Breaking Point in the Gaza Strip: The ‘Cracking’ of the WASH-Health Nexus Since October 2023

Communities in Gaza face an unprecedented long-term water crisis, worsened by the war from October 2023 to October 2025 which has intensified the already dire situation caused by a 16-year blockade of Gaza. The recent blockades imposed after 7 October 2023 impeded the entry of goods, resulting in water and food insecurity and worsening severe public health issues exacerbated by these resource shortages. These developments have further exacerbated the already fragile conditions of Water, Sanitation, and Hygiene (WASH) infrastructure and installations. Access to clean water has decreased by 94 percent, to <5 liters/person/day, well below the World Health Organization’s (WHO) minimum standards. The crisis has damaged 84.6 percent of critical WASH infrastructure in Gaza, causing operational services to decline and leaving no functional wastewater or desalination treatment plants. Over 1.9 million people (90 percent of Gaza’s population) have been displaced. Due to overcrowded living conditions and inadequate sanitation, there has been a fivefold increase in the spread of epidemics compared to pre-war levels, including the recrudescence of polio in 2024. WASH-related diseases have surged, and the destruction of wastewater treatment facilities has contaminated freshwater resources, leading to severe health burdens for individuals, people, and communities. Gaza’s healthcare system is overwhelmed and unable to respond adequately to the crisis. Many health facilities have been damaged or rendered non-operational due to the conflict. Despite the scale of conflict that has severely limited the healthcare sector’s capacity for disease surveillance and ability to detect and track health conditions across the entire Gaza Strip, the WHO and the local health authorities have been able to scale up a flexible disease surveillance system in many of the shelters and health facilities.  

In this working paper, we take stock of how the ongoing escalation of violence in the Gaza Strip has pushed the WASH and health systems to a breaking point, severely impacting both disease control and overall well-being. We assert that urgent action is needed to restore essential delivery service, improve healthcare capacities, implement disease prevention measures, and address human rights violations related to immediate water access and long-term water security (including a dedicated focus on the WASH-health nexus). We call for active and meaningful collaboration between local authorities, humanitarian agencies, and international organizations as ‘response and recovery’ processes and protocols are discussed and designed. Plans must meet Gazans’ needs by addressing the complexity of fully addressing this nexus. Overall, the situation demands immediate attention, sustained intervention, and long-term solutions to protect the health and well-being of Gaza’s residents, ensuring their fundamental human right to clean water, adequate healthcare, and infrastructure rehabilitation. Assessments from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) from July 2025 indicate that 1 million people in Gaza are accessing less than 6 liters of drinking water per day, a level catastrophically below emergency minimum standards. The crisis in Gaza has resulted in severe damage to critical WASH infrastructure, amounting to a complete loss of safely managed sanitation for the entire population. These new assessments underscore the growing intersection between climate-induced vulnerabilities, displacement, and public health emergencies, reinforcing the urgent need for integrated policy action.