Acute respiratory infections are the most prevalent communicable disease, with over 995 000 reported cases in the Gaza Strip between October, 2023, and August, 2024.3 The burden of respiratory diseases in the West Bank was previously ranked third and the burden of respiratory diseases in the Gaza Strip was previously ranked fourth among the assessed non-communicable diseases.4 Chronic respiratory conditions have also increased in both regions.

 

Everyone in the Gaza Strip is breathing toxic and polluted air,5 including people with chronic respiratory disease. There is dust, debris, and a high risk of inhalation of toxic agents due to warfare, demolitions, and rubble. During attacks, smoke and environmental pollutants (including PM2·5 and PM10, heavy metals such as cadmium, chemical residues, and other toxic agents such as white phosphorus and depleted uranium) are released. Particulates remain after the use, disposal, or detonation of explosives (munitions residue). These can include unreacted energetic compounds (explosive material that remains after imperfect or incomplete reaction), metal fragments, and other chemical compounds. All have detrimental effects to lung health. Also, asbestos has been widely used, particularly in roofing across urban refugee camps in the Gaza Strip, with the amount of contaminated rubble being around 800 000 tons.5 The link of asbestos with asbestosis, lung cancer, and especially mesothelioma is well documented.

 

The scale of illness due to starvation, malnutrition, and thirst is massive. Adequate nutrition is essential for healing from trauma, particularly following intensive care and surgery. Malnutrition can compromise the immune system of individuals, particularly children, and lung development in fetuses. Malnutrition, alongside gastroenteritis and respiratory infections, are major causes of infant mortality in the Gaza Strip. Furthermore, overcrowding and poor sanitation due to water shortages contribute to poor living conditions and hygiene in the refugee camps and increased risk of respiratory infections.