JUANA SUMMERS, HOST:
In Gaza, the World Health Organization says that disease may ultimately kill more people than direct military action. The group says rates of infectious diseases are, quote, "soaring." Already, over 100,000 cases of diarrhea have been reported. NPR's Ari Daniel has this story about the efforts to spot and prevent outbreaks in an increasingly desperate situation.
ARI DANIEL, BYLINE: In times of war and of peace, tracking illnesses is crucial for keeping a population healthy. Rick Brennan is a regional emergency director with the WHO.
RICK BRENNAN: It's our way of detecting the emergence of diseases that can result in an epidemic very, very quickly.
DANIEL: Public health experts told me that before the war, despite the Israeli blockade, Gaza's health system was doing a pretty good job - solid vaccination rates, three dozen hospitals and effective disease surveillance.
BRENNAN: There was a reasonably good system to pick up cases of infectious diseases, to transfer the specimens to test them in the laboratories, and then implement control measures.
DANIEL: But since the October 7 Hamas attack, that system, along with the rest of Gaza's health infrastructure, has crumbled amidst Israel's bombardment and ground offensive. That's because Israel has accused Hamas of harboring fighters and weapons in and around hospitals and under them in tunnels, putting them in the line of fire. The WHO says only a quarter of Gaza's hospitals are partially functional. Tahrir Al-Sheikh is a pediatrician in Gaza. She was working at Al-Nasr Children's Hospital until the war displaced her to the south, where she's been offering medical help. She spoke with our producer, Anas Baba.
TAHRIR AL-SHEIKH: (Through interpreter) We used to culture bacteria in Gaza, prescribe medication based on the results. Now we can't do cultures or anything, and the infections are spreading.
DANIEL: She's seeing brutal cases of diarrhea.
AL-SHEIKH: (Through interpreter) I treated a 4-month-old baby who had 20 bowel movements in a day.
DANIEL: Along with a torrent of respiratory diseases.
AL-SHEIKH: (Though interpreter) I've had cases that didn't respond to any treatment, but I can't say they have COVID. I can't diagnose it because I don't have the equipment.
DANIEL: All this disease is being accelerated by the brew of conditions inside Gaza right now. Marwan Al-Homs directs the Mohammed Yousef El-Najjar Hospital in Rafah.
MARWAN AL-HOMS: (Through interpreter) Wherever there's overcrowding, these epidemics exist - inside shelters, even in tiny apartments where the number of inhabitants is 35 people.
DANIEL: Plus, there's the colder winter weather and a lack of clean water, sanitation and proper nutrition - services that are difficult to secure under Israel's near-total siege of Gaza.
AMBER ALAYYAN: It's just sort of a cauldron of possibility of infectious disease.
DANIEL: Amber Alayyan is deputy program manager for Doctors Without Borders in the Palestinian territories.
ALAYYAN: If you have no access to antibiotics because you can't get to the doctor, then something that's so simple to treat can turn into something quite deadly. This really just is an infectious disaster in waiting.
DANIEL: Which the WHO says could endanger even more lives than combat. So global health groups are racing to ramp up disease surveillance efforts in Gaza to avoid a cholera outbreak, like in Syria or Haiti, or a measles outbreak, like in Somalia. A WHO official recently traveled from Jerusalem to Gaza to bring rapid diagnostic tests for hepatitis and cholera. They're hoping to resuscitate one or two of the local laboratories in Gaza that did pathogen screening before. In addition, says Rick Brennan...
BRENNAN: We are looking at options to even bring a mobile laboratory from outside.
DANIEL: Meanwhile, Brennan says he's relieved that some of the really terrible diseases, like measles or cholera, haven't surfaced yet in Gaza, in part due to pre-war vaccinations.
BRENNAN: If we get an influenza outbreak into those massively overcrowded shelters, if we've got Shigella dysenteriae, that could rip through a community very quickly. And to be honest, you know, I'm grateful that we've got to this point. We've got increased rates, but we haven't had a deadly outbreak yet.
DANIEL: Whether that good fortune lasts isn't certain. But health experts say testing and surveillance are crucial for identifying the first handful of cases of something sinister, ideally while it can still be contained. Ari Daniel, NPR News. Transcript provided by NPR, Copyright NPR.
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