World Health Organization
منظمة الصحة العالمية
Organisation mondiale de la Santé

UNRWA’s health service in Gaza: Challenges and response to the October 2023 crisis

Print

PDF version

Review

Ghada Aljadba1, Zoheir Elkhatib2, Khalil Hamad1, Sayed Shah2, Wafaa Zeidan2, Shatha Albeik2 and Akihiro Seita2

1Gaza Field Office, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Gaza. 2United Nations Relief and Works Agency for Palestine Refugees in the Near East Headquarters, Amman, Jordan (Correspondence to Shatha Albeik: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Keywords: healthcare access, UNRWA, Gaza

Citation: Aljadba G, Elkhatib Z, Hamad K, Shah S, Zeidan W, Albeik S, Seita A. UNRWA’s health service in Gaza: Challenges and response to the October 2023 crisis. East Mediterr Health J. 2025;31(2):73–76. https://doi.org/10.26719/2025.31.2.73.

Received: 06/11/2024; Accepted: 20/01/2025

Copyright: © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

UNRWA’s health system in Gaza before October 2023

Before 7 October 2023, the health programme of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in Gaza operated 22 primary health centres with over 1000 health professionals. Despite challenges like poverty, prolonged siege and an overwhelmed healthcare system, it achieved notable milestones. The programme delivered comprehensive primary health care, including maternal and child health, non-communicable disease care, and mental health support. It served over 100 000 diabetes and hypertension patients, provided 35 000 antenatal care visits, and maintained robust infectious disease surveillance system. The programme achieved 100% vaccination coverage and used digital health technologies to manage over 3.5 million consultations annually (1).

The health shock of October 2023

Since 7 October 2023, Gaza’s healthcare system has faced severe disruptions, including damaged facilities, staff shortages and highly depleted supplies. The situation worsened on 13 October 2023, when an evacuation order forced civilians to move from northern Gaza to southern Gaza, intensifying pressure on already strained health services amidst widespread displacement and collapsing infrastructure (2).

Impact of the war on UNRWA health services and health programme response

To address the healthcare crisis due to the war, UNRWA prioritized restoring access to healthcare, re-establishing vaccination programmes, enhancing disease surveillance, and replenishing medical supplies. The evacuation order on 13 October 2023 caused UNRWA to lose access to over half of its health centres. By late October, only 9 centres remained operational, further decreasing to 7 by December 2024 (3). The situation worsened on 31 January 2024, with only 4 centres that were functional in Rafah after the Khan Younis incursion, drastically limiting healthcare access.

Despite partial recoveries in early 2024, access to health centres remained inconsistent, fluctuating between 6 and 10 throughout the year, and as of 22 November 2024, only 6 of the original 22 centres were operational, highlighting the severe and prolonged impact of the war on healthcare services (3). To address the health service gap resulting from the loss of health centres, UNRWA established 3 new facilities in the coastal Mawasi area, one in Khan Younis, and another one in Deir al-Balah. These efforts aimed to ensure continued access to health care services despite the challenging circumstances (1,3).

The Gaza population has faced mass displacement, with most internally displaced persons (IDPs) taking refuge in UNRWA-designated schools that serve as emergency shelters. The number of IDPs fluctuates between 1.7 and 1.9 million (4). UNRWA has established medical points at all designated shelters to provide essential health care services for IDPs and set up additional medical points in the Mawasi area.

In addition to the loss of health centres and essential infrastructure, UNRWA lost medical supplies stored in Gaza’s main warehouse in the north, further threatening healthcare continuity (5). Emergency procurement processes were activated to secure supplies from Jordan and launch an accelerated 6-month procurement plan with support from suppliers in Jordan and Egypt. Vaccines stored in northern Gaza’s cold chain facilities were also lost, halting vaccination services. However, UNRWA addressed this disruption by implementing a detailed plan, with resources mobilized, in coordination with WHO Regional Office for the Eastern Mediterranean and the United Nations Children’s Fund (UNICEF).

Addressing urgent healthcare needs remains a priority, but the crisis has also severely exacerbated food insecurity, particularly impacting children. Before the conflict, many Gazan families faced significant food insecurity and relied heavily on humanitarian assistance. The crisis has worsened food insecurity, affecting over 96% of Gaza’s population (6,7). UNRWA and UNICEF assessed children and provided nutritional supplements to IDPs in shelters.

The conflict has also caused severe disruptions to staffing and personnel deployment. Employees faced hardships such as violence, displacement and resource shortages, making communication very difficult. However, persistent efforts helped reconnect 70–80% of staff using mobile phones, messaging apps, emails, and other platforms. Reachable colleagues helped locate others, creating a network that helped re-establish connection with the staff. To meet immediate needs at UNRWA shelters, temporary personnel were recruited, who provided health services at the newly established medical points, conducted medical assessments, administered treatments, managed supplies, and offered psychosocial support.

The collapse of water and sanitation services in Gaza has led to severe shortage of safe drinking water, forcing many to rely on unsafe sources and increasing the risk of waterborne diseases (8). UNRWA data reveals an alarming health decline in shelters (9). Between October 2023 and October 2024, cases of non-bloody diarrhoea surged 39 times, while bloody diarrhoea and acute jaundice increased 22 and 343 times, respectively (8) (Figure 1). Overcrowding, poor sanitation, and inadequate healthcare have also contributed to a sharp increase in acute respiratory infections. Figure 2

A WASH Cluster assessment found that two-thirds of families in Gaza access less than 6 litres of water per person daily, and nearly half lack the minimum 15 litres required for drinking, cooking, and hygiene (10). Only 25% of families have access to soap, forcing many to live in unsanitary conditions surrounded by waste and pests. These conditions have led to an increase in WASH-related diseases, particularly acute diarrhoea and skin infections among under-5 children (11,12). To address the water crisis, UNRWA prioritized safe drinking water access through water trucking and bottled water distribution (13). Hygiene kits were distributed despite the logistics challenges, and efforts were made to restore damaged water and wastewater systems, aiming to mitigate disease risks and promote public health recovery. In addition, UNRWA deployed mobile health teams to shelters, focusing on treating waterborne and respiratory infections while conducting hygiene awareness campaigns (14). Surveillance prioritized infectious diseases with epidemic potential, supported by WHO's EWARs-in-a-box platform to monitor outbreaks and manage health data efficiently (15).

In July 2024, a circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected, the first polio case in Gaza in 25 years (16,17). UNRWA, in collaboration with the Palestinian Ministry of Health, WHO and UNICEF, launched 2 rounds of vaccination campaign, immunizing nearly 600 000 under-10 children (18).

Above all, UNRWA lost its advanced electronic health system, leading to a major disruption and making it imperative to establish alternative methods to capture, manage and report health data in Gaza (19).

Conclusion and recommendation

The people of Gaza urgently need basic support. Although UNRWA continues to deliver essential health services despite the severe challenges, there is a need for recovery efforts that focus on restoring healthcare facilities, reviving core services and improving the living conditions of Gazans. This can only be effective and achieved through productive collaborations with partners. Advocacy for a humanitarian corridor and permanent ceasefire remain critical to secure resources and rebuild Gaza’s healthcare system.

References

  1. Al-Jadba G, Zeidan W, Spiegel PB, Shaer T, Najjar S, Seita A. UNRWA at the frontlines: managing health care in Gaza during catastrophe. The Lancet 2024;403(10428):723-726.
  2. Seita A, Al-Jadba G. Gaza is facing a humanitarian catastrophe. The Lancet. 2023 Nov 11;402(10414):1745.
  3. United Nations Relief and Works Agency for Palestine Refugees in the Near East. Resilience Amidst Chaos: 100 Days of UNRWA's Health Response to the Humanitarian Crisis in the Gaza Strip (7 October 2023 to 14 January 2024). Jordan: UNRWA, 2024. 100dayshealthreport_eng_final.pdf.
  4. UNRWA. The humanitarian crisis in the Gaza Strip and the West Bank, including East Jerusalem. UNRWA Situation Report #148, 20 November 2024. https://www.unrwa.org/resources/reports/unrwa-situation-report-148-situation-gaza-strip-and-west-bank-including-east-jerusalem.
  5. UNRWA. The situation in the Gaza Strip and the West Bank, including East Jerusalem. UNRWA Situation Report #114, 21 June 2024. https://www.un.org/unispal/document/unrwa-situation-report-114-21jun24/.
  6. Integrated Food Security Phase Classification. Gaza Strip. IPC Acute Food Insecurity Special Snapshot, 1 May–30 September 2024. https://www.un.org/unispal/document/gaza-strip-famine-ipc-snapshot-25jun24/.
  7. Horino M, Zaqqout R, Habash R, Albaik S, Abed Y, Al-Jadba G, West KP, Seita A. Food insecurity, dietary inadequacy, and malnutrition in the Gaza Strip: a cross-sectional nutritional assessment of refugee children entering the first grade of UNRWA schools and their households before the conflict of 2023–24. Lancet Global Health 2024;12(11):e1871-80.
  8. World Health Organization. Hostilities in the occupied Palestinian territory (oPt). Public Health Situation Analysis (PHSA), 2 May 2024. https://www.un.org/unispal/wp-content/uploads/2024/05/WHO-PHSA-oPt-020524-FINAL.pdf.
  9. UNRWA. the Humanitarian Crisis in the Gaza Strip and the West Bank, including East Jerusalem. UNRWA Situation Report #154, 12 January 2025. https://www.unrwa.org/resources/reports/unrwa-situation-report-154-humanitarian-crisis-gaza-strip-and-west-bank-including.
  10. OCHA. Gaza Strip. Humanitarian Situation Update #233, 29 October 2024. https://www.unocha.org/publications/report/occupied-palestinian-territory/humanitarian-situation-update-233-gaza-strip#:~:text=Across%20the%20Gaza%20Strip%2C%20a,minimum%2015%20litres%20per%20person.
  11. World Health Organization. Risk of disease spread soars in Gaza as health facilities, water and sanitation systems disrupted. News, 8 November 2023. https://www.emro.who.int/media/news/risk-of-disease-spread-soars-in-gaza-as-health-facilities-water-and-sanitation-systems-disrupted.html.
  12. Dardona Z, Amane M, Boussaa S. Top Five Infectious Disease Outbreaks among Displaced Populations during the Gaza Conflict 2023-2024: A Comprehensive Review. J Infect Dis Epidemiol. 2024;10:328.
  13. ACAPS. Palestine: Water crisis in the Gaza Strip. Briefing Note, 13 December 2023. https://www.acaps.org/fileadmin/Data_Product/Main_media/20231213_ACAPS_briefing_note_Palestine_water_crisis_in_the_Gaza_Strip.pdf.
  14. OCHA. Gaza Humanitarian Response Update: 22 July-4 August 2024, 7 August 2024. https://www.unocha.org/publications/report/occupied-palestinian-territory/gaza-humanitarian-response-update-22-july-4-august-2024.
  15. World Health Organization. Early Warning, Alert and Response System (EWARS). Geneva: World Health Organization, n.d.. https://www.who.int/emergencies/surveillance/early-warning-alert-and-response-system-ewars#:~:text=in%20a%20box-,%22EWARS%20in%20a%20box%22%20contains%20all%20the%20equipment%20needed%20to,report%20and%20manage%20disease%20data.
  16. World Health Organization. Humanitarian pauses vital for critical polio vaccination campaign in the Gaza Strip. Statement, 16 August 2024. https://www.who.int/news/item/16-08-2024-humanitarian-pauses-vital-for-critical-polio-vaccination-campaign-in-the-gaza-strip.
  17. Zayed D, Banat M, Al-Tammemi AB. Infectious diseases within a war-torn health system: The re-emergence of polio in Gaza. New Microbes New Infect. 2024 Sep 5;62:101483. doi: 10.1016/j.nmni.2024.
  18. Daniel Johnson and Alpha Diallo. Thousands more children protected on day 2 of Gaza polio campaign. UN News, 2 September 2024. https://news.un.org/en/story/2024/09/1153821.
  19. UNRWA. Dr. Ghada Al Jadba, UNRWA Chief Field Health Programme, Gaza. Address to the World Health Assembly 2024. Newsroom, 10 June 2024. https://www.unrwa.org/newsroom/official-statements/dr-ghada-al-jadba-unrwa-chief-field-health-programme-gaza-address-world.