Addressing Water, Sanitation, and Hygiene insecurity and health outcomes for internally displaced persons: immediate interventions needed – a commentary on Zinszer & Abuzerr (2024), http://dx.doi.org/10.2166/washdev.2024.361

Dear Editor,

The severe Water, Sanitation, and Hygiene (WASH) insecurity of the populations in Gaza who have been forcibly displaced and continue to endure WASH insecurity must be addressed immediately.

Recently, Zinszer & Abuzerr (2024) addressed the impact of WASH insecurity on the health of internally displaced populations (IDPs) in the Gaza Strip. Their study provided a comprehensive assessment of the health challenges faced by these vulnerable groups, revealing alarming incidence rates of infectious diseases, particularly diarrhea and acute respiratory infections. However, their findings warrant a deeper exploration of the implications of WASH conditions on health outcomes, particularly in the context of the complex humanitarian landscape in Gaza.

Psychological distress can impact reported health outcomes, as noted in the study by Iasiello et al. (2022). It has been observed that individuals suffering from high levels of distress may underreport their actual health status or overstate a misinterpretation of their health. This tendency to underreport or misreport health status compromises the reliability of survey data. Therefore, it is essential to complement self-reported health measures with objective assessments to improve the quality of health-related data, particularly among at-risk populations such as IDPs.

The report on the health impacts of displacement in Yemen also elaborated that while the authors connect the disease outcome directly to WASH security, broader determinants of health must still be taken into account. This would include nutrition, access to healthcare, and pre-existing health conditions, which significantly affect health outcomes among IDPs (Suprenant et al. 2020). It is also important to remember that malnutrition increases the risk of infectious diseases, and therefore, any WASH-related interventions will be incomplete – but necessary – when the underlying issues cannot be addressed. The integration of these interrelated factors is, therefore, essential for a proper understanding of the health problems experienced by displaced populations (Sinha & Guerrant 2024).

The study calls for immediate action to improve WASH conditions among IDPs in Gaza. However, any such intervention must take into account the context of the zone of conflict. The ongoing political instability and security challenges in the region pose significant barriers to effective humanitarian response. Al-Haq (2024) highlighted that the ongoing challenges faced by individuals have led to significant hardships, ultimately hindering their ability to access essential services and resources. The authors should take into consideration the consequences of these challenges on the proposed interventions and rethink the strategies that could help overcome the challenges of implementing such projects in the context of the humanitarian crisis. Involving local partners who have built confidence among the populations may in return increase the effectiveness of WASH programs.

I hope this commentary connects to the remarks made regarding the urgent situation of displaced populations in Gaza. Their health and survival are at stake, and we have to speak out in their favor.

Sincerely,

Genie Rose C. Tiempo

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.