Eastern Mediterranean Health Journal | All issues | Volume 31 2025 | Volume 31, issue 4 | Tobacco control in the State of Palestine during wartime

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Tobacco control in the State of Palestine during wartime

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Commentary

Tom Gatehouse1, Nour A Obeidat2 and Raouf Alebshehy1

1Department of Health, University of Bath, United Kingdom. 2King Hussein Cancer Centre, Cancer Control Office, Amman, Jordan (Correspondence to Nour Obeidat: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Keywords: tobacco, Palestine

Citation: Gatehouse T, Obeidat NA, Alebshehy R. Tobacco control in the State of Palestine during wartime. East Mediterr Health J. 2025;31(4):285–287.

https://doi.org/10.26719/2025.31.4.285. Received: 14/10/2024; Accepted: 23/01/2025

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).

Background

Over 55% of Palestinian men and approximately 43% of 13–15-year-old boys are current tobacco users (1), a high rate in a region which has been disproportionately affected by the global tobacco epidemic. Treatment for nicotine addiction, already extremely scarce before Israel's current military offensive in Gaza, is now almost non-existent. The few practitioners in the territory have no premises from which to operate, exacerbated by the tragic loss of healthcare workers (2), including one of Gaza's few tobacco treatment specialists. Aya Ferwana, a family doctor who aspired to establish the first tobacco dependence treatment programme in the State of Palestine, was killed in an Israeli airstrike in October 2023, along with most of her immediate family members (2,3).

Dr Ferwana is just one of over 1151 healthcare workers, including doctors, nurses and administrative staff, who have been killed since October 2023 (4). Not only have Palestinian healthcare professionals been killed at a time when they were most needed, they have also been arrested by Israeli forces, even while on duty. As of May 2024, there had been at least 214 arrests (5,6). These healthcare workers are being sent to detention facilities in Israel without charge or trial, with widespread reports of torture and maltreatment while in detention (7–9). Some of them never make it out alive; as of 24 September 2024, 3 doctors from Gaza had been confirmed dead while in Israeli detention (10).

A crisis under the shadows

The tobacco industry thrives during times of crisis and chaos (11). In recent years, it has exploited conflict situations in countries like Ukraine and Sudan (11-13), yet the harm due to tobacco use often tends to be overlooked in such contexts. Media coverage of Israel's assault in Gaza has mostly focused on those killed and injured by bombs and bullets, and more recently, on the spread of infectious diseases due to the severe water shortages and the destruction of critical infrastructure (14). However, tobacco use is an important aspect of a public health crisis that has been unfolding under the shadows of war, and will have severe and long-lasting consequences unless it is addressed.

In the Eastern Mediterranean Region (EMR), tobacco use is associated with 14.5% of all-cause deaths and 23.2% of risk-factor associated deaths (15). It is a major driver of the high burden of noncommunicable diseases (NCDs) (16), from which two-thirds of elderly Palestinians suffer (17). However, due to the conflict, which has disrupted pharmaceutical supply chains, 350 000 patients in Gaza now receive no medication for chronic health conditions (17,18), while cancer services, which were in a precarious state before 7 October 2023, have collapsed entirely (19,20). The little capacity that remains has been redirected towards dealing with trauma and infections (20).

One of the exacerbating factors of tobacco use is poor mental health, which makes individuals twice as likely to use tobacco (21). Gaza’s population exhibits high rates of depression, post-traumatic stress disorder (PTSD) and other mental health conditions, having lived under air, land and sea blockade since 2007, with repeated incursions by the Israeli military (22,23). The youngest suffer the most. A 2022 report by Save the Children found that most Gazan children and young people had constant feelings of fear, worry, sadness, and grief (24,25). With at least 90% of Gaza’s population displaced by the conflict (26) and countless families mourning their dead, the mental health of Palestinians has surely deteriorated further, and this may fuel the tobacco epidemic in the future (18).

Joining the global tobacco control

community

Tobacco control in the State of Palestine has long been in need of reinforcement. Its tobacco control laws have not been updated since 2011 (27) and implementation of WHO’s recommended tobacco control strategies has not been comprehensive (1). Although strengthening tobacco control may appear far-fetched in the current scenario, Israel’s military offensive may in fact have brought the State of Palestine closer to joining international legal frameworks, including the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). The appalling suffering in Gaza has generated greater momentum towards recognition of a Palestinian State, with Norway, Spain and Ireland all formally recognising Palestine in 2024, bringing to 146 the number of countries that have done so. The World Health Assembly described Palestine as a State for the first time in May 2024 (28,29). The State of Palestine can leverage this international support to join the WHO FCTC and lay the foundation for a comprehensive tobacco control programme, as part of the wider effort to rebuild its now-ruined healthcare system.

Given that most countries in the EMR have joined the WHO FCTC, there is opportunity to collaborate at the regional level to pre-empt challenges and prepare for strong implementation of the treaty in the State of Palestine. Neighbouring countries can support Palestinian tobacco control experts in updating the regulations on tobacco products, share experiences and lessons learned in implementing targeted advocacy and effective enforcement of legislation, help build the capacity of healthcare practitioners to increase availability of tobacco dependence treatment programmes, and help expand policy and epidemiological research efforts using approaches that have been tried and tested in other countries in the region.

First steps to recovery

The public health crisis in Gaza is complex and multifaceted, with interrelated factors coming together to worsen outcomes for a wide range of clinical conditions, including communicable and non-communicable diseases. However, a prerequisite for beginning the process of addressing this crisis is a permanent ceasefire. There is an urgent need to establish secure supply chains for medications, begin to restore Gaza’s ruined medical infrastructure and implement the health education programmes necessary to enable Gazans to self-manage their conditions and make healthy choices, including tobacco use cessation (18). Tobacco control experts and partners in the EMR and elsewhere should strengthen collaboration with their Palestinian counterparts in identifying strategies to support Gaza and the rest of the State of Palestine, with the ultimate aim of ensuring that tobacco control is included in its recovery plans.

Funding: None.

Competing interests: None declared.

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