Alaa Al-Attar was shocked when his 8-year-old son Ahmed was diagnosed with Hepatitis A by a doctor at one of the hospitals in the crowded city of Rafah, which is the home to hundreds of thousands of displaced people fleeing the severity of the Israeli war on the Gaza Strip.

Al-Attar hurriedly took his son to the hospital after jaundice appeared all over his body, along with persistent nausea, vomiting, and diarrhea, only to be shocked by the doctor confirming that Ahmed was infected with Hepatitis A.

Signs of fear began to show on Al-Attar as he spoke about his son living a life of displacement away from his home in northern Gaza, and about his son’s need for health care and the necessity of providing him a special diet to overcome the disease.

The doctor treating Ahmed minimized the seriousness of the infection, saying that Hepatitis A is unlike Hepatitis C, which is considered more deadly. 

“In early December, we fled from Beit Lahia in northern Gaza to the city of Rafah in the far south, where we pitched a tent at the Egyptian border. We share one bathroom with dozens of families in nearby tents,” said Ahmed.

More than 70 families, including the Al-Attars, use the same bathroom, as there is not enough water for personal hygiene for each person. This in itself is considered the source of the spread of epidemics and diseases, including Hepatitis, among the displaced.

Al-Attar did not receive proper treatment for his son, as the doctor told him that he only needed to consume some sugars, including honey, and avoid using the communal bathroom with other families, all of which are requirements he is unable to meet.

In a camp for displaced people in the Mawasi area of Khan Yunis in the southern Gaza Strip, a number of children line up in front of a small bathroom made of pieces of cloth and metal sheets. One of these children is 10-year-old Lana Abu Luli, who is infected with Hepatitis A as a result of the insufficient water sources for hygiene and sharing the bathroom with dozens of other children.

Lana contracted Hepatitis A while displaced with her family from eastern Khan Yunis to the Mawasi area west of the city. She began experiencing symptoms of the disease on her journey, especially diarrhea and jaundice.

Lana’s father, Khaled, said: “Since we fled from eastern Khan Yunis in January, we have been living in an environment where garbage is spread, there is no clean water or suitable food, which has made the whole family susceptible to diseases and epidemics, including my daughter Lana.”

Lana’s family are not vaccinated against diseases and epidemics, and they do not have the means to provide cleaning products, or even enough water to clean the bathrooms and provide each person with what’s needed for personal hygiene.

Dr. Ibrahim Hamed, a pediatrician, confirmed that he has diagnosed dozens of cases of Hepatitis A in Rafah, especially among children and teenagers who have been displaced.

“The symptoms of the disease, including nausea, jaundice, diarrhea, and fever, are clear in children, and confirming the disease does not require laboratory tests,” said Hamed. 

Hamed attributed the spread of Hepatitis A among the displaced to several reasons, including the lack of personal hygiene, the use of bathrooms by dozens of families in one day, or the overflow of sewage among the tents of the displaced, in addition to the lack of proper nutrition.

Hepatitis A is a contagious disease primarily spread through bathrooms and close contact with an infected person.

Increasing number of cases due to low levels of hygiene

The Ministry of Health in the Gaza Strip confirmed the spread of Hepatitis A due to overcrowding in areas hosting the displaced, warning of the cessation of CBC laboratory blood tests due to a lack of supplies.

In a statement on its official Facebook page, the Ministry stated that “the spread of Hepatitis A is due to overcrowding and low levels of hygiene in areas hosting the displaced in the Gaza Strip.”

The Ministry warned of the cessation of laboratory blood tests (complete blood count) at any moment due to a lack of supplies.

In addition to the Palestinian Ministry of Health, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, confirmed 24 registered cases of Hepatitis A in the Gaza Strip. He said that the inhumane conditions due to the Israeli attacks on the sector will lead to an even wider spread of the disease.

“Thousands are also likely to suffer from jaundice due to being infected with Hepatitis A,” wrote Ghebreyesus on X. He explained that inhumane living conditions, such as the lack of clean water and toilets, and the difficulty of maintaining general cleanliness, will lead to the spread of the disease on a larger scale.

The World Health Organization also warned of the danger of the rapid spread of infectious diseases in the Gaza Strip, amid the continuous Israeli aggression on the sector and the continued increase in the number of deaths and injuries, the severe crowding in shelters, the paralysis of the health system, and the disruption of water and sewage networks, which increases the spread of epidemics.

According to them, “This situation is alarming for approximately 1.5 million displaced people across Gaza, especially those living in overcrowded shelters where there are no opportunities to use personal hygiene facilities and safe water, increasing the risk of transmitting infectious diseases.”

The organization warned that the spread of diseases without access to treatment in Gaza can kill more people than the current airstrikes and bombings are if the health system does not resume its work. It also estimates that in 2016, 7,134 people died from Hepatitis A worldwide, accounting for 0.5% of deaths from viral hepatitis.

What is Hepatitis A?

Hepatitis A is a highly infectious infection caused by the Hepatitis A virus (HAV), which is spread by consuming contaminated foods or drinks. The infection can also be transmitted through close physical contact with an infected person.

The disease is linked to unsafe water or food, inadequate sanitation, and poor personal hygiene, according to the World Health Organization.

Unlike Hepatitis B and C, Hepatitis A does not cause chronic liver disease, but it can cause debilitating symptoms ranging from mild to severe, including fever, loss of appetite, diarrhea, nausea, abdominal pain, and jaundice (the yellowing of the eyes and skin). Not all infected individuals experience all these symptoms.

HAV continues to spread in a particular environment, and it can resist routine food production processes used to inhibit or control pathogens.

The disease’s incubation period ranges from 15 to 50 days, and the symptoms can last from one to two weeks, while the likelihood of death from the disease is less than 0.5 percent (4 per 1000 infected) in normal settings.