Overview
Among the Gaza Strip’s unstable and displaced communities, where inhabitants may encounter snakes and other deadly reptiles around temporary shelters and living areas, snakebite envenoming poses a health risk. The constant mobility of these communities, coupled with severely limited access to health care due to the ongoing conflict, exacerbates the vulnerability of these populations to snake bites.
Globally, snakebite envenoming affects millions. It is a concern in the Gaza Strip, where displaced populations can encounter venomous snakes in and around temporary shelters and communal areas. Overcrowding in shelters and the makeshift nature of living spaces increase risks among displaced populations who often reside or gather outside due to lack of space. Bites by venomous snakes can cause severe health outcomes such as paralysis that may prevent breathing, bleeding disorders that can lead to fatal haemorrhaging, irreversible kidney failure and local tissue damage that can result in permanent disability and limb amputation. Children may suffer more severe effects and can experience the effects more quickly than adults due to their smaller body mass.
Most of the deaths and serious consequences caused by snake bites could be prevented if antivenoms were more widely available and accessible. Antivenom, derived from antibodies created in response to snake venom, neutralizes the toxic effects of venom and can prevent or reverse its effects, including severe tissue damage and paralysis.
High-quality snake antivenoms, the most effective treatment to prevent or reverse most of the venomous effects of snake bites, are included on WHO’s list of essential medicines for primary health care. Given snake bites pose a risk in Gaza, it is important that antivenoms are included in international aid and integrated into primary health care packages.
Key challenges facing Gaza’s displaced communities
- Direct exposure to venomous snakes
- Frequent relocation and the makeshift nature of shelters increase the risk of snake encounters. Tents and temporary shelters can allow snakes easier access to human habitats and the lack of permanent shelters means children often play and live outside, increasing the risk of exposure to venomous snakes.
- Severely limited medical resources
- Ongoing blockades and conflict severely restrict access to medical supplies, including antivenoms, and the transient nature of communities complicates the distribution and storage of medical aid.
- Infrastructure and educational gaps
- Continuous displacement disrupts formal education and community structures, hindering the dissemination of information about snake bite prevention and first aid.
- Data collection on snake bite incidents is scarce due to the transient population and damaged health care infrastructure, leading to gross underestimations of the extent of the problem.
Strategies for managing snakebite envenoming in Gaza
1. Enhanced habitat safety and adaptive community engagement
- Prevention of snake bites
Protective footwear
80% of snake bites occur below the knee on the legs or feet. This could be prevented if people had access to affordable, practical and protective footwear and were better informed about the importance of wearing shoes.
Environmental management
Clearing up and keeping grass short in areas close to dwellings, along pathways and in places where children play can reduce the likelihood of snake bites. Organize community-led efforts to inspect and clear debris, trash and overgrown vegetation which might harbour snakes from around tents and communal living areas. Given the constraints in Gaza, focus on quick and effective clearing actions that require minimal time and resources.
Use lights at night
Using a light when walking outside at night is essential in areas where snakes forage after dark. A short walk to an outdoor latrine can be fatal if you step on a snake in the dark.
Sealing makeshift shelters and sleeping on raised platforms
Use mobile alerts and local community meetings to inform residents about ways to create safer sleeping areas. Emphasize the importance of sealing makeshift shelters to prevent snake entry and, where this is not possible, recommend sleeping on a raised platform with a well-tucked in mosquito net which can prevent mosquito-borne diseases as well as snake bites. Implement effective barriers using available materials such as fabric or plastic sheets to fill gaps that could serve as entry points for snakes.
2. Community education and practical safety measures
Encourage communities, even those with limited clothing options, to wear the safest possible attire and cover legs and feet. Distribute any extra fabric and protective material that can be adapted into protective wear.
Hold brief, focused sessions at community gathering points to inform communities of signs indicating that snakes might be present and ways to avoid snake bites, emphasizing that avoidance is safer than identification and confrontation.
3. Resource-efficient alert systems and rapid response
Develop a resource-efficient alert system using visual signals or verbal alerts within the community to communicate information about snake sightings. The system should be simple to use and could include signals such as flags or painted rocks positioned prominently.
Provide basic training on emergency response to snake encounters, tailored to a limited medical resource context, including immobilizing the bitten area and seeking immediate help.
Establish a simple procedure for communities to report snake sightings to a designated community member who can coordinate safe removal and/or containment efforts.
Formulate plans for community response when a snake is sighted that keeps the area secure and monitors snake presence without exposing individuals to snakes.
4. Targeted first aid education and improvised care
Provide training on first aid for snake bites, focusing on immediate steps like immobilization of the affected area and the importance of maintaining calm to slow the spread of venom.
Immobilizing the bitten limb involves keeping as still as possible to slow the spread of venom through the lymphatic system. This can be achieved by using splints or makeshift supports to secure the limb fully.
Provide instructions on applying immobilization bandages. Start by wrapping a bandage directly over the bite site, with enough pressure to lightly compress the tissue but not so tight as to cut off blood circulation. Extend the wrapping to cover the entire limb, from the extremities towards the body, to help slow the movement of venom.
Emphasize the importance of keeping the patient calm and stationary. Movement can increase heart rate and blood circulation, speeding up the spread of venom. Encourage the use of reassuring communication to prevent panic.
Regularly refresh training and provide accessible, easy-to-understand instructional materials, such as posters or handouts, which outline step-by-step first aid responses for snake bites. These resources should be readily available in community centres, schools and other public places.
5. Building health care collaboration amidst conflict
Develop partnerships with international NGOs and health agencies to facilitate snake bite management training and mobile clinics equipped with supplies, tailored for rapid deployment in response to snake bite incidents in high-risk zones.
Advocate for the stockpiling and distribution of antivenoms within displaced communities, training local volunteers in their administration under emergency conditions.
6. Integration of local knowledge and practical innovations
Partner with local healers and community elders to create awareness of snake bite symptoms such as swelling, severe pain or difficulty breathing which need urgent medical intervention.
Explore and, where possible, introduce low-tech solutions such as simple mechanical traps to safely capture snakes and natural repellents derived from local plants known to deter snakes and control snake populations near human habitats.
Conclusion
Creating awareness on the increased risk of snake bites, prevention and effective management of snakebite envenoming in displaced communities in the Gaza Strip requires an adaptive, community-focused strategy that takes into account the challenges posed by community living conditions and constant mobility.
Strengthening community education, health care collaborations and innovative, locally adapted solutions should aim not only to reduce the incidence of snake bites but build enduring health resilience within these vulnerable populations.
Sources
Snakebite envenoming. Geneva: World Health Organization; 2023.