Hepatitis A Outbreak in Gaza: A Growing Threat to Children

The people of Gaza, already beleaguered by years of conflict and hardship, are now facing a significant public health threat: a widespread outbreak of Hepatitis A, which is spreading rapidly, including among children. The United Nations has described the situation as a “frightening increase” in Hepatitis A cases, particularly among children living in overcrowded shelters and displaced by recent conflicts. ¹ The World Health Organization (WHO) has raised alarms about the rapid spread of various infectious diseases in the area, including diarrheal diseases, respiratory infections, and bacterial infections such as cholera. The compromised health infrastructure and inadequate sanitation are significant contributing factors to this situation. These conditions hinder efforts to contain the spread of infections and to provide adequate healthcare, especially in crisis-affected regions. Diseases like cholera and other waterborne infections thrive in overcrowded environments with limited access to clean water and healthcare facilities, significantly exacerbating public health challenges and making it harder to control outbreaks. ²

The conflict in Gaza has drastically affected the health and well-being of Palestine Refugees, resulting in elevated instances of injury, trauma, and mental health issues. The destruction of infrastructure and transportation networks has exacerbated challenges in healthcare delivery. Overcrowding living conditions and inadequate access to clean water have increased the prevalence of infectious disease. Reports indicate a surge in cases of acute hepatitis and various diarrheal illnesses. ³

The Hepatitis A outbreak in Gaza remains severe, with United Nations Relief and Works Agency (UNRWA) health centers and shelters reporting 800 to 1000 new cases of acute jaundice syndrome each week. From October 2023 to October 2024, nearly 40 000 cases have been documented in UNRWA facilities, compared to just 85 cases reported during the same period in October 2022, prior to the escalation of the conflict. This dramatic increase has been described as alarming by the UNRWA Commissioner-General. ⁴ This surge presents a major public health challenge as the healthcare infrastructure struggles to respond to the crisis under the pressures of conflict and mass displacement. ⁴

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus (HAV). It spreads primarily through ingestion of contaminated food and water, a situation that is prevalent in Gaza due to the severe water and sanitation crisis. Symptoms of HAV include fever, fatigue, nausea, abdominal pain, and jaundice. While, the disease is rarely fatal, it can cause severe illness, particularly in young children and those with pre-existing health conditions. ⁵ The overcrowding living conditions and lack of access to clean water and proper sanitation in Gaza create an environment ripe for the spread of this virus. Poor living conditions and limited or no access to adequate water, sanitation, and hygiene (WASH) facilities are driving the ongoing outbreak of disease. ³

The impact of this outbreak on Gaza’s children cannot be overstated. Already vulnerable due to the socio-political climate, these children are now at an increased risk of serious health complications. The spread of Hepatitis A among children not only threatens their immediate health but also compromises their ability to attend school and participate in normal childhood activities, thereby affecting their long-term well-being and development. In the light of this urgent health crisis, immediate action is required.

International health organizations, non-governmental organizations (NGOs), and governments should prioritize and collaborate on vaccination campaigns targeting children and high-risk groups to effectively curb the spread of Hepatitis A. ⁶ Strengthening water, sanitation, and hygiene (WASH) infrastructure is essential to ensure access to safe drinking water and reduce transmission through contaminated sources. ² Additionally, deploying emergency health services with mobile clinics will help reach displaced populations who currently lack access to healthcare facilities. Lastly, improving disease surveillance and monitoring systems will be critical to track new cases and identify outbreak patterns in real-time, enabling timely interventions to control the spread of infections. ⁷

Vaccination plays a crucial role in controlling outbreaks by providing immunity, especially among children and other high-risk populations. Providing HAV vaccination campaigns could help halt the spread of the virus, as the vaccine is known to provide long-term protection and has been effective in preventing outbreaks in other regions. ⁸ Implementing targeted vaccination campaigns, as seen in ongoing polio vaccination efforts in Gaza, would be an essential step to protect vulnerable populations from Hepatitis A and minimize the public health impact.^5,9