Palestinian men and children are carry water bottles in Tal Al-Sultan, a neighborhood in the southern Gaza town of Rafah.

In Gaza, lack of clean water brings disease and suffering

What is happening today in Gaza?

The long line is visible from afar, hundreds of people of all ages, most of them holding distinctive yellow or blue 40-litre jerrycans. Some live in tents close to the water truck that attracted the crowd to this spot in Rafah, a town in the south of the Gaza Strip. 

Others live in shelters up to several kilometres away and bring wheelchairs, hand trucks, shopping carts, and even strollers to carry the vital resources back to their shelters. One visually impaired man has come with his young daughter – the girl leading the way, her father carrying the water. They walked two kilometres to get here, for there is no clean water in Al-Mawasi, the coastal area where they are living.

Palestinian residents queue for water in Gaza
A group of displaced Palestinians waits in front of Abed Al-Salam Yassin company in the Tal Al-Sultan area of the southern Gaza town of Rafah.
Mohammed Abed

What has been happening since October 7?

Since the war began in Gaza four months ago, little infrastructure has been spared by the near-incessant airstrikes that have struck the enclave, including water pipes. According to UNICEF, at least half of the water and sanitation facilities in Gaza have been destroyed or damaged, while UNWRA reports that around 70 per cent of the population of Gaza is drinking salinized or contaminated water.

Palestinians in Rafah on the Egyptian border – once a town of 300,000 but now hosting 1.5 million displaced people from all over Gaza – struggle to find clean water for drinking, cooking or washing. Living conditions for people in this part of the enclave are desperate – a result of the overcrowding and the lack of clean water, toilets, showers and sewerage systems, aggravated by the cold winter weather.

People of Gaza are queueing for water in Palestine.

Lack of water and essential services in Gaza.

Doctors Without Borders (MSF) is doing water distribution, but the water needs are still bigger than MSF can provide.

Living conditions in Gaza

“We have noticed that, due to the lack of clean water for drinking or other uses, patients suffer from intestinal disorders and the flu virus, which is circulating widely,” says MSF health promotion manager Mohammad Abu Zayed. “Lately, we’ve also witnessed children suffering from skin rashes due to the lack of clean water for bathing or washing.”

Other health risks include dehydration and hepatitis A. "The lack of clean water can lead to many diseases related to the quality of the water, such as diarrhoea and skin diseases, but simply not having enough water can also lead to dehydration," says MSF medical advisor Marina Pomares in Gaza. Cooking and personal hygiene are also affected, increasing the risk of infection. "The effects are worse in children, who have weaker immune systems than adults and are more exposed to diseases and allergies," she says.

Palestinian men and children are carry water bottles in Tal Al-Sultan, a neighborhood in the southern Gaza town of Rafah.
Palestinian men and children are carry water bottles in Tal Al-Sultan, a neighbourhood in the southern Gaza town of Rafah.
Mohammed Abed

Doctors Without Borders (MSF) teams helping in Gaza

MSF teams are providing basic healthcare in two locations in Rafah. As of 2 February, almost 30 per cent of morbidities of patients under five years old coming to the MSF Shaboura clinic and Al-Mawasi health post were for diarrhoea or skin diseases. In recent weeks, MSF teams in Rafah have also received 43 patients with suspected hepatitis A. These medical conditions are all related to the shortage of clean water and are compounded by the lack of functioning medical facilities in the area.

To respond to some of the most urgent needs of the displaced people in Rafah, MSF teams started a water distribution programme in December 2023. Today, MSF water and sanitation teams provide an average of 110,000 litres of safe drinking water daily to around 20,000 people. However, this is nowhere near enough to go around. “In a normal situation, one person needs two to three liters of drinking water per day,” says MSF water and sanitation agent Youssef Al-Khishawi. “Now, with the current shortage, the average for one family of six is one gallon of water (3.8 litres).”

Infographic about MSF water supply on Rafah, Gaza, since December 2023.
Infographic about MSF water supply on Rafah since December 2023.
MSF/Jorge Montoya
If we get the chance to get some water, we will use it for washing and dish-washing, and if we can’t get any water, we will wait for the next day. Hanin, a displaced woman in Gaza

Surviving in Gaza

Hanin fled her home in Gaza City in the early days of the war due to shelling and is now sheltering in Rafah. Like most people in the town, she struggles to get hold of enough food, water and other essentials. "We stand in lines to get water,” she says. “If we get the chance to get some water, we will use it for washing and dish-washing, and if we can’t get any water, we will wait for the next day.”

Proving aid and calling for a ceasefire in Gaza

MSF is ready to scale up the amount of water distributed, but other types of shortages stand in the way of the process, such as the limited number of trucks allowed into the enclave carrying aid and fuel. “The main challenge we face in distributing water is the lack of fuel to pump and transport it,” says Al-Khishawi. “The second is the lack of proper roads for our trucks to drive on, because there are tents even on the asphalt. The third is that there are no water distribution points – even they have been bombed. Water pipes, streets and infrastructures are destroyed.”

Image of Al-Awda Hospital destroyed in Gaza.

Inside Gaza Episode 1, with Jacob Burns, MSF Project Coordinator.

Jacob Burns, Doctors Without Borders (MSF) project coordinator, arrived in southern Gaza on 17 December 2023. He shares what he saw and experienced at the heart of the conflict during his first days on the ground through a series of audio recordings divided into four episodes. The recordings were made on 22, 24, 25 and 26 December 2023.

MSF reiterates its calls for a sustained ceasefire, which is the only way for people in Gaza to return to their homes. It also calls for the flow of humanitarian aid into Gaza to be restored and scaled up so as to ensure people have access to essential items such as food, water and healthcare.