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Cover: REUTERS/Ibraheem Abu Mustafa
iii
Preface
Gaza has long suffered from a dual water crisis: a shortage of potable
water for drinking, cooking, and hygiene, combined with a lack of
wastewater sanitation. In addition, more than 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 infrastruc-
ture, strict limitations on the importation of construction materials
and water pumps, and a diminished and unreliable energy supply have
in recent years accelerated the water crisis and exacerbated the water-
related health risks.
This report describes the relationship between Gaza’s water prob-
lems and its energy challenges and examines the implications of Gaza’s
water crisis for public health. It reviews the state of the current domes-
tic water supply and state of water sanitation in Gaza and analyzes
water-related risks to public health in Gaza and potential risks for Israel
and Egypt. The report then recommends a number of steps to amelio-
rate 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, includ-
ing the Palestinian, Israeli, and Egyptian governments, various interna-
tional organizations and nongovernmental organizations working on
the ground there, and the donor community seeking to rehabilitate the
region. The report should also be valuable to academics and experts
assessing the current status of Gaza’s humanitarian crisis and its pos-
sible effects if unaddressed.
ivThe Public Health Impacts of Gaza’s Water Crisis: Analysis and Policy Options
This report was funded through the generous contributions of
the RAND Center for Middle East Public Policy (CMEPP) Advisory
Board and conducted within CMEPP, part of International Programs
at the RAND Corporation.
RAND Ventures
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safer and more secure, healthier and more prosperous. RAND is non-
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tributions support our ability to take the long view, tackle tough and
often-controversial topics, and share our findings in innovative and
compelling ways. RAND’s research findings and recommendations are
based on data and evidence, and therefore do not necessarily reflect
the policy preferences or interests of its clients, donors, or supporters.
Funding for this venture was provided by gifts from RAND supporters
and income from operations.
RAND Center for Middle East Public Policy
This work was conducted within the RAND Center for Middle East
Public Policy (CMEPP).CMEPP brings together analytic excellence
and regional expertise from across the RAND Corporation to address
the most critical political, social, and economic challenges facing the
Middle East today. For more information about the RAND Center for
Middle East Public Policy, visit/cmeppor contact the
director (contact information is provided on the webpage).
v
Contents
Preface .....iii
Figures and Table ....vii
Summary ..ix
Acknowledgments .xvii
Abbreviations ........xix
CHAPTER ONE
Introduction ...........1
CHAPTER TWO
Water and Wastewater Services in Gaza ..9
Gaza’s Water Supply: Limited in Both Quantity and Quality—
and Unaffordable .10
Sewage Treatment Is Only Partially Operational....19
Energy Scarcity Complicates Water and Wastewater Treatment ...........20
CHAPTER THREE
Public Health Risks from Water Contamination ..25
Chemical Contamination .......27
Biological Contamination ........32
Health Risks Associated with Water Quantity and Hygiene..38
Potential for Waterborne Disease Spread to Israel and Egypt ...41
Medical and Public Health Response Capacity.....44
CHAPTER FOUR
Conclusions and Policy Recommendations .........47
Energy Supply Recommendations..........47。