Gaza—ceasefire and prepare for a surge in infectious diseases! Free

On the 27th of October, Israel began ground invasion on the Gaza strip in retaliation to an attack by Hamas on the 7th of October 2023. The Gaza strip has been thrown into turmoil following the war which has resulted in unprecedented death, injury, and the displacement of large numbers of people with over 1.9 million displaced and over 22 000 deaths as of 3rd January 2024 [1]. According to the WHO, the situation is “indescribable” with children and women being the most affected. Hospital infrastructures have been completely destroyed, turning hospitals, which are supposed to be life-saving zones into “death zones,” while international aide has been severely compromised [2]. The impact of war on infectious diseases has been well-described and witnessed during previous armed conflicts in the Middle East such as in Iraq, Syria, and Yemen [3]. However, unlike other conflicts, the war in Gaza is likely to have a greater impact on the burden of infectious diseases in the region given the scale of the conflict and likelihood for large numbers of people and patients to be displaced and relocated to other neighboring countries in the Middle East. The risk is likely to increase exponentially if the war evolves into a regional conflict. The current death tolls from war are likely to be exceeded by death tolls resulting in the aftermath of Infectious diseases.

In the short term, the immediate impact is likely to be on the occurrence of outbreaks of vaccine preventable infections since childhood vaccination programs have been halted. Outbreaks of infections such as polio and measles are therefore likely to occur in Gaza and neighboring countries. In addition, given the overcrowding and poor living conditions in make-shift refugee camps in and around Gaza, there are likely to be outbreaks of food- and water-borne infections such as cholera. The rise in patients with major burns and trauma coupled with overcrowding and destruction of hospital infection control programs is likely to lead to a rise in infections due to multidrug-resistant organism such as carbapenem-resistant Acinetobacter, Enterobacteriaceae and Pseudomonas aeruginosa. The likelihood of spread of these organisms in hospitals in the region receiving these patients is high and likely to also result in outbreaks if appropriate precautions are not taken. The large numbers of casualties and dead bodies buried under the rubble of destroyed buildings and poor living conditions are also likely to lead to a rise in zoonotic infections such as leptospirosis related to a rise in rodent populations.

In the medium term, malnutrition and deterioration of determinants of health such as housing, nutrition, access to water, and sanitation are likely to lead to reactivation and spread of infections such as tuberculosis. In addition, infections in patients with chronic conditions such as diabetic foot infections, skin and soft tissue infections, pneumonia and urinary tract infections are likely to rise. The absence of appropriate care for patients with chronic medical conditions is also likely to increase the impact of infections in immunosuppressed patients such as invasive fungal infections.

Long term, displaced, and vulnerable communities especially women may result in a rise in assault and infections such as hepatitis B, hepatitis C, and Human Immunodeficiency Virus (HIV). In addition, the likelihood of outbreaks of emerging and insect-borne infections such as Crimean Congo Hemorrhagic Fever (CCHF), lice, cutaneous leishmaniasis, malaria, and dengue in Gaza and neighboring countries will rise.

These are the current and future infectious disease concerns which are likely to not only affect Gaza and Israel but also the rest of the Middle East and other continents. The recent Coronavirus Disease 2019 (COVID-19) pandemic and global Mpox outbreak have shown us that infections are never limited to one region and can easily spread. Therefore, there needs to be a concerted effort to minimize the impact of the above infectious diseases. Countries receiving patients from the Gaza strip such as the United Arab Emirates (UAE) should also develop strategies and interventions to minimize the impact of these infectious diseases and prevent outbreaks. Regional, national, and local surveillance systems for infections and antimicrobial resistance should be strengthened in order to identify trends and outbreaks. Hospital, regional, and national emergency preparedness protocols should be activated to prevent and respond to potential outbreaks. Hospitals should also prepare for the pressure on healthcare services, which is likely to follow as other countries in the region receive the wounded and displaced populations.

The Emirates Infectious Diseases Society joins the United Nations, WHO, and UAE Government [4–7] to call for an immediate and unconditional ceasefire in order to prevent a surge in infectious diseases in the region and globally. Our message is simple, ceasefire in Gaza and prepare for a surge of infectious diseases!

The Emirates Infectious Diseases Society is a non-profit organization and one of the scientific societies of the Emirates Medical Association. It brings together infectious disease professionals in the UAE with a mission of achieving a society free of infection by providing leadership to reduce mortality and suffering related to infections.

Conflict of interest statement

The authors do not have any conflict of interest to declare.

Funding

This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Authors Contribution

The initial paper was drafted by E.N.; all authors reviewed the draft and provided input.

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