This guidance was developed to support community health workers and health volunteers deliver essential information. It aims to help individuals and concerned stakeholders take effective measures to detect, treat and prevent lice infestations.

Lice general messaging

Lice are parasites that can infest a person and easily spread from one person to another.

Lice spread more easily in close-contact environments like shelters, schools and overcrowded households.

Lice can be treated with medication. It is essential to decontaminate household items like bedding and clothing to avoid re-infestation.

Lice can be found in the hair on your head and body, including the scalp, eyelashes and groin area.

Lice survive by feeding on human blood.

Signs and symptoms

Common symptoms of lice infestation include

itching on the scalp, neck and ears

sores from scratching

visible lice and nits (eggs) on the hair

Transmission

Anyone can catch head lice.

Head lice are spread by direct hair-to-hair contact with another person who has head lice.

Head lice cannot jump or fly but can be passed on by sharing hats and brushes. They are easily transferred by contact with clothing, scarves, bedding, towels, washcloths, hairbrushes and combs used by infected persons.

Head lice do not transmit any infectious diseases though scratching can cause skin infections and sores.

Treatment

Head lice can be killed by medicinal preparations in the form of sprays, ointments, lotions and shampoos, applied as per instructions. The treatment period ranges from a week to 10 days.

How to use the medication

Permethrin lotion 1% is used to treat lice.

Wash the hair and scalp using regular shampoo.

Rinse thoroughly and towel dry the hair and scalp.

Allow the hair to air dry for a few minutes.

Shake the permethrin lotion well before applying.

Thoroughly wet the hair and scalp with permethrin lotion, covering the areas behind the ears and the back of the neck.

Keep the lotion away from the eyes. If lotion gets into your eyes, flush thoroughly with water.

Allow the lotion to remain in place for 10 minutes.

Rinse hair and scalp thoroughly and dry them with a clean towel. When the hair is dry comb it with a fine-toothed comb to remove any remaining nits (eggs) or nit shells.

Everyone in the living space should be examined for head lice and receive treatment if infected. If you have any questions, check with your community health worker.

Topical dosage (cream and lotion)

Adults and children aged 2 years and above: a single application to the hair and scalp.

Children under 2 years of age: consult with a community health worker.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture and direct light.

Keep from freezing.

Keep out of reach of children.

Environmental treatment

Wash and dry clothing, bed linens and other items used by a person with head lice during the 2 days before treatment using the hot water laundry cycle and high heat drying cycle.

Clothing and items that are not washable should be dry-cleaned or sealed in a plastic bag and stored for 2 weeks.

Regularly clean floors and furniture, particularly where an infected person sat or lay.

Prevention

Simple strategies to help prevent lice from spreading

Avoid sharing personal items such as hats, scarves, brushes, combs, hair accessories, pillows and towels.

Avoid lying on beds, pillows or sleeping places used by someone with head lice.

Keep hair clean and tied. Cut hair for males.

Hang children’s and adults’ clothes separately.

In shelters, mothers and/or health educators should conduct regular examinations for lice.

Recommendations for managing head lice in shelters and makeshift accommodation in the Gaza Strip

The following recommendations are based on the best available evidence and existing guidance.

Personal hygiene and regular inspection

Encourage regular inspection of hair for lice and nits, particularly among children, to catch infestations early.

Promote personal hygiene by washing hair regularly using available water sources, even if limited.

Mechanical removal

Regular combing: use a fine-toothed lice comb daily to remove lice and nits. Dampen hair and use conditioner, if available, to make combing easier and more effective. This process should be done in a well-lit area to ensure thoroughness.

Manual removal: if combs are not available, individuals can manually remove nits and lice by using their fingers, ensuring they clean their hands before and after.

Minimize the sharing of personal items

Educate the community on the importance of not sharing personal items such as hats, scarves, clothing, bedding, combs and brushes.

If individuals must share bedding or clothing, encourage them to wash these items regularly using available water and to dry them under direct sunlight when possible.

Environmental control

Maintain cleanliness in living spaces by regularly disposing of trash and reducing potential habitats for lice and other parasites.

Encourage the washing of bedding as frequently as resources permit and dry it under direct sunlight which can help kill lice and nits.

Community health worker engagement

Regularly engage community health workers to educate and assist individuals in managing lice infestations.

Health workers should conduct community awareness sessions on identifying lice, proper hygiene practices and the importance of early treatment.

Alternative treatments

When medicinal preparations are unavailable, consider using natural remedies that may help deter lice such as applying a diluted vinegar rinse to the hair. These are not as effective as chemical treatments.

Encourage the use of available abrasive substances like ground neem leaves, traditionally used in some cultures to manage lice. Boil the neem leaves in water and use the cooled water as a rinse for the hair to help deter lice.

Sources

Lice. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 (https://www.cdc.gov/lice/index.html).