In the scorching summer heat of Gaza, Palestinians are surrounded by sewage and trash

DEIR AL-BALAH, Gaza — Children wearing sandals wade through sewage-contaminated waters and climb over growing mounds of rubbish in the Gaza region crowded campsites for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.

In the sweltering heat of summer, Palestinians say the odor and filth surrounding them are just another inescapable reality of war – like the pains of hunger or the sounds of bombing.

The territory’s ability to dispose of trash, treat sewage and provide drinking water was practically decimated by eight brutal months of war between Israel and Hamas. This worsened living conditions and increased health risks for hundreds of thousands of people deprived of adequate shelter, food and medicines, aid groups say.

Cases of hepatitis A are rising and doctors fear that with the arrival of warmer weather, a cholera outbreak is increasingly likely without dramatic changes in living conditions. The UN, aid groups and local authorities are scrambling to build latrines, repair water lines and get desalination plants back online.

COGAT, the Israeli military body that coordinates humanitarian aid efforts, said it is committed to efforts to improve the “hygiene situation.” But relief can’t come soon enough.

“The flies are in our food,” said Adel Dalloul, a 21-year-old whose family has settled in a beach camp near the town of Nuseirat in central Gaza. They arrived there after fleeing the southern city of Rafah, where they disembarked after leaving their home in northern Gaza. “If you try to sleep, flies, bugs and cockroaches will be all over you.”

More than a million Palestinians lived in hastily set up camps in Rafah before the Israeli invasion in May. Since fleeing Rafah, many have sought shelter in even more crowded and unsanitary areas in southern and central Gaza, which doctors describe as breeding grounds for disease – especially as temperatures regularly reach 32 degrees Celsius (90 degrees Fahrenheit).

“The stench in Gaza is enough to make you immediately sick,” said Sam Rose, director of the UN agency for Palestinian refugees.

The conditions are also taking an emotional toll.

Anwar al-Hurkali, who lives with his family in a camp in the city of Deir al-Balah, in central Gaza, said he cannot sleep for fear of scorpions and rodents. He doesn’t let his children leave the tent, he said, fearing they will get sick from pollution and mosquitoes.

“We can’t stand the smell of sewage,” he said. “This is killing us.”

The UN estimates that nearly 70% of Gaza’s water and sanitation facilities have been destroyed or damaged by Israel’s heavy shelling. This includes all five wastewater treatment plants in the territory, as well as water desalination plants, sewage pumping stations, wells and reservoirs.

Employees who once managed municipal water and waste systems have been displaced and some have been killed, authorities say. This month, an Israeli attack on Gaza City killed five government workers who were repairing water wells, the city said.

Despite staff shortages and damaged equipment, some desalination plants and sewage pumps are operating but are hampered by a lack of fuel, aid workers say.

A UN assessment of two Deir al-Balah tent camps concluded in early June that people’s daily water consumption – including drinking, washing and cooking – was on average less than 2 liters (about 67 ounces), a lot less than the recommended 15 liters per day.

COGAT said it is coordinating with the UN to repair Gaza’s sewage facilities and water system. Israel opened three water lines “pumping millions of liters daily” into Gaza, he said.

But people often wait in line for hours to collect drinking water from delivery trucks, transporting as much as they can carry back to their families. Scarcity means families often wash in dirty water.

This week, Dalloul said, he lined up to ask a vendor for water. “We discovered it was salty, polluted and full of germs. We found worms in the water. I was drinking from it,” he said. “I had gastrointestinal problems and diarrhea, and my stomach hurts even now.”

The World Health Organization declared an outbreak of hepatitis A which, by early June, had led to 81,700 reported cases of jaundice – a common symptom. The disease spreads mainly when uninfected people consume water or food contaminated with fecal matter.

As wastewater treatment plants have closed, untreated sewage is seeping into the ground or being pumped into the Mediterranean Sea, where the tides move north toward Israel.

“If there are poor water conditions and polluted groundwater in Gaza, then this is a problem for Israel,” said Rose, of the UN agency for Palestinian refugees. “In the past, this has led to actions by Israel to try to improve the situation.”

COGAT said it is working on “improving waste management processes” and analyzing proposals to establish new landfills and allow more garbage trucks into Gaza.

Barefoot on a street in the Nuseirat refugee camp, Abu Shadi Afana, 62, compared the pile of rubbish next to him to a “waterfall”. He said trucks continue to dump garbage even though families live in tents nearby.

“There is no one to give us tents, food or drinks and on top of that we live in rubbish?” Afana said. The rubbish attracts insects he has never seen before in Gaza – tiny bugs that stick to his skin. When he lies down, he said, he feels as if they are “eating his face.”

There are few other places for trash to go. When Israel’s military took control of a 1-kilometer (0.6-mile) buffer zone along its border with Gaza, two main landfills east of the towns of Khan Younis and Gaza City were off-limits.

In its absence, informal landfills developed. Displaced Palestinians left without shelter say they have had no choice but to pitch tents near piles of trash.

Planet Labs satellite images analyzed by The Associated Press show that an informal landfill in Khan Younis that emerged after Oct. 7 appears to have doubled in size since January. Since the evacuation of Rafah, a tent city has sprung up around the landfill, with Palestinians living among piles of rubbish.

Doctors in Gaza fear cholera could be on the horizon.

“Overcrowded conditions, lack of water, heat, poor sanitation – these are the preconditions of cholera,” said Joanne Perry, a doctor who works in southern Gaza with Doctors Without Borders.

Most patients have illnesses or infections caused by poor sanitation, she said. Scabies, gastrointestinal illnesses, and rashes are common. More than 485,000 cases of diarrhea have been reported since the start of the war, says the WHO.

“When we go to the hospital to ask for medicine for diarrhea, they tell us it is not available and I will buy it outside the hospital,” said al-Hurkali. “But where do I get the money?”

COGAT says it is coordinating the delivery of vaccines and medical supplies and is in daily contact with Gaza health authorities. COGAT is “unaware of any authentic and verified reports of unusual illnesses other than viral illnesses,” it said.

With efforts to broker a ceasefire between Israel and Hamas stalled, Dalloul says he has given up hope that help is on the way.

“I’m 21 years old. I should start my life,” he said. “Now I just live in front of the trash.”

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Frankel reported from Jerusalem. AP journalists Jack Jeffery in Ramallah, West Bank, and Michael Biesecker in Washington contributed to this report.