experts say that these are the first warning signs of a health catastrophe as the ongoing conflict will exacerbate the situation further, spreading outbreaks to new territories and causing an even higher burden on the population.
Routine surveillance systems are not currently functioning, which has hampered effective detection and the ability to respond to threats to public health, a WHO spokesperson said.
Healthcare capacity is continuing to decline as 69 per cent and 65 per cent of hospitals and primary health care facilities respectively are not functioning.
The World Food Programme has reported an increase in cases of dehydration and malnutrition and warned about the threat of starvation due to the collapsed food supply chain and insufficient aid delivery.
Shelters are overcrowded as Gazans flee from the north, with people left to sleep outside on the ground with no blankets.
“Our staff in Gaza have all been displaced themselves and they are living in crowded shelters – mostly in the south, supposedly the ‘safe’ zone – with poor access to water, food and power,” said Mr Carroll.
“They are exhausted and are quite literally putting their lives at risk going out to deliver relief. No place is safe in Gaza.”