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 Environmental Health in Gaza Strip 
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• Contents
• 1- Introduction 2- Definition of
  Environmental Health 3- Background of E. H. in
  Gaza Strip 4- Water5- Waste Water  6- Solid
  Waste 7- Pesticides Toxic Substances
  Pollution 8- Air Pollution9- Food
  Hygiene 10-How the environment affect
  health?11- Environment-related killers in
  children
• 12- Tackle the environmental risks to our
  children 13- Strategic objectives  14-
  Recommendations  15- Conclusion and Comments

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• Historical perspective
• "If you want to learn about the health of a
  population, look at the air they breathe, the
  water they drink, and the places where they
  live.
• Hippocrates, the Father of Medicine

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• The Hippocratic Oath ''well being of man is
  influenced by all environmental factors the
  quality of the air, water, food, the winds and
  the topography of the land''.
• Environmental improvements and efforts toward the
  control of communicable disease continue in the
  20th century with the wide spread use of
  immunization and the discovery of antibiotics.
• However
• New set of environmental concerns result from the
  introduction of new technology and chemicals
  combined with lifestyle risks and stresses
  cancer, heart disease, CVA

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Introduction Understanding the effect of
environmental factors on health and disease
requires studying many factors like social,
cultural, political, economical and physical
factors that interact with psychological and
physiological rhythms that form the foundations
of human existence.   Studying this issue
will assist in recognizing the Environment as an
important contributor to health and well being of
the population.   Environmental health is a
state of health that exists as a result of the
force and conditions that surround and influence
human being.     Due to rapid growth of
industrial countries, the environmental hazards
increase.
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What is 'Environmental Health'?
Definition of Environmental Health by
WHOEnvironmental health comprises those aspects
of human health, including quality of life, that
are determined by physical, chemical, biological,
social and psychosocial factors in the
environment. It also refers to the theory and
practice of assessing, correcting, controlling
and preventing those factors in the environment
that can potentially affect adversely the health
of present and future generations. Definition
of Environmental Health by CDCrefers to
protection against environmental factors that may
adversely impact human health or the ecological
balances essential to long-term human health and
environmental quality, whether in the natural or
man-made environment.
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Definition of Environmental Health by National
Institute of Environmental Health Sciences
Environmental health is the branch of public
health that is concerned with all aspects of the
natural and built environment that may affect
human health. The priorities of the Environmental
Health lie in areas related to contamination of
the environment and the possible adverse effects
of environmental pollutants on human health.
  
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Sanitation may be defined as the control of those
factors of the environment affecting public
health. It is apparent that the fundamental
principles will be found in the science of
bacteriology, biology, entomology, chemistry and
physics. Environmental health problems in
Palestine resemble the major environmental health
problems in the Middle East region. Subjects or
problems of Environmental Health in Gaza Strip
are Water quality and quantity, Waste water,
Solid waste, Pesticides and toxic substances
pollution, Air pollution and Food hygiene. 
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Background of Environmental Health in Gaza
StripGaza Strip is a semi-arid region of
roughly 365 km2 which lies on the Mediterranean
Sea. On this narrow strip, almost 1.4 million of
the Palestinian people live and work.  A "
Catastrophic" water shortage, water pollution
with high salinity and micro-pollutants, lack of
sewage and solid waste treatment, maritime
pollution, overcrowding, poverty and uncontrolled
use of pesticides are the most pressing
environmental problems in Gaza Strip.
 Internationally suspended, banned and canceled
pesticides which considered mutagenic and
carcinogenic are still used in the agricultural
environment.   
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Mediterranean Sea is used for the disposal of
sewage water, solid wastes, agricultural and
industrial waste water. In general these
environmental problems have multiplied the
Palestinians human environment problems,
socio-economic problems and increasing health
hazards. Therefore, the environment in Gaza
Strip requires a more thoughtful and
comprehensive policy and planning of awareness
and conservation.  
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Water Importance Water is one of the
essential components of the human body. It plays
active role in the physiological process that is
necessary to human life. Water is essential for
heat regulation, acid-base balance, excretions to
toxins and waste material and metabolism of all
food material. Sources of water The
underground water is the main source of water in
Gaza Strip. Wells are used to get the underground
water.  
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Raining water is used in West Bank. The water is
collected in private store under each house. The
family uses this water during all the year.
 Surface water could be from rivers or lakes.
Tabria lake is one of the main water store in
Palestine.  The main source of water in Gaza
Strip is the ground water (about 5000 well) which
is used for irrigation, industrial and domestic
purposes. The consumption about 120 MCM / year
and the recharge about 70 MCM /year. In Fact,
per capita water consumption in Gaza Strip is
less 4 5 times other countries. This has led
to the depletion of available quantities in Gaza
Strip and reduction of ground water storage as
well as the degradation of water quality.
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Water Characters 1- Physical the water
should be colorless, tasteless and odorless.
Change of odor, color or taste indicates water
pollution or contamination.  2- Biological
Drinking water should be free from all
microorganisms. The best indicator for water
contamination is the presence of E. Coli
indicates fecal contamination.  3- Chemical
The accepted level of chemical concentration is
referred to the maximum concentration of specific
material in water that if exceeded it will
endanger human heath .
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Water pollution  Types of water pollution
 1- Organic wastes from domestics. 2-
Infectious agents contributed by domestic sewage.
 3- Plant nutrients as algae.  4- Synthetic
organic chemicals as pesticides, detergents etc.
 5- Inorganic chemicals and minerals
substances.  6- Sediments that fill stream
channels and reservoirs.  7- Radio active
pollution
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Health Hazards of WaterWater Sources in Gaza
Strip are subjected to excessive over-
exploitation and over - pumping , this has led
to degradation of water quality in Gaza Strip ,
where severe water shortage (about 50 MCM / year)
are experienced and where the situation has
become catastrophic.   Water Pollution with
different pollutants (Salinity such as Chloride
and Nitrate and Micro - pollutants such as
Pesticides, Fertilizers Detergents).   For
example chloride and nitrate concentration in
some wells reaches more than 1500 and 100 ppm
respectively.  
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Palestinian and German scientists have
recommended to the Palestinian Authority to take
immediate measures to combat excessive nitrate
levels in the drinking water.  90 of Gaza
Strip water samples were found to contain nitrate
concentrations that were between two and eight
times higher than the limit recommended by the
(WHO). Over the long term they recommend that
the best protection would be provided by quality
management for groundwater resources.  In
babies younger than six months, nitrate can lead
to methaemoglobinaemia, to diarrhoea and to
acidosis. The WHO recommends keeping nitrate
levels to 50 mg/ L or less.
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Waste Water  Gaza Strip
produced about 35 MCM / Year sewage water.
Unfortunately about 50 the raw sewage is
discharged untreated in the Mediterranean Sea
where the biological oxygen demand increases.
 The rest of sewage is collected in three
central sewage collecting pools with semi
treatment such as the first step of primary
treatment which is the aeration and sometimes the
secondary treatment. When these pools filled with
sewage water, it's flooded aside and pollutes the
ground water because our aquifer is shallow. 
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Sewage networks cover no more than 70 of total
residential areas in the Gaza Strip. So far,
there is no adequate sewage collection and
treatment facilities where use of septic tanks to
drain waste water is still widespread thus
causing, through leakage , the contamination
and pollution of the aquifers and increasingly
saline. Open sewage channels spread in some
parts of the Gaza Strip, particularly in refugee
camps, creating health hazards through the
accumulation of garbage and wastes. The
situation is so dramatic that during a visit to
the West Bank and Gaza Strip in January 1988, the
British Minister of the Foreign Office David
Miller described the situation in the Occupied
Palestinian Territories as being an affront to
civilized values.
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Waste Water Disposal Waste water disposal is of
great importance for population health because of
the main link between human excreta and
transmission of disease from one person to
another.  It is important that adequate
disposal measures are applied to control this
method of disease transmission.  All liquid
wastes should be handled properly in a sanitary
manner. Industrial wastes are a special problem
endangers the health of communities if not
managed properly.
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Health Hazards of Waste Water Disease
transmission most of enteric diseases could be
transmitted from one person to another through
contaminated environment such as Cholera,
Typhoid, Dysentery, Parasites, polio and
Hepatitis. Bad smell resulted in psychological
disturbance. Sewage collection is a breading
place for insects as mosquitoes and flies.
Contamination of underground water by biological
and chemical pollutants.Management of Sewage 
Treatment Biological treatment is performed
by these mechanismsa. Filtration b.
Aeration (???????? , ????????? ) c. Disinfection
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Solid Waste Gaza Strip produced about 0.68
MCM/Year solid waste. There are no enough dumping
sites, sanitary landfills, containers and
vehicles. Therefore, the solid waste is
sometimes thrown everywhere.  Gaza Strip
utilizes the old method of landfills for disposal
thus negatively affecting the environment. This
of course leads, in turn, to the spread of
diseases and increases the difficulties
encountered for disposal.
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Sources of Solid Wastea- Houses are the main
source of the solid waste and are the main place,
which necessitate proper waste disposal.b-
Streets this is mainly dust and the amount of
solid wastes depends on the population
orientation to their health. Healthy communities
have clean streets.c- Industries result in huge
amount of solid waste mainly metals, containers
and carton, this waste could be dangerous if it
contains chemicals or poisonous material.
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• d- Hospitals, domestic wastes and medical wastes
  are thrown daily from hospitals. Hospital wastes
  should be managed carefully where it contains
  contaminated syringes, gloves, cotton and
  utensils of patients. This material could be a
  source of infection for the community if not
  managed properly.

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Solid Waste disposal Extensive development of
incinerators, improved collection trucks and
procedures, solid wastes collection and disposal
has assumed its place as protective measures for
the public health.Hazards of Solid
Wastes1-Socio psychic The population does
not accept the sight of wastes. The heaps of
waste could result in fire with all the hazards
associated with this unsatisfactory event.
2-Economic Disposal of the waste without
proper utilization is an economic loss. Recycling
is one of the ways were the material could be
used again .
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3-Health Hazards 1- Fly Rodent Refuse is
a good media for breading of flies and rodents.
Both of them are harmful for human health. 2-
Mechanical injuries Where children are exposed
to wounds and injuries if they handle the refuse
un- properly. 3- Chemical pollution Chemical
hazards are common in factory waste. 4-
Bacterial contamination The chance of bacterial
contamination is higher when hospital is present.
Putrefaction of the organic material results in
production of a great number of pathogens that
could influence human.  
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• Management of Solid wastes
• Management of solid wastes includes
  these items
• 1- Collection
• 2-Transport
• 3- Disposal
• a- Dumping b- Incineration c- Recycling

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Pesticides Toxic Substances Pollution  More
than 350 metric tons of formulated pesticides
(more than 100 pesticides) in addition to 800
metric tons of Methyl Bromide are used annually
in Gaza Strip.  Such heavy use of pesticides
causes water pollution and soil degradation and
contamination of the agricultural products which
finally affect seriously the human and
animals. It was found that 19 of these
pesticides, that have been used, are
internationally suspended, cancelled and banned
pesticides, according to their mutogencity,
carcinogencity , teratogencity and delayed
neurtoxicity.
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About 5800 cases of cancer have been registered
in Gaza Strip (1990 - 1999). The distribution of
cancer types among those patients are lung
cancer, breast cancer, lymphoma and leukemia
malignancy, head and neck, gastrointestinal
malignancy, reproductive system, urinary system,
soft tissue tumors, brain tumors and others .
 Consequently, the introduction and heavy use
of pesticides and other toxic substances in the
Gaza Strip environment is suspected to correlate
with the growing incidence of cancer and other
abnormalities in the nation.  Precise
determination of the effects of chronic exposure
is, therefore, urgently needed. Finally, it is
the responsibility of the civilized world to take
the initiative towards regulating, production,
exportation and importation of any suspected
cytotoxicants.
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Air PollutionDefinition of Air Pollution
Concentration of foreign matter in the air which
adversely affect the health and welfare of the
people or their enjoyment. The most severe
pollution is the chemical pollution.  In Gaza
Strip there is a large number of transportation
means estimated at about 35,000 to 45,000 motor
vehicles that constitute the major source of air
pollution.  Car exhausts release to the air
large quantities of carbon monoxide, carbon
dioxide, nitrogen oxides, hydrocarbons and lead
that are considered very poisonous and some may
be carcinogenic and may affect the respiratory
and nervous system.  Melting Lead and burning
solid wastes are other major sources of air
pollution in Gaza Strip.
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Food Hygiene The primary objective of sanitary
supervision over all places where food is
prepared and served to the public is to prevent
illness and possibly death from spoiled or
contaminated foods.  The local health
department is responsible for protecting the
publics health against food contamination.
 Salmonella and staphylococci gastroenteritis
germs are very prevalent and multiply rapidly in
food and thus and food poisoning are the
predominant infections transmitted by food. 
Other diseases transmitted by food include
typhoid fever, amebic dysentery and bacillary
dysentery.
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FOOD BORNE DISEASES
I. Biological Agents  1. Food intoxication and
bacterial infections 1-1 Botulism performed
toxins produced by the growth of (Clostridium
botulism) in food under anaerobic conditions
cause Botulism. Symptoms develop in 2 hs to 8
days.  1-2 Staphylococcus food poisoning The
onset is 1-6 hours after ingestion  1-3 Amine
poisoningCheese and alcoholic drinks or certain
tranquilizers can result in such poisoning
 1-4 Salmonellosis Contamination of food by
salmonella poses a significant public health
problem
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Other bacterial infections
- Typhoid fever - Shigellosis
- Hemolytic
Streptococcal infections
- Enterococci - Brucellosis
- Cholera - Dysenterys  Viral
Infections-Infectious hepatitis -Others such
as poliomyelitis  
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• Parasitic infections- Amebiasis - Tenia - Tape
  worm diseases - Trichinosis from pork food -
  Giardiasis - Ascariasis
• Chemicals and Radiation Zinc, lead, Nicotinic
  acid, mercury acid, mercury, fluorine, lithium
  chromium, iodine, silicon, magnesium .. etc.
  pesticides are famous and known source of health
  hazards that endanger human life.

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How can the environment affect our
health?For better or worse, chemicals and other
contaminants have become a part of everyday life.
They exist in every aspect of our lives even
before we are born. Hundreds of new chemicals are
created every year.Exposure to large amounts of
any substance can be harmful to ones health.
However, some contaminants are more harmful, or
toxic, than others.
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• There are many types of toxicity. When thinking
  about toxicity, researchers consider a chemicals
  ability to cause or promote cancer, or cause
  neurological problems (damage to the brain and
  nervous system), respiratory problems (like
  asthma), and reproductive problems (chemicals
  that may harm the developing fetus, or an
  individual's ability to conceive).

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It is important to remember that some chemicals
in small amounts can improve or protect ones
health. Chlorine, which is used to purify
drinking water, can be toxic in large quantities.
In small quantities it protects us from cholera
and other diseases.
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Major environment-related killers in children
under five years of age (WHO)Diarrhea kills an
estimated 1.6 million children each year, caused
mainly by unsafe water and poor sanitation.
Indoor air pollution associated with the
still-widespread use of biomass fuels kills
nearly one million children annually, mostly as a
result of acute respiratory infections.
Malaria, which may be exacerbated as a result of
poor water management and storage, inadequate
housing, deforestation and loss of biodiversity,
kills an estimated one million children under
five annually, mostly in Africa. Unintentional
physical injuries, which may be related to
household or community environmental hazards,
kill nearly 300 000 children annually.
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The solutionsIn many cases, low-cost solutions
for environment and health problems exist. For
instance, simple filtration and disinfection of
water at the household level dramatically
improves the microbial quality of water, and
reduces the risk of diarrhea disease at low cost.
Education is also a key - mothers who receive
the information they need to understand the
environmental risks present in their homes and
communities are better equipped to take
appropriate action to reduce exposure.
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• Improved stoves reduce exposures to indoor air
  pollution. Better storage and safe use of
  chemicals at community level reduces exposures to
  toxic chemicals, especially among toddlers, who
  explore, touch and taste the products found at
  home. Personal protection from malaria through
  the use of insecticide-treated mosquito nets has
  a proven track record of saving lives,
  particularly children's.

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What can we do to tackle the environmental risks
to our children?The Healthy Environments for
Children Alliance (HECA) promotes a number of
simple, low-cost, effective and sustainable
measures to combat the environmental risks to our
children. Household water securitySafe water
storage at home and treatment of water in the
home when its quality is in doubt - reduces water
contamination and leads to proven health
benefits.
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• Hygiene and sanitationWash hands with soap
  before food preparation, before meals and after
  defecating significantly reduces the risk of
  diarrhea disease.
• Follow the WHO Five Keys to Safer Food to reduce
  the risk of food borne disease keep clean
  separate raw and cooked cook thoroughly keep
  food at safe temperatures and use safe water and
  raw materials.

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Air pollutionGood ventilation in the home, clean
fuels and improved cooking stoves decrease indoor
air pollution and the exacerbation and
development of acute respiratory
infections.Disease vectorsAs children usually
go to bed earlier than adults at the time
mosquitoes become active, the use of
insecticide-treated mosquito nets and the
screening of windows, doors and eaves provide a
very effective means of protecting them against
malaria.
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• Chemical hazardsEnsure safe storage, packaging,
  use and clear labeling of cleaners, fuels,
  solvents, pesticides and other chemicals used at
  home and in schools.
• Unintentional injuries Advocate for safer roads
  and organized traffic

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Housing and HealthHousing is a basic
determinant of health, and many organizations,
including the World Health Organization (WHO) and
the American Public Health Association (APHA),
have developed standards for healthy
housing.The most important role of housing is
to provide shelter from the elements. At its most
basic level, housing needs to keep its
inhabitants dry, warm (or cool), and safe.
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• For more info of what is possible, please refer
  to the HECA website
• www.who.int/heca/en

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Strategic objectives Strengthen the
capabilities and information exchange related to
health, and environment (water, air, hazardous
waste. vectors). Protect portable water,
indoor and outdoor air from pollution.
Protect form hazardous waste effects of
environment health
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• Protect the public from vectors and toxic
  materials.
• Collaborate with the national local authorities
  in the creation of supportive environment for
  health.
• Promote the environment of the non-
  governmental organization in planning and
  implementation of national plans and meeting
  national goals with special emphasis on health
  education.

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Recommendations1- Making environmental
assessment by a. Identifying the hazards
present. b. Assess the effect of these hazards
on the health of Individual, families and
communities. c. Assess the risk factors. d.
Diagnose and reasoning the environmental
influence at health  2- Playing to control
environmental hazards by primary, secondary, and
tertiary prevention by increase health Education,
treatment and rehabilitation.
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Conclusion and Comments The environmental
health is very important topic in relation to
health and disease. Clean air and water and
effective waste management remains critical
issues for 21st. century. Increase scientific
knowledge will decrease the hazards, which result
from the environment.
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• So the use of preventive measures also decrease
  such hazards.Good health education and programs
  contribute in large benefit in the preventive
  measures. The degree of development of the
  country also assists this subject. Increase
  awareness among population also decreases the
  hazards and deceases the number of risks people.

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The environment we personally create for
ourselves, through our habits, diet and lifestyle
are now seen as very important