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Epidemiology of skin diseases in the context of the war in Gaza (2) Written by Prof. Dr. Ahmad Amro

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Epidemiology of skin diseases in the context of the war in Gaza

Written by Prof. Dr. Ahmad Amro

Specialist in epidemiology/Al-Quds University

As part of a series of articles I started to shed light on the epidemiology of diseases in the context of the war in Gaza, this article aims to shed light on the epidemiology of skin diseases there, including vector-borne diseases, fungal and bacterial infections, and traditional and alternative treatment and containment methods. The ongoing war poses direct threats that exacerbate the risk of various skin diseases due to disrupted healthcare systems, overcrowded living conditions, and insufficient access to clean water and sanitation facilities. We present a classification of the most important diseases, methods of preventing them, and alternative methods of treatment and containment in light of the collapsed health system and the lack of medicine.

Diseases transmitted by insects:

They are infectious diseases transmitted to humans through the bite of arthropods, such as mosquitoes, ticks, fleas and flies, which act as vectors. Insect-borne diseases constitute more than 17% of infectious diseases in total, and cause the death of more than 700,000 people annually. These diseases can be caused by parasites, bacteria, fungus, or viruses. The accumulation of stagnant water, inadequate waste management and sanitation seen in shelters and refugees camps creates a breeding sites for disease vectors, leading to an increased risk of diseases such as malaria, dengue and cutaneous leishmaniasis. According to reports by the World Health Organization and local health authorities, cases of malaria and dengue fever are on the rise in Gaza. Prevention measures include using mosquito repellent, wearing protective clothing, mosquito nets, spraying insecticides, managing larval sources, and educating the community on personal protection. Rubbing the skin with castor oil is considered one of the most effective ways to prevent mosquitoes from approaching and avoiding their bites. Treatment usually includes antimalarial or antiviral and antiparasitic medications, depending on the specific disease.

Ectoparasites:

Ectoparasites are organisms that live on the outside of the host’s body, such as skin, hair, or feathers, and feed on blood, tissue, or body fluids. These parasites do not transmit pathogens directly from one host to another. However, they can transmit diseases indirectly through their bites or feces, leading to secondary infections or allergic reactions in humans. The ongoing war in Gaza and its consequences on the health system and overpopulation constitute a decisive factor in the emergence and spread of these diseases, which include ticks (transmitting Lyme disease and Rocky Mountain spotted fever), fleas (transmitting plague and typhus), lice (transmitting epidemic typhus and trench fever), mites (transmitting epidemic typhus and trench fever),  scabies, and scrub typhus. According to the witnesses of workers in shelter centers and refugees tents, all of these parasites are widespread among people, especially the mites that transmit scabies, but reports about the dangerous diseases transmitted by these parasites have not yet been recorded. Symptoms resulting from infection with these parasites are limited to discomfort, itching, and skin lesions, which exacerbates the difficult living conditions faced by infected individuals. Preventive measures such as regular bathing, washing clothes and bedding, using insecticide treatments, and isolating infected people from others can help control ectoparasite infestation. In addition, community-level interventions targeting environmental sanitation and personal hygiene are essential to reduce the transmission of ectoparasitic diseases. Among the treatment methods available, especially for scabies patients, and in the absence of medications and medical treatments, one can use all kinds of vinegar by wiping the affected areas three to four times a day for a week, then stopping for another week, and then repeating the process again.

Fungal infections:

Overcrowded living conditions and limited access to hygiene facilities contribute to the spread of fungal infections such as dermatophytosis (ringworm) which is a fungal infection affecting the skin, scalp or nails, candidiasis (yeast infection), and dermatophytosis also known as “athlete’s foot” or “itchy foot” which are fungal infections of the skin and nails caused by dermatophytes.

Warm and humid conditions, as well as poor sanitation, can promote the spread of dermatophyte infections. According to a report issued by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), very high rates of fungal infections have been reported among the displaced population in Gaza. Prevention strategies include maintaining personal hygiene, wearing clean, dry clothing, avoiding sharing personal items such as towels or clothing and wearing appropriate shoes in public areas. Treatment options may include the use of antifungal medications, topical creams, and traditional treatments such as herbal preparations. One of the most important ways to treat skin fungi is to use apple cider vinegar 3 times a day by placing it on the affected area using a cotton ball. Vinegar is one of the most important treatments used in treating skin fungi because it contains antifungal properties that help relieve itching and dryness. Possible treatments include using turmeric, garlic, tea tree oil, licorice powder, in addition to coconut oil.

Bacterial infections:

Inadequate sanitation and hygiene practices increase the risk of bacterial skin infections. Perhaps the most important of these diseases is cellulitis, which is a bacterial skin infection that usually affects the deeper layers of the skin and underlying tissues, impetigo, which is a highly contagious bacterial skin infection characterized by red sores or blisters that rupture and form yellow crusts, folliculitis, which is an inflammation of the hair follicles, and abscesses, which are localized collections of pus within tissues, are often caused by a bacterial infection, a eczema, which is a deeper and more serious form of impetigo that penetrates the dermis layer. Reports issued by international and local institutions highlight the extent of the spread of these infections among the displaced population in Gaza. Prevention measures include proper wound care, maintaining good personal hygiene, washing hands regularly with soap and water, avoiding scratching or touching affected skin and avoiding contact with contaminated water. Public health education and awareness campaigns can also play a crucial role in preventing the spread of bacterial infections and promoting skin health in residents in shelters and tents for displaced population. Treatment may include antibiotics, wound cleansing, and supportive care. Many plants that contain natural antibiotics can also be used, such as thyme, cloves, ginger, and garlic, in addition to honey.

The epidemiology of skin diseases, vector-borne diseases, fungal and bacterial infections, and ectoparasites during the war in Gaza emphasise the urgent need for comprehensive public health interventions. By addressing underlying risk factors, strengthening vector control measures, and improving access to health care services, it is possible to reduce the burden of these diseases and alleviate people’s suffering.

Prof. Dr. Ahmad Amro

Dean of the Faculty of Pharmacy

Al-Quds University

Mob 00970599205307

ahmad.amro@staff.alquds.edu

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