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A U.S. Emergency Manager’s View of the Water Systems Crisis in Gaza

Published online by Cambridge University Press:  29 September 2026

Michael PrasadOpen the ORCID record for Michael Prasad[Opens in a new window]
Michael Prasad*
Affiliation:
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*
Corresponding author: Michael Prasad; Email: info@bartondunant.com
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Abstract

Before October 2023, Gaza’s water sector already faced severe and persistent challenges, including aquifer contamination, damaged infrastructure, and limited system reliability. The ongoing armed conflict has intensified these conditions, causing unprecedented destruction and the near-total breakdown of water and wastewater services. The conflict itself continues to obstruct remediation, mitigation, and broader efforts to address the longstanding public health crisis.

Many residents now depend on brackish well water, limited desalination output, or imported bottled water because local systems cannot provide consistently reliable and safe drinking water. Access to clean water remains a critical humanitarian concern, with repeated disruptions caused by damaged pipelines, fuel and parts shortages for water pumps, and restrictions on the import of repair materials. From an emergency management perspective, this constitutes a chronic disaster with urgent and unresolved life-safety consequences.

Gaza’s wastewater infrastructure has also sustained extensive damage, leaving large portions of the system inoperable. Damage to treatment plants and sewage pipelines has led to repeated sewage overflows and the discharge of untreated wastewater into the environment, including discharge of untreated sewage into the Mediterranean and the flow of sewage near displacement sites. These failures heighten public health risks by increasing exposure to contaminated drinking water, waterborne disease, and broader environmental pollution/contamination, including direct human exposure to sewage-contaminated coastal water.

This paper posits that protecting civilians’ health and restoring essential water and wastewater services remain central to any response, and suggests applying the relatively new U.S.-based Community Lifelines concept for emergency management to help prioritize critical infrastructure restoration. It will examine the crisis in Gaza through a U.S. emergency management lens—a view not previously taken by disaster researchers—with particular attention to the humanitarian and ethical imperative to prioritize life safety before, during, and after any type of disaster, via the WASH-Health nexus.

Information

Type
Commentary
Information
Disaster Medicine and Public Health Preparedness , Volume 20 , 2026, e168
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Introduction

Both international and non-international armed conflicts can have adverse impacts on the public health of civiliansReference Turkman, Shaikh Ibrahim and Ayyad 1, especially if civilian objects such as potable water supply systems, desalination plants, and wastewater treatment infrastructure are even incidentally damaged/destroyed.Reference Daniele 2 The response and recovery efforts 3 of both public health and emergency management systems needed to resolve the immediate and long-term adverse impacts can be disrupted and even prohibited, even though such damage and destruction of civilian objects is generally understood to be a violation of International Humanitarian Law. 4

U.S. emergency managers evaluate a broad range of threats and the ways hazards affect the systems that sustain society. To support this work, the U.S. Federal Emergency Management Agency (FEMA) developed the Community Lifelines framework, 5 defined as “a collection of essential elements of information, to enable the continuous operation of critical government and business functions, and which are essential to human health and safety, economic security, or both.” 3

As in medical care, where life safety takes priority regardless of the patient, emergency managers have a duty to restore Water, Sanitation and Hygiene (WASH) capabilities for everyone in any crisis.Reference Prasad 6 Their role is to protect civilian infrastructure and other life-sustaining systems, as well as to prevent, respond to, recover from, and mitigate the adverse impacts of disasters, including those arising during armed conflict. 3

Community Lifelines (see Figure 1) are inherently interdependent,Reference Kruger 7 with Energy (Power & Fuel) connected most extensively to the others.Reference Kim and Kim 8 In any crisis, Water Systems and Food, Hydration, and Shelter present the most immediate life-safety concerns and therefore become top restoration priorities for emergency managers. Regardless of what caused the disruption or destruction, the Community Lifelines framework can guide response coordination, stabilization, and recovery. Every lifeline should be restored to collectively ensure reliability, redundancy, and resilience in future disasters.Reference Kim and Kim 8

Figure 1.

FEMA Community Lifelines. Source: Barton Dunant. (C). Used with permission.

A grid diagram of F E M A Community Lifelines icons organized into eight thematic columns with a color-coded impact legend. See long description.
Figure 1. Long description

The diagram consists of eight vertical columns, each topped with a primary lifeline icon inside a thick circle.

* Column 1, Safety and Security: Includes Law Enforcement/Security, Fire Services, S A R (Search and Rescue), Government Services, and Community Safety.

* Column 2, Food, Hydration, Shelter: Includes Food, Hydration, Shelter, and Agriculture.

* Column 3, Health and Medical: Includes Medical Care, Patient Movement, Public Health, Fatality Management, and Medical Supply Chain.

* Column 4, Energy (Power and Fuel): Includes Power (Grid) and Fuel.

* Column 5, Communications: Includes Infrastructure, Alerts, Warnings, and Messages, 9 1 1 and Dispatch, Responder Communications, and Finance.

* Column 6, Transportation: Includes Highway/Roadway, Mass Transit, Railway, Aviation, and Maritime.

* Column 7, Hazardous Materials: Includes Facilities and H A Z M A T, Pollutants, Contaminants.

* Column 8, Water Systems: Includes Potable Water Infrastructure and Wastewater Management.

A legend in the bottom right corner uses a faucet icon to define impact levels:

* Green equals Minimal Impact.

* Yellow equals Moderate Impact.

* Red equals Significant Impact.

* Grey equals Unknown Impact.

Narrative Approach

This paper presents an abbreviated narrative synthesis of open-source information, including media coverage and reports from international humanitarian organizations, alongside research on the condition of Gaza’s WASH systems before and after the most recent armed conflict, resulting in the cumulative and cascading collapse of this critical infrastructure. It also draws on academic sources that inform emergency management perspectives and potential solutions. The literature review covers publications from 2017 to the present, with greater emphasis on recent peer-reviewed studies. Pre-conflicts water systems capability (prior to 2017) was disregarded, as it has little bearing on the current state of WASH systems today. Sources were identified through web searches of Google Scholar, PubMed, and JSTOR, and supplemented by reporting from established humanitarian organizations, including the British Red Cross, the International Federation of Red Cross and Red Crescent Societies (IFRC), the United Nations, and the World Health Organization.

The author is also a U.S. disaster and international humanitarian law volunteer with more than 20 years of service to the American Red Cross. The only media source cited was itself referenced in a peer-reviewed article. Some recent developments, both positive and negative, were either too new to appear in academic literature or too focused on causality to support an unbiased analysis. The author also acknowledges the limitations associated with rapidly evolving conflict settings, a reliance on secondary data, and challenges in independently verifying some reported information. This short exploratory paper also emphasizes a new proposal: the importance of restoring what U.S. emergency management defines as the Water Systems Lifeline, including potable water infrastructure and wastewater management, in Gaza. Background on Community Lifelines is drawn from the U.S. Federal Emergency Management Agency (FEMA) and from the author’s previously published work and continuing advocacy for systems which support whole of government/whole community cooperation, collaboration, coordination, and communication for problem-solving.

Narrative

Environmental health conditions in Gaza have never been pristine. The armed conflicts in and around Gaza can be characterized, from emergency management and public health perspectives, as prolonged, chronic, or even a catastrophic disasterReference Abuawad, Griffiths and Edwards 9:

  • • From the 2014 Israel-Gaza conflict, the disparities in access to potable water and its adverse impacts on public health in Palestine were then reported widely by international media and peer-reviewed research.Reference Al-Shalalfeh, Napier and Scandrett 10

  • • In 2017, Gaza’s water threats were WASH-related, noting that over 108,000 cubic meters of untreated sewage was flowing daily from Gaza into the Mediterranean Sea.Reference Efron, Fischbach, Giordano, Kurz, Dekel and Berti 11 These WASH threats expanded the public health risks to not only Gaza, but to Egypt and Israel. The energy lifeline degradation and the restrictions on importing construction materials, water pumps, etc. only made the public health risks worse.Reference Efron, Fischbach and Blum 12

  • • At one point, the United Nations (UN) predicted that Gaza would become uninhabitable by 2020. They recognized that 95% of Gaza’s well water was unsuitable for human use—and this was before the most recent armed conflict. 13

  • • And the potable water infrastructure and wastewater management systems have massively deteriorated since October 2023.Reference Sarsour and Nagabhatla 14

In 2024, the BBC reported that wastewater management failures, including damaged or destroyed treatment systems, have contaminated several displaced persons camps and once again sent raw sewage into the Mediterranean Sea, causing harm elsewhere. Israeli defense officials reported that the Coordination of Government Activities in the Territories (COGAT) had taken steps to restore water wells, desalination capacity, water pipes, and sewage-system functions in Gaza; however, the BBC stated that it could not independently verify all of these measures.Reference Nour, Saeed and Altalebi 15 , Reference Hassoun 16 These sewage-network failures, combined with accumulated garbage, have increased the presence of flies, mosquitoes, other insects, and rodents, further contributing to infectious and non-communicable disease risks among displaced populations.Reference Dardona, Boussaa and Dardona 17

The armed conflict, which started in 2023, has exacerbated the already chronically damaged WASH infrastructure, as noted. This conflict has displaced nearly 2 million people, representing approximately 90% of Gaza’s population. With overcrowding in camps, continued WASH challenges, food insecurity, and other hazards, researchers have found that epidemics—including a return of polio—have increased fivefold over the pre-conflict timeframe.Reference Hassoun, Al-Muhannadi and Hassan 18

Waterborne illnesses remain prevalent in Gaza. A March-July 2025 cross-sectional survey of 1,200 displaced people in shelters across 5 governorates found that 31.5% reported symptoms consistent with waterborne illness, rising to 38.3% among children under 5. Most participants relied on trucked water from unregulated vendors (61.2%), while only 27.5% had piped or humanitarian water. Shared sanitation and limited soap access were common. This is especially critical as displaced families, facing freshwater shortages, have resorted to seawater for bathing and washing. Of 240 household water samples tested, 74.2% exceeded WHO fecal coliform thresholds and 62.5% contained E. coli, with significantly higher contamination in unregulated vendor water (P < 0.001).Reference Abuzerr, Hamdan and Charafeddine 19

For example, the WASH protections for water systems are critical for Infant and Young Child Feeding in Emergencies (IYCF-E).Reference Deniz Bilgin and Karabayır 20 Even with adherence to the International Code of Marketing of Breast-milk Substitutes from the World Health Organization, 21 any powdered formula use requires clean, safe water. Boiling the water first can significantly reduce microbiological contamination when alternatives are lacking. However, boiling consumes energy and does not eliminate chemical contaminants like salinity and heavy metals, and the powdered formula itself is not sterile. Nursing mothers may prioritize sourcing food and fuel for others’ use, above their own nutritional needs,Reference Strong, Rhoads and Russell 22 especially those who have been displaced for long periods of time, as in Gaza today.Reference Elnakib, Fair and Mayrhofer 23 Proper nutrition for the nursing mother is also a life safety mission for U.S. emergency managers, as part of the Food, Hydration and Shelter Community Lifeline, through deliberative planning.Reference Prasad, Russell, Phipps and McEntire 24

Regardless of potential bias or lack of foundational research identified in the limited literature review, the prolonged conflict and successive military escalations have cumulatively devastated the Water, Sanitation, and Hygiene (WASH) infrastructure within the Gaza Strip. The interdependence of systems (e.g., lack of fuel, stopped sewage pumps, flooding of streets, contamination of the sole aquifer and outbreak of waterborne disease) has created a cascading collapse.

Discussion

Emergency management missions in the U.S. 3 flow through a cycle of before, during, and after incidents of scale:

The use of the Community Lifelines framework highlights both the interdependencies of the cycle, as well as between the Lifelines themselves.

Before

Parties to armed conflicts, international organizations, and other civilian practitioners working in the contexts of armed conflicts, including in pre- and post-conflict situations, should prepare themselves with the protection and prevention aspects of the Geneva Conventions, especially the Geneva List of Principles on the Protection of Water Infrastructure. 25

Attacks on water and sanitation systems include ground, sea, and air operations, may harm civilians or civilian objects, including through munitions or unexploded ordnance. They also include actions that cut off civilian water services, target the providers responsible for operating and maintaining this infrastructure, or deny access to the spare parts and consumables needed for repairs and continued operation. 26

During

During armed conflict, many of these response missions should be coordinated through military channels, even when civilians carry them out. Water is essential to life, dignity, and recovery in conflict settings. Yet it is increasingly targeted, manipulated, or incidentally damaged, making it both a casualty and, at times, a weapon of war, with effects that often go undocumented or unattributed. Although international humanitarian law (IHL) provides multiple protections for water, legal uncertainty, operational constraints, and weak implementation limit their effectiveness.Reference Kaelin, Pellaton and Kebebew 27

While the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) 28 is still performing emergency WASH missions across the Gaza Strip, at its shelters and spontaneous displacement areas, the degraded or destroyed Water Systems Community Lifeline is still adversely impacted. Instead, UNRWA’s protection relies on international humanitarian law and the diplomatic immunities granted to United Nations facilities and personnel. The warring parties in conflict zones are legally obligated to respect and safeguard UN premises (like schools and clinics) and civilian staff. 29

Emergency managers still need to perform:

Emergency management in this context should be collaborative, cross-border, and focused on civilian protection rather than military conquest. Gaza has no national emergency management agency of its own and instead depends heavily on the United Nations, international non-governmental organizations, the Palestinian Civil Defense, and the Palestine Red Crescent Society. 34 Armed conflict also creates major obstacles for humanitarian operations, including restrictions on aid organizations, particularly those outside the groups recognized under the Geneva Conventions. 35

Practical measures noted above, including risk assessment, 36 coordination with humanitarian actors, mechanisms for deconfliction, protection for repair crews, contingency planning, and stockpiling essential resources, are not currently legal obligations of conflict parties, especially when implementing the principles of proportionality and precautions for civilian protection in their actions.Reference Morais Figueiredo 37

In 2023, the International Committee of the Red Cross (ICRC), working through the Syrian Arab Red Crescent (SARC), sought security guarantees to allow technical personnel, including United Nations staff, to access, operate, assess, maintain, and repair civilian WASH infrastructure. Pauses in fighting also enabled the delivery of diesel for generators, disinfectant chemicals, and other essential materials and equipment. 38

After

Water Management for WASH, as well as agro-economic use, should be considered essential for the civilian long-term recovery from conflict, as well as mitigation against the adverse impacts to the Water Systems Community Lifeline elements on an all threats and hazards basis. Application of a Water Evaluation and Planning (WEAP) management plan, as was performed in Syria,Reference Mourad and Alshihabi 39 is an effective tool for long-term mitigation.

The totality of the Water Systems Community Lifeline includes the interdependencies with other Community Lifelines such as Energy (Power & Fuel) and Food, Hydration, and Shelter. Partial solutions or short-term fixes will not correct core public health and engineering systemic needs. Even the threat vectors, such as biological/chemical contamination, structural degradation of wastewater networks, fuel/energy dependency, or the breakdown of disease surveillance, are themselves interdependent in this disaster.

And the WASH-health nexus is represented by the connections between the Community Lifelines of Water Systems and Health and Medical, which also incorporates public health. The failure of water and wastewater infrastructure is correlated to public health adverse outcomes like diarrheal disease,Reference Abuzerr, Hamdan and Charafeddine 19 hepatitis A,Reference Turkman, Shaikh Ibrahim and Ayyad 1 poliovirus transmission,Reference Turkman, Shaikh Ibrahim and Ayyad 1 dermatological conditions,Reference Ahmed, Alhajeeli and Badheeb 40 malnutrition,Reference Al Bakri, Khader and Khatib 41 and other health hazards related to displacement.

Conclusion

This paper argues that Gaza’s water and wastewater emergency should be understood not only as a humanitarian crisis, but also as a prolonged failure of a core life-sustaining system. From a U.S. emergency management perspective, the degradation of potable water infrastructure and wastewater management constitutes a collapse of the Water Systems Community Lifeline, with cascading effects on public health, displacement conditions, food security, and broader social stability.

This analysis, including the practical applications discussed above, suggests that the U.S. Community Lifelines framework offers a useful interdisciplinary model for consolidating and prioritizing essential civilian services in conflict-affected settings where those services have been chronically degraded. Just as all levels of government coordinate to restore Community Lifelines after natural hazards with comparable public health adverse impacts, all parties to an armed conflict should coordinate to stabilize and restore these same life-sustaining systems for civilians.

In Gaza, protecting civilians requires more than the urgent delivery of emergency supplies. The Community Lifelines framework adds value, compared to the existing humanitarian WASH coordination, in its restoration toward permanency and identifies priority interventions beyond feeding, hydration, and sheltering for immediate response, stabilization, and long-term recovery.

Identifying and holding responsible the U.S. stakeholders for its own disasters, aligned to the Community Lifelines, is straightforward: “Disaster response should be locally executed, state or tribally managed, and federally supported.” 42 Such is not the case for Gaza or the Palestinian people for their ongoing and chronic disaster. A single nation with long-term economic strength, even with disparate levels of emergency management capabilities across internal jurisdictions, can rebuild and restore Community Lifelines—in some cases with international organizations’ assistanceReference Gauto Gunther and WG 43 and support. This will be the challenge for Gaza: Who will politicallyReference Harvey 44 lead and coordinate a cross-borderReference Shah and Irfan 30 coalition of governmental and non-governmental organizations to restore the infrastructureReference Kawashima 45 involved in the Community Lifelines, especially Water Systems? Will this require a modern version of the Marshall Plan? 46 These questions are beyond the scope of both public health and emergency management.

Yet all these activities remain to be performed at a sufficient level to stabilize the water and wastewater systems themselves, regardless of the causality of either pre-existing WASH vulnerabilities or the unprecedented damage caused by the current armed conflict. Absent such measures, the effects of infrastructure loss will continue to propagate through health, nutrition, shelter, and recovery systems, increasing both immediate life-safety risks and long-term human insecurity. Accordingly, restoration of Gaza’s water and wastewater services should be treated as an urgent operational priority and a foundational condition for public health protection, humanitarian effectiveness, and any credible path toward societal recovery.

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Figure 0

Figure 1.FEMA Community Lifelines. Source: Barton Dunant. (C). Used with permission.Figure 1. long description.