Amidst Israel’s military invasion of Rafah that threatens further deterioration to the Water, Sanitation and Hygiene (WASH) conditions in southern Gaza, and based on recent trips to Gaza, the International Rescue Committee (IRC) and Medical Aid for Palestinians (MAP) are alarmed that:

Field observations last month by WASH experts from the International Rescue Committee (IRC) and Medical Aid for Palestinians (MAP) in Gaza have shown that some Palestinians living in scattered settlements in central Gaza are surviving on just 3% of what should be the minimum standard water intake, with at least one major hospital struggling to keep sufficient water supplies to meet its needs. Now, with Israel’s closure of the Rafah crossing and more than 800,000 people displaced from Rafah in just the last week, we are deeply concerned about the sanitation and hygiene-related health impact for displaced people.

The situation at one of Gaza’s hospitals, where IRC and MAP emergency medical teams have been working intermittently under desperate conditions, is critical. The facility is overwhelmed, accommodating 700 patients in a 200-bed facility, while approximately 10,000 displaced individuals seek shelter within the grounds of the hospital and share limited sanitation facilities. Essential cleaning supplies like soap are absent, compromising hygiene and increasing infection risks. Doctors report significant concerns about spreading infections due to inadequate handwashing facilities.

Kiryn Lanning, IRC Country Director for the Gaza crisis, said, "In Gaza, a shelter we visited housing 10,000 people receives just 4,000 liters of water per day. This translates to about half a liter (0.4 liters) per person per day for drinking, washing, cooking, and cleaning, compared to the minimum standard of 15 liters per person per day - a standard developed by humanitarian organizations to ensure people affected by emergencies have access to the essentials they need to maintain their dignity and health. This severe shortage of water, especially in the north, forces people to compete to access water when delivered through water trucking, and rely on unsafe water sources like seawater and agricultural wells, increasing health risks from contaminants like pesticides and animal waste. In Gaza, I saw firsthand how the situation is worsened by poor sanitation in shelters, as evidenced by widespread diarrhea outbreaks among children. The restricted access to clean water and the low availability of hygiene items in local markets have made it nearly impossible for many to maintain basic hygiene, leading to severe public health risks.

“Put simply, we are witnessing a catastrophic decline in living standards and health conditions every day. A permanent ceasefire and a major increase in humanitarian aid and fuel are critical to putting an end to this humanitarian crisis. Without fuel, WASH services will remain substandard as fuel is essential to operate many of the water pumps, and trucks are needed for extensive water trucking and solid waste disposal.”

The crisis extends beyond water scarcity to a severe lack of adequate sanitation facilities. Many areas lack latrines, showers, or basic hygiene supplies. For example, one shelter had large families of up to ten people living in tents with makeshift latrines that have open squat holes, exposing them to further transmission of water-borne diseases. Another shelter that was visited housed over 8,000 people, with a few thousand more around the grounds, with only 12 toilets. On average, 600 people are sharing a single latrine cubicle - 30 times more people than the minimum standard of 20 people per latrine. High costs of hygiene products like soap priced at three dollars per 200-gram tablet, hinder proper hygiene and increase the risk of exploitation and abuse, particularly for women and girls, who lack access to safe and adequate toilet facilities.

Melanie Ward, MAP’s CEO, said, “When I was in Rafah last month, I saw literal lakes of human waste which have accumulated right beside tents, where children and their families are trying to survive. With some people surviving on just 3% of their minimum water needs, our doctors already report that this is leading to the spread of more infectious diseases, including diarrhea and skin diseases. But simply not having enough water can also lead to dehydration, and we have already seen children dying of dehydration and starvation in Gaza.”

“The closure of the Rafah crossing means that now just the tiniest trickle of aid is coming into Gaza. This will have further disastrous impacts for public health. The international community must do everything they can to halt Israel’s assault on Rafah and across Gaza, and avert a further health and humanitarian catastrophe.”

The IRC and MAP are continuing to provide essential humanitarian aid to communities, including distributing hygiene and menstrual kits. However, as the occupying power in Gaza, Israel must uphold its obligations to ensure that the occupied population receives adequate food and shelter and can access suitable sanitation and healthcare facilities. Israel must immediately reopen all land crossings, and allow unhindered access for aid and aid workers. 

The International Rescue Committee (IRC) and Medical Aid for Palestinians (MAP) have deployed six successive Emergency Medical Teams to provide emergency and life-saving medical care, including direct medical care at hospitals, and the distribution of medical supplies and pharmaceuticals. Our teams have also procured or released vital pharmaceuticals and medical supplies which the IRC and our partners are distributing to support health facilities across Gaza.