Gaza’s hepatitis A outbreak omen of deadlier epidemics as health system ‘flat broken’: Experts

By Rabia Ali

ISTANBUL (AA) – Hepatitis A is now among the myriad of threats stalking Palestinians in Gaza, with tens of thousands of cases recorded and top UN officials sounding the alarm over “a frightening increase.”

Experts are warning that the rising incidence of hepatitis A highlights the larger danger of deadlier epidemics in Gaza, where Israel has killed or wounded over 135,000 Palestinians and laid to waste almost all critical infrastructure, including healthcare facilities.

Dr. John Kahler, a retired pediatrician and co-founder of aid group MedGlobal, witnessed firsthand the destruction in Gaza during two missions there in January and March.

“The spread of hepatitis A tells you that the (healthcare) system is flat broken,” Kahler told Anadolu.

In such conditions, there are at least a couple of other things that could possibly take root, and these are ones “that will start killing people real quickly,” he said.

One is the salmonella bacteria, which causes typhoid fever, and then Shigella, another type of bacterial infection that has severe symptoms including bloody diarrhea and very high fever, he explained.

Both of these can be easily controlled with antibiotics, but those are just not available in Gaza, he said.

A “huge worry,” Kahler continued, is the risk of cholera being “introduced into the community.”

“Given that the entire public health system and infrastructure has been destroyed, if cholera is introduced into this community, the deaths will mount by powers of 10,” he warned.

“There’ll be no question about that … If cholera were unleased into this community, people would be dying within 12 hours. They’re already dehydrated and they’ll die. That’s how quickly it’ll happen, and there won’t be a chance to do anything.”

Another potential problem could be the spread of E. coli infections, which is usually not a problem, but can cause terrible diarrhea and death because of kidney failure, he said.

“That would probably be the big five that we should pay attention to,” he added.

“All of these are a possibility because there literally is no public health system right now.”

- Growing danger

Hepatitis A is an inflammation of the liver that can cause a mild illness, but can be severe in some cases, particularly in adults. Infected children under age 6 do not usually experience noticeable symptoms, and only 10% develop jaundice, according to the World Health Organization (WHO).

The virus is transmitted when people consume food and water contaminated by feces, or come into contact with a sick person, and its risk is associated with a lack of safe water and poor sanitation and hygiene, such as contaminated and dirty hands.

More than 107,000 cases of acute jaundice syndrome, or suspected hepatitis A, have been reported in Gaza since last October, according to WHO figures.

Hepatitis A has an incubation period of one month and people can be particularly infectious in the first two weeks without showing any symptoms, which means “the disease could be spreading more widely than syndromic surveillance could detect,” the WHO said.

As for fatalities, without any testing capacities in place, the UN health agency said it is unable to confirm deaths related to the disease, as people can also “die of a combination of diseases and other factors.”

In comments to Anadolu, WHO spokesperson Tarik Jasarevic also pointed to the growing danger of other deadly disease outbreaks.

“The ongoing spread of hepatitis A in Gaza highlights the risk of other epidemics transmitted the same way,” he said.

It shows the “urgent need to improve water and sanitation conditions, but also to have better detection and surveillance capacities in place to implement the right response and prevent such outbreaks from happening,” he added.

“Most of the hepatitis A cases have been reported among young children, who are less likely than adults to have prior immunity in the context of Gaza,” said the WHO official.

“The disease can be also more severe in people with weak immune systems, due to the lack of proper nutrition and dehydration and the spread of other infectious diseases, as is the case in Gaza at the moment.”

- ‘Extremely dire living conditions’

During his time in Gaza, Kahler recalled seeing “tens of patients” suffering from jaundice.

In January, he said, Gaza’s Health Ministry was still conducting laboratory tests, so he was able to send patients for tests “and then the family would get looked at.”

“That system fell apart between January and March,” he said.

That meant there was no longer any way of isolating cases, which is the usual public health approach that keeps it from spreading, he explained.

“So, between January and March, the number of cases increased and our ability to do anything about them decreased,” said Kahler.

Controlling the spread of the disease is “absolutely impossible” in conditions where tents are crowded with 20 or 30 people, or people are living on the street where there is no solid waste pickup and no sewage system, he asserted.

On potential measures to control the outbreak, WHO’s Jasarevic said enhancing community access to safe water would be a key step, but it is “nearly impossible to achieve in Gaza in the current circumstances.”

“The extremely dire living conditions faced by the displaced people all across the Strip will compound the situation and we can expect to see a rise in the number of cases in the coming weeks,” he added.