Research Questions What is the current state of potable water (quantity and quality) in Gaza? What is the current state of wastewater treatment in Gaza? How does Gaza's water crisis relate to its energy shortages? What are the implications of Gaza's water crisis for public health in Gaza, Israel, and Egypt? What can be done to lower the risk of a waterborne public health crisis in Gaza? How can stakeholders address implementation barriers to proposed solutions?

       Gaza has long had water and sanitation challenges, but today it is in a state of emergency. Its dual water crisis combines a shortage of potable water for drinking, cooking, and hygiene with a lack of wastewater sanitation. As a result, over 108,000 cubic meters of untreated sewage flow daily from Gaza into the Mediterranean Sea, creating extreme public health hazards in Gaza, Israel, and Egypt. While these problems are not new, rapidly deteriorating infrastructure, strict limitations on the import of construction materials and water pumps, and a diminished and unreliable energy supply have accelerated the water crisis and exacerbated the water-related health risks. Three wars between Israel and Hamas since 2009 and intra-Palestinian rivalry between Hamas and Fatah have further hindered the rehabilitation of Gaza's water and sanitation sectors.

       This report describes the relationship between Gaza's water problems and its energy challenges and examines the implications of this water crisis for public health. It reviews the current state of water supply and water sanitation in Gaza, analyzes water-related risks to public health in Gaza, and explains potential regional public health risks for Israel and Egypt. The authors recommend a number of steps to ameliorate the crisis and decrease the potential for a regional public health disaster that take into consideration current political constraints. The audience for this report includes stakeholders involved in Gaza, including the Palestinian, Israeli, and Egyptian governments, various international organizations and nongovernmental organizations working on the ground in Gaza, and the donor community seeking to rehabilitate Gaza.

       Key Findings Gaza's young and growing population lacks water not only for drinking but also for hygiene and sanitation More than a quarter of all reported disease in Gaza is caused by poor water quality and access. Chemical and biological contamination could lead to bacterial (cholera, Salmonella, Shigella), parasitic (Giardia), and viral (polio, viral meningitis) infections. If present trends continue, Gaza and the surrounding region are at risk of a disease outbreak or another water-related public health crisis. Recent events have accelerated Gaza's longstanding water challenges The main source of Gaza's water, its aquifer, is being depleted and its quality diminished by seawater intrusion, wastewater seepage, and agricultural runoff. Gaza's inconsistent energy supply greatly limits the operations of its water and wastewater treatment facilities. Recurring wars between Israel and Hamas have damaged Gaza's water infrastructure. Gaza's water crisis could be resolved through greater investment in water and power infrastructure as well as additional water or electricity purchases, but many barriers remain Israel and Egypt, Gaza's neighboring states, severely restrict access and movement of goods into Gaza, including materials needed for repairs and construction of electricity, water and wastewater infrastructure. Intra-Palestinian strife and a governance vacuum in Gaza have exacerbated externally inflicted damage in severely limiting the power supply and hindering reconstruction. International aid has been pledged inconsistently yet not followed through in full. Political complications hinder the implementation of all proposed solutions.

       Recommendations Increase the quantity and consistency of Gaza's electricity supply through infrastructure and other investments such as advancing the "161kV Line;" upgrading and expanding the electricity transmission network to and inside Gaza; restoring the fuel storage tank at the Gaza Power Plant and connecting it to a natural gas pipeline; investing in solar energy; developing the Gaza Marine gas field; increasing the supply of purchased power from Egypt; ensuring consistent supply of electricity for the Khan Yunis Short-Term Low-Volume desalination plant; and improving fee collection to cover the ongoing cost of electricity. Increase Gaza's water supply and improve wastewater treatment, including by increasing water purchases from Israel; expanding desalination capacity; improving water storage and distribution systems; investing in household and industrial wastewater treatment; distributing chemicals and spare parts for household treatment systems; constructing more wastewater treatment plants; using treated wastewater to recharge the aquifer; repairing the wastewater collection system, and connecting all of Gaza residents. Protect public health and promote hygiene and sanitation practices by preventing and preparing for disease outbreaks (e.g., cholera vaccinations and rehydration salt packets); maintaining basic health services; promoting more-rigorous hygiene and sanitation education in schools; and creating a regional pandemic task force to prevent a disease outbreak and implement containment. Reduce implementation barriers and work within political differences through creating a follow-up mechanism on donor pledges; increasing funds for public health risk mitigation initiatives; relaxing restrictions on access and movement; and identifying trusted third parties to mediate political disputes over payments for water and electricity.

       Table of Contents Chapter One

       Introduction

       Chapter Two

       Water and Wastewater Services in Gaza

       Chapter Three

       Public Health Risks from Water Contamination

       Chapter Four

       Conclusions and Policy Recommendations

       Research conducted by RAND International

       This project is a RAND Venture. Funding was provided by gifts from RAND supporters and income from operations. The research was conducted by the Center for Middle East Public Policy (CMEPP) within RAND International Programs.

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