Gaza Strip (Al-Hayat al-Jadida) – The night sky is filled with clouds, blotting out the moonlight as though to warn that a tragedy was about to befall the household of Fouad Sawalhi.
The family spent the next few hours tending to their ailing mother. After performing her evening prayers, she collapsed in bed, feeling seriously ill and running up a high fever. By daybreak, 85-year-old Hajjeh Suad’s suffering had worsened. Her frail body had become covered in rashes, and she breathed her last breath as her husband held her in his arms.
That was not the end of the family’s ordeal. The day after they began receiving condolences on the death of their mother, her first grandchild, Malek (9 months) developed the same symptoms she had shown. He had to spend 11 days at the Kamal Adwan government hospital, in northern Gaza. Medical diagnosis showed that he and his grandmother had suffered from meningitis caused by bacterial infections that would remain in his body for the rest of his life.
Malek is now two years old, and has grown accustomed to going to hospital three times a month. His body is covered with black and blue patches and his immune system is weak.
Sawalhi is convinced that the family matriarch’s death was caused by the contamination of tap-water with sewage in the area of Jabalya refugee camp where he lives. This had happened the previous week, prompting some of his neighbors to move out and stay with relatives elsewhere. He says the health ministry later tested the water and confirmed there had been contamination, and provided advice on how to prevent anyone else falling ill.
This report investigates the increased levels of bacterial and chemical pollution in Gaza’s water – a result both of sewage leaking into the supply network and the underground aquifer, the Strip’s only freshwater source, and of over-extraction of water from the aquifer. The outcome has been an increase in the incidence of waterborne diseases, especially bacterial infections, in some cases causing death.
These deaths are not recorded as such by the health ministry. Our investigation found serious lapses on its part, both in terms of medical testing and failure to keep records of water-related illnesses. It also found that while responsibility for the water pollution problem rests chiefly with the Water Authority and the Strip’s municipalities, the public is also partly to blame.
Sewage-polluted water is a major problem for the inhabitants of the Gaza Strip – around two million people squeezed into 365 square kilometers, the most densely-populated spot on earth. Only 65% of them are connected to the sewage network. The rest dispose of their wastewater through open channels from which it seeps underground, in turn leaking into and further polluting the aquifer. Only 5% of the aquifer’s water is currently drinkable, and it is liable to run out by 2016.
According to a report issued by the Planning Ministry in Gaza on the wastewater sector for the years 2010-2020, the problem is most severe in Khan Yunis in the south of the Strip, where the sewage network only reaches 40% of the population, contributing to “high rates of water pollution and low water quality.” In Rafah and the northern Gaza Strip, 70% of homes are connected to the sewage network. The rate rises to 80% in Gaza City, and drops to 64% in the central district of the Strip.
A few days before Suad’s death, Fouad Sawalhi discovered some red, worm-like parasites in the tap-water in his home. “The water continued to be polluted with sewage for a week. The authorities did nothing, though I informed them many times. There’s no other explanation for what happened than sewage contamination of the water. Neither my wife nor her grandson showed any sign of illness before the incident,” he recalls.
But he says doctors refused to provide him with a medical report linking the two cases to the polluted water.
The link, however, is not doubted by Yasser al-Bayouni, who runs the health ministry laboratory that tests samples of piped and well water.
”Microbiological analysis of samples of water from both the wells and the networks in the Strip show biological evidence of fecal contamination as a result of it mixing with sewage,” he affirms.
Random samples tested at Bayouni’s lab showed contamination rates of up to 20%. Pollution levels have increased sharply since 2008, and are far higher than Palestinian or international regulations permit, he says.
Bayouni examined a number of samples which contained the bacterium Aeromonas hydrophila, which can cause gastroenteritis and serious inflammations that can be deadly, and which is a sure sign of sewage contamination.
“This bacterium caused the death of four children from Bureij refugee camp,” he adds. “The hospital denied their deaths were linked to polluted water. But when the water was tested it was found to contain the same bacteria that were the cause of death.”
Bayouni examined the samples on his own initiative, without being asked to by ministry officials.
His tests showed the presence of another kind of bacteria, called Pseudomonas, which is a major public health hazard, as well a Klebsidla pneumonia, which is particularly dangerous because it is highly resistant to antibiotics.
The latter was the cause of several deaths, though this was not recorded, he says, adding that that the Gaza Strip’s water is unfit for human use and should not be pumped into networks.
For the purposes of this investigation, we had six samples of water, taken from pipes and wells in different parts of the Strip in mid-November 2012, analyzed by the Water Research Institute at al-Azhar University.
All showed a high degree of salinity – particularly a sample from Shatee refugee camp, which at 1600mg per liter, was the equivalent to seawater – which can lead to kidney failure and various renal and other illnesses.
They also showed excessive concentrations of sodium, which is especially hazardous to people with high blood pressure, and high acidity and chlorine levels.
These chemical pollutants alone make the water unfit for consumption.
Four of the six samples were also contaminated with much higher levels of nitrates than international guidelines allow, of up to 100mg per liter. Sewage and agricultural fertilizers are the main source of this pollutant, which is associated with miscarriages, cancers and other serious illnesses.
Microbiological analysis of the samples found that what is scientifically termed the total coliform contamination rate was as high as 50%, meaning the water is infested with disease-causing bacteria. An earlier analyses by the health ministry’s laboratory also indicated fecal coliform contamination in many samples.
A UNICEF report in 2010 estimated that 26% of all illness in Gaza is linked to the quality of the water. It identified nitrate pollution of the aquifer as a particular threat to infants and pregnant women, and a cause of methemoglobinemia or “blue baby child syndrome,” cases of which have begun appearing among babies born in Gaza.
A seven-year study begun in 2000 by environmental scientist Dr Majed Yasin found that microbiological pollution levels were far in excess of internationally-permitted norms, and were much higher in water taken from the distribution network than from wells – implying that damage and disrepair to the network is a major cause.
The study showed a strong link between fecal coliform contamination of water and gastroenteritis and other illnesses, and that people reliant on network water were the most vulnerable.
A medical source in Shawkeh, a rural area in the south of the Strip, says his clinic receives an average of seven patients per day suffering from water-related illnesses including renal problems, bacterial infections and parasites – amounting to over 2,000 per year in a small locality, not counting those who do not come to the clinic.
But the health ministry in Gaza seems to turn a deaf ear to warnings about the growing incidence of water-related illnesses and the link to polluted water.
“There’s nothing to ascertain that any illness is linked to polluted water in the villages and towns of the Strip, because many other environmental factors are also involved,” says Dr. Majdi Duhair of the health ministry’s primary healthcare department.
In any case, he concedes, primary healthcare centers do not document all cases of illness, and many are never noted in official records.
According to the Palestinian National Information Campaign, water pollution is a menace to public health, with rising sulphur levels causing skin diseases, rising flouride levels causing bone problems to the elderly and tooth decay in the young, and rising lead levels causing brain damage among children, in addition to causing a number of bacterial and parasitic diseases.
The main problem, says Mohammad Daher, head of the World Health Organization (WHO)’s Gaza office, is the leaking of waste-water into the aquifer, resulting in very high levels of nitrates and other chemical pollutants. Water from some 70% of Gaza’s sources contain many times the WHO-prescribed maximum nitrate levels, especially in the north and south of the Strip, and the quality is steadily deteriorating due to over-extraction from the aquifer.
Nitrates are a particularly dangerous pollutant which can have a variety of damaging effects and lead to blood disease, brain damage or blue baby syndrome, he explains. But bacteria and parasites cause a host of additional gastric, liver and other illnesses, and may unexplained illnesses can also be attributed to the water.
“There are no high quality laboratories to analyze the water and reveal the pollutants in it and the threat they pose to human health,” he adds, “and the information available about the health system is minimal.”
The drawers of the director of the water and sanitation department in Gaza City municipality, the Strip’s largest, are filled with letters from members of the public complaining about water being polluted, salty and unfit for human consumption.
We know this from speaking to people who sent such complaints, though the director, Ramzi Ahl, declines to let us see any of them.
One letter was sent by residents of the Fairouz Towers district west of Gaza City a few years ago after a sudden outbreak of gastric and skin illnesses in the area.
“The water is extremely salty and contaminated with sewage,” the complaint read. “This has led to the spread of diseases such as skin rashes, intestinal diseases and hair loss, over and above the financial burden resulting from the contamination.”
The residents’ spokesperson, Younes al-Turkmani, accused the municipality of neglecting the problem, wondering: “Why do the municipality and health ministry not act before the health situation deteriorates further? Sea water has become better than the piped water.”
Ahl responds: “Tackling pollution is not our responsibility as a municipality. It is national problem, and it cannot be resolved without an alternative to the aquifer.”
4,000 shekels (nearly $1000) is enough for anyone in the Gaza Strip to obtain a permit to drill a water well, without being subject to any oversight. Still, most people drill without permits, and some make money selling the water they obtain.
Abu Haitham, a farmer, was granted a licence in the late 1990s to drill a well on his land in Rafah. But the water became increasingly salty with time, so, using the same licence, he drilled more wells. “I have 30 cultivated dunums of land. They need a lot of water, and I can only get it from the aquifer,” he explains.
He also sells water to his neighbors, though he has no licence to do that. He justifies that on the grounds that there is no authority preventing such practices.
Mazen al-Banna, director of the Water Authority, which is responsible for managing the aquifer and the Gaza Strip’s water, concedes that it has, “as an exception,” permitted the drilling of wells without obtaining a license.
“We’ve allowed some people to dig wells, in line with what the Authority considers appropriate. But we categorically banned drilling on the western side so as to limit the phenomenon of sea water seepage into the aquifer,” he says.
While Banna insists that the Authority monitors the drilling of the wells and the amount of water extracted from them, as it is supposed to, he declines to provide us with documentary evidence of that.
Several license-holders, however, told us that the Authority keeps no eye on what they do after providing them with the license. Abu-Haitham confirms that there has been no follow-up from any official body since he drilled his first well.
According to the Water Authority’s former head, Mohammad Ahmad, many attempts were made in the past to establish a system for monitoring and controlling the amount of water taken from wells.
“But they were foiled by a variety of powerful people. Also, the courts do not issue rulings on water laws, so they do not prosecute the people who violate the law,” he says.
Ahmad estimates there are almost 10,000 unlicensed water wells in the Gaza Strip. Some have existed for decades, but they have proliferated in recent years under the Israeli siege.
As a result, the aquifer’s days are numbered, with some 180 million cubic meters of water extracted from it annually, but only 70 mcm being replenished.
But while faulting the authorities for not applying the law, Ahmad also holds members of the public responsible for the deteriorating water situation. “Violations by citizens are a major factor in wasting water and damaging the network,” he says.
“The increased level of chemical compounds in the water is a result of the unregulated extraction of groundwater” says Munther Shiblaq, director of the coastal municipalities’ water authority. “That has made 95% of the aquifer water unfit for human use, and what remains can be expected to be lost within the coming few years.”
At this rate, he warns, Gaza is set to run out of usable water by 2016, and the municipalities will no longer be able to supply it to provide it to citizens.
“A strategy must be put in place to replenish the aquifer water in the coming few years.”
Shiblaq says people often tap in illegally to the water distribution system, breaking pipes and causing it other damage that results in water being mixed with sewage, and stretching it to over double its capacity.
A survey of 150 randomly-selected families living in the Strip’s five governorates found that 89% thought there was a link between polluted water and the illnesses rife in the Gaza Strip. 58% reported that at least one of their members had suffered from gastric illness or skin disease in the past six months. 18% of these reported cases of gastroenteritis, 19% skin rashes, 10% parasites, 10% diarrhea, 16% had worms, 13% bacterial infections, 18% hair loss, 9% staining of the teeth, 6% kidney failure or stones, and 4% blue baby.
Water experts have long proposed developing an alternative source of water for the Gaza Strip, such as desalinated seawater. The preliminary cost of a desalination plant has been put at US $300 million, but Israeli restrictions make it impossible to import the necessary equipment to build one .
They also recommend action to connect all homes to the sewage network to stop wastewater leaking into the aquifer.
“The water problem cannot be resolved without building a seawater desalination plant and stopping the hemorrhage from the aquifer, as well as recovering the water rights stolen from us by the occupation,” says environmental researcher Ahmad Hala,
He also suggests that schemes could be established for piping fresh water from the West Bank to the Gaza Strip, as well as for capturing and storing rainwater.
Adnan Ayesh, head of the water and environment department at al-Azhar University, suggests in addition that treated waste-water should be re-injected into the aquifer to offset the amounts extracted and raise the water table.
This investigation was conducted with support from ARIJ (Arab Reporters for Investigative Journalism) under the supervision of coach Walid Batrawi.
A UN report issued in August 2010 warned that the water situation was becoming life-threatening, with the aquifer beneath the coast set to become unusable by 2016, and irreparably damaged by 2020 unless remedial action is taken immediately.
By then, demand for water in the Gaza Strip is projected to have risen by 60% from present level to an annual 260 million cubic meters.