Assessment of Health and Well-Being Effects Associated With the Challenging Drinking Water Situation in the Gaza Strip: Protocol for a Cross-Sectional Household Survey Study
Authors: Brugger Curdin , Dietler Dominik , Abu Hamad Bassam A , van Gastel Tammo , Sittaro Federico , Rossi Rodolfo , Owen Branwen Nia , Probst-Hensch Nicole , Winkler Mirko S 
Published: October 2024

Background
The water supply in the Gaza Strip, Palestine, has been unstable and under strain for decades, resulting in major issues with drinking water quality, reliability, and acceptability. In 2018, between 25% and 30% of Gazans did not have regular access to running water. The progressive deterioration of water infrastructure and concerns over the quality of piped water have resulted in a complex mix of drinking water sources used in the Gaza Strip. The challenges of safe water provision in the Gaza Strip could potentially have severe adverse effects on the population’s health and well-being.

Objective
The main objectives of this survey are to determine the quality of drinking water at the household level and to investigate the association of various health outcomes with water quality at the household level in the Gaza Strip.

Methods
We conducted a cross-sectional household survey in the North Gaza, Gaza, and Rafah governorates between January and March 2023. We selected a subsample of households from a representative cross-sectional survey conducted in the Gaza Strip in 2020 with persons aged 40 years and older. From each household in the 2023 survey, we invited 3 individuals (2 older than 40 years and 1 between 18 and 30 years) to participate. The face-to-face interview included questions on drinking water, mental health and well-being, self-reported diagnoses for selected diseases, use of antibiotics, and knowledge about antimicrobial resistance. Additionally, we measured each participant’s blood pressure. We sampled drinking water from each household and analyzed the samples for microbial contamination, nitrate, sodium, and mineral content.

Results
In total, we visited 905 households and interviewed 2291 participants. In both age groups, more female participants were interviewed. A total of 56.60% (914/1615) were aged ≥40 years, and 58.9% (398/676) were aged between 18 and 30 years. We obtained water samples from nearly all households (902/905, 99.8%). The results are expected to be published in several papers in 2025.

Conclusions
The extensive survey components, coupled with drinking water testing and building on an existing survey, allowed us to identify a broad set of potential impacts on health and well-being and to track changes over time. This study intends to identify humanitarian and development interventions that could impact the population served most. However, we completed data collection before the escalation of violence in October 2023. Given the impact of the still ongoing conflict, the initial intent of this work is no longer valid. However, the results emerging from the survey may still serve as a valuable baseline to assess the impacts of the current escalations on physical and mental health and on drinking water quality. In addition, our findings could provide important information for rebuilding the Gaza Strip in a more health-promoting way.

International Registered Report Identifier (IRRID)
DERR1-10.2196/63415