JMIR Publications

ABSTRACT

Background:

The water supply of the Gaza Strip has been unstable and under strain for decades, resulting in major issues with drinking water quality, reliability, and acceptability. In 2018, between 25-30% of Gazans did not have regular access to running water. Progressive deterioration of water infrastructures and concerns over the quality of piped water have resulted in a complex mix of drinking water sources used in the Gaza Strip. The challenges of safe water provision in the Gaza Strip could potentially have severe adverse effects on the health and well-being of the population.

Objective:

The main objectives of the survey were to determine the quality of drinking water at the household level and to investigate the association of various health outcomes with water quality at household level in the Gaza Strip.

Methods:

We conducted a cross-sectional household survey in North Gaza, Gaza and Rafah governorates between January and March 2023. We selected households from a subsample of a representative cross-sectional survey conducted in the Gaza Strip in the year 2020 with persons aged 40 years and older. In each household in the 2023 survey, three individuals (two above 40 years and one between 18 and 30 years) were invited to participate. The face-to-face interview included questions on drinking water, mental health and well-being, self-reported diagnoses for selected diseases, use of antibiotics and knowledge about antimicrobial resistance. Additionally, the blood pressure of each participant was measured. Drinking water was sampled from each household and analyzed for microbial contamination, nitrate, sodium and mineral content.

Results:

We visited a total of 905 households and interviewed a total of 2’291 participants. In both age groups more female participants were interviewed (57% (914/1’615) in those 40 years and older; 59% (398/676) in those 18 to 30 year olds). Water samples were obtained from nearly all households (903/905).

Conclusions:

The extensive survey components, coupled with drinking water testing and building on an existing survey, allows us to identify a broad set of potential impacts on health and well-being and to track changes over time. This study intended to identify humanitarian and development interventions that could impact the population served most. However, data collection was completed before the escalation of violence in October 2023. Given the impact of the still ongoing escalation, the initial intent of this work is no longer valid, but the results emerging from the survey may still serve as a baseline to assess impacts of the current escalations on physical and mental health as well as on drinking water quality. In addition, our findings could provide important information for rebuilding the Gaza Strip in a more health-promoting way.