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Gastrointestinal diseases in the context of the war in Gaza

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Written by Prof. Dr. Ahmad Amro

Specialist in epidemiology/Al-Quds University

In reference to the press release issued by the Palestinian Central Bureau of Statistics on Monday, April 7th, which highlighted the collapse of the healthcare system in the Gaza Strip and the absence of medical supplies, medicines, food, water, and fuel, along with continuous assaults and targeting of medical workers leading to the closure of many hospitals and healthcare centers, out of 36 public hospitals in the Gaza Strip, only 10 hospitals are partially operational (4 in the north and 6 in the south and center). As part of a series of articles initiated to shed light on the epidemiology of diseases in the context of the war in Gaza, this article aims to highlight the epidemiology of gastrointestinal diseases in an attempt to address the most common diseases, their causes, treatment options, and possible preventive measures, including traditional and herbal treatments.

It is difficult to ascertain the exact number of cases of gastrointestinal diseases in the Gaza Strip during the war due to limited access to healthcare services and reporting mechanisms. However, the Palestinian Central Bureau of Statistics reports indicate that more than 90% of children under the age of five were previously infected with at least one infectious disease. Moreover, at least 31 deaths were reported due to malnutrition and dehydration, including 28 children, and nearly 346,000 reported cases of diarrhea, of which 105,635 were among children under five years.

Types of gastrointestinal diseases:

Acute Gastroenteritis (AGE): Acute gastroenteritis is one of the most common gastrointestinal diseases in wartime, characterized by diarrhea, vomiting, abdominal pain, and fever. Causative agents include bacteria, viruses, and parasites, which thrive in unsanitary conditions of interrupted water supply and sanitation.

Hepatitis A: This is a viral infection transmitted through feces and mouth, usually associated with poor sanitation and hygiene practices. The patient shows symptoms such as jaundice, fatigue, nausea, and abdominal pain. According to reports issued in March, the Ministry of Health in Gaza Strip indicated that more than 31,348 cases of Hepatitis A infection have been recorded.

Typhoid fever: Typhoid fever is caused by the bacteria Salmonella typhi, which is transmitted primarily through contaminated food and water. Symptoms include persistent fever, abdominal pain, headache, and diarrhea.

Cholera: Cholera is an acute diarrheal infection caused by the cholera bacteria, which is often spread through contaminated water and food. It leads to watery diarrhea, vomiting, and dehydration, which can be fatal if not treated immediately.

Amoebic dysentery: This disease is caused by a group of protozoan parasites (amoeba and giardia), and it is characterized by bloody diarrhea, abdominal cramps, and fever. It poses a great danger due to insufficient sanitation facilities.

The spread of these diseases in Gaza during the war can be attributed to several factors, including contaminated water sources, the collapse of sewage disposal systems, and overcrowded living conditions in shelters and refugee camps, which facilitate the rapid spread of pathogens. Furthermore, healthcare services are disrupted, hindering appropriate diagnosis and treatment. Since October 7th, the World Health Organization has documented over 600 attacks on healthcare facilities. Moreover, food insecurity and food safety practices leading to the consumption of contaminated food should be considered.

Treatment options:

Management of gastrointestinal disease during wartime requires a multifaceted approach, including treatment of dehydration resulting from recurrent diarrhea and vomiting. Fluids must be given intravenously for severe cases of dehydration. Antibiotic treatment for bacterial infections, especially those causing typhoid fever and dysentery, is also necessary. Additionally, medications to relieve symptoms of abdominal pain, nausea, and fever are essential.

In the absence of diagnostic capabilities and the scarcity or absence of medicines, resorting to preventive measures and potential containment is crucial. These measures include improving sanitation, as enhancing sewage infrastructure and promoting cleanliness practices such as handwashing and proper waste disposal can prevent the spread of gastrointestinal pathogens. Additionally, ensuring access to clean and safe water is essential for preventing waterborne diseases such as cholera and hepatitis A. Boiling water before drinking or cooking is necessary. Health education campaigns to raise awareness about the importance of food and water hygiene, proper sanitation, and early recognition of gastrointestinal disease symptoms are crucial in reducing the burden of these infections.

One of the fundamental crisis prevention measures, especially for children, is the implementation of vaccination programs against preventable diseases such as viral hepatitis A, which can reduce the incidence of disease outbreaks during wars.

Regarding traditional and herbal treatments, which can be resorted to in the face of resource scarcity and the collapse of the healthcare system, here are some therapeutic recipes that can be used:

Ginger: Ginger is a natural antiemetic and can be used to relieve nausea and vomiting associated with intestinal diseases.

Garlic: Garlic is a natural herb that possesses antibacterial, antiviral, anthelmintic, and antiparasitic properties, and can be used to effectively combat intestinal infections.

Chamomile: Chamomile is used to soothe the digestive system and relieve inflammation, making it a suitable option for relieving pain and reducing intestinal bloating.

Thyme: Thyme is considered an herb with antibacterial and anti-inflammatory properties, and it can be used to treat gastrointestinal infections.

Cumin: Cumin is useful for stimulating digestion, relieving bloating and intestinal gas, and it also has antibacterial properties.

Cloves: Cloves are used to relieve stomach pain and indigestion, and are considered antibacterial and antifungal.

In conclusion, the spread of gastrointestinal diseases during the war in Gaza poses a significant challenge to public health, exacerbated by weak infrastructure and limited access to healthcare services. Efforts by international organizations and local authorities to address these issues should focus on improving sanitation, ensuring access to clean water, promoting health education, and implementing vaccination programs. Furthermore, integrating traditional and herbal treatments into healthcare practices may provide complementary benefits in managing gastrointestinal diseases and protecting the health of the population.

Prof. Dr. Ahmad Amro

Dean of the Faculty of Pharmacy

Al-Quds University

Mob 00970599205307


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