Ever since Israel intensified its attacks on Palestine in October 2023, sparing not even hospitals, more than 66,000 Palestinians have been killed, according to the latest bulletin from the Gaza’s Health Ministry. But nearly three times that number of people, some 1.6 lakh, have been left grievously wounded.
In this crisis comes a worrying report on Gaza’s health crisis in the latest edition of The Lancet Infectious Diseases: according to the paper, disease outbreaks have proliferated in the area, and now the infections are becoming multidrug resistant as well, imposing a new challenge on an already beleaguered population.
Multi-drug resistance is defined “as non-susceptibility to at least one drug in three or more classes”. In the study, the researchers calculated the multiple antibiotic resistance (MAR) index for each isolate. The index is equal to the number of antibiotics to which an organism is resistant divided by the number of antibiotics to which it was exposed.
Ballistic, crush trauma
Tests on 1,317 samples collected from al-Ahli hospital in Gaza revealed that MAR was reported in over two-thirds of the samples (in the form of pus, wound swabs, and urine) collected last year, “reflecting the overwhelming burden of ballistic and crush trauma,” the paper, authored by scientists including faculty at the Islamic University of Gaza, read.
Pseudomonas aeruginosa, a bacteria already known to be associated with serious illnesses, including hospital-acquired infections such as ventilator-associated pneumonia, dominated, followed byStaphylococcus aureus, common cause of skin abscesses and respiratory infections; Klebsiella, known to cause pneumonia, urinary tract infections, and meningitis; and Escherichia coli, which can cause serious food poisoning.
The study also found that two-thirds of all isolates were multidrug resistant.
“We found high resistance among Enterobacterales spp. isolates, with more than 90% of wound isolates resistant to amoxicillin–clavulanate, cefuroxime, and cefotaxime. Resistance to ceftriaxone and ceftazidime was also alarmingly high in wound isolates,” the paper noted.
Children targeted
Gaza’s healthcare system has been progressively devastated by Israel’s onslaught. Since October 2023, one of Gaza’s only functioning microbiology service centres is a small laboratory at Al-Ahli Arab Hospital in Gaza City, which retained power largely via diesel generators and battery inverters.
“The hospital, which is one of the only hospitals in Gaza that has remained partly operational, has treated large volumes of traumatic injuries despite frequent airstrikes (beginning as early as October, 2023, and continuing at the time of writing) in the northern two governorates of the Gaza Strip,” the paper read.
According to the World Health Organisation (WHO), between October 7, 2023, and July 30, 2024, Israel carried out 498 attacks on healthcare facilities in the Gaza Strip. “A total of 747 persons were killed directly in those attacks and 969 were injured, and 110 facilities were affected,” the Independent International Commission of Inquiry for the U.N. reported. As many as 500 medical staff were killed while Israeli security forces also blocked access by humanitarian agencies.
“Direct attacks on healthcare facilities, including those offering sexual and reproductive health care and services, have affected about 540,000 women and girls who are of reproductive age in Gaza,” it added.
The U.N. report also said the high number of child deaths is likely attributable to the fact that “children represent a majority of the patients treated in hospitals for blunt and penetrating trauma”.
Medical professionals told the Commission they had treated children with direct gunshot wounds, meaning the kids had been targeted.
“Children were operated on without preoperative and post-operative care, increasing the risk of wounds becoming infected, including by insects and parasites, resulting in complications and, in some cases, death,” the report said.
Vulnerable to disease
“A major finding is that about 76% of that sample did come from blast- or trauma-related injuries, which speaks to the volume of blast-related injuries that are coming in as a result of the Israeli military assault on Gaza,” Bilal Irfan, a coauthor of the study and a global health scholar with an interest in bioethics, conflict medicine, and trauma systems, with the Centre for Bioethics at Harvard Medical School, said in an interview with a US daily.
We don’t even know the true scale “because of the destruction of almost all the laboratories and the killing of a lot of the medical staff, so to even get a small insight into what is happening in Gaza is extremely important,” Dr. Irfan, who also conducts research at Harvard’s Brigham and Women’s hospital and the University of Michigan, told The Guardian. “We don’t even know the true scale because of the destruction of almost all the laboratories and the killing of a lot of the medical staff, so to even get a small insight into what is happening in Gaza is extremely important.”
Al-Ahli Arab Hospital has also been reporting an increasing number of daily admissions with little sterile irrigation fluid, wounds remaining undressed for days, and only ad-hoc donations of broad-spectrum antibiotics, per the paper. “Long-term sheltering of displaced families outside the hospital might also have contributed to transmission of infectious diseases,” it added.
Beyond Gaza’s borders
The international medical community “has a duty” to act and respond to this crisis, the paper’s authors wrote.
“First and foremost, health-care workers and governments worldwide must advocate for the cessation of the Israeli military invasion that has resulted in a surge of trauma injuries and the widespread deliberate targeting of hospitals, laboratories, and water desalination plants; without this ceasefire, the infection burden will escalate further.”
It added that drug supply should be coordinated across humanitarian agencies and donors, perhaps through the WHO, so that the antimicrobial response can be tailored to the documented need of hospitals.
“If protection of Palestinian health facilities, antibiotic supply pipelines, and functional laboratories are not secured soon, the resistant organisms documented here will probably disseminate far beyond Gaza’s borders,” the paper warned.
