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Gaza's young and growing population lacks water not only for drinking but also for hygiene and sanitation

• More than a quarter of all reported disease in Gaza is caused by poor water quality and access.
• Chemical and biological contamination could lead to bacterial (cholera, Salmonella, Shigella), parasitic (Giardia), and viral (polio, viral meningitis) infections.
• If present trends continue, Gaza and the surrounding region are at risk of a disease outbreak or another water-related public health crisis.

Recent events have accelerated Gaza's longstanding water challenges

• The main source of Gaza's water, its aquifer, is being depleted and its quality diminished by seawater intrusion, wastewater seepage, and agricultural runoff.
• Gaza's inconsistent energy supply greatly limits the operations of its water and wastewater treatment facilities.
• Recurring wars between Israel and Hamas have damaged Gaza's water infrastructure.

Gaza's water crisis could be resolved through greater investment in water and power infrastructure as well as additional water or electricity purchases, but many barriers remain

• Israel and Egypt, Gaza's neighboring states, severely restrict access and movement of goods into Gaza, including materials needed for repairs and construction of electricity, water and wastewater infrastructure.
• Intra-Palestinian strife and a governance vacuum in Gaza have exacerbated externally inflicted damage in severely limiting the power supply and hindering reconstruction.
• International aid has been pledged inconsistently yet not followed through in full.
• Political complications hinder the implementation of all proposed solutions.

Gaza has long had water and sanitation challenges, but today it is in a state of emergency. Its dual water crisis combines a shortage of potable water for drinking, cooking, and hygiene with a lack of wastewater sanitation. As a result, over 108,000 cubic meters of untreated sewage flow daily from Gaza into the Mediterranean Sea, creating extreme public health hazards in Gaza, Israel, and Egypt. While these problems are not new, rapidly deteriorating infrastructure, strict limitations on the import of construction materials and water pumps, and a diminished and unreliable energy supply have accelerated the water crisis and exacerbated the water-related health risks. Three wars between Israel and Hamas since 2009 and intra-Palestinian rivalry between Hamas and Fatah have further hindered the rehabilitation of Gaza's water and sanitation sectors.

This report describes the relationship between Gaza's water problems and its energy challenges and examines the implications of this water crisis for public health. It reviews the current state of water supply and water sanitation in Gaza, analyzes water-related risks to public health in Gaza, and explains potential regional public health risks for Israel and Egypt. The authors recommend a number of steps to ameliorate the crisis and decrease the potential for a regional public health disaster that take into consideration current political constraints. The audience for this report includes stakeholders involved in Gaza, including the Palestinian, Israeli, and Egyptian governments, various international organizations and nongovernmental organizations working on the ground in Gaza, and the donor community seeking to rehabilitate Gaza.

• Chapter One

  Introduction

• Chapter Two

  Water and Wastewater Services in Gaza

• Chapter Three

  Public Health Risks from Water Contamination

• Chapter Four

  Conclusions and Policy Recommendations