Comparing the Effects of Humanitarian Crises on Water Sanitation and Human Health

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Introduction:

Humanitarian crises of varying degrees are set to become more commonplace with increasing intensity in the future (Kohrt, et. al, 2019). As the global stage changes, a comparative analysis of similar health impacts of various crises is becoming progressively important in order to minimize human costs. This paper compares two types of humanitarian crises in the 21st century, a natural disaster and a man-made conflict, and examines the effects on water sanitation and human health. 

Background on Humanitarian Crisis in Haiti:

Haiti experienced an earthquake of magnitude 7.0 on January 12th, 2010 resulting in 316,000 deaths and 1.3 million people displaced. Additionally, the earthquake caused about USD 7.9 billion in damage (Hill, et. al, 2011). Before the earthquake, according to the United Nations Human Development Index, Haiti ranked 163/188 among the most impoverished countries (Dube, et. al, 2017). According to sanitation records from Haiti, in 2010, about 85% of the population had access to improved water sanitation, while 51% of the rural population had access to clean water (Gelting, et. al, 2013). Furthermore, in 2010, Haiti ranked last in the Water Security Index out of all the countries surveyed (Walton, et. al, 2011). 

After the earthquake, disproportionately low access to clean drinking water was exacerbated by infrastructure damage, placing more residents of Haiti at risk for water-borne diseases. Infectious diseases, including cholera, accounted for some of the greatest proportion of deaths associated with the earthquake (Dube, et. al, 2018). However, immediately following the disaster there was a suspicious lack of infectious disease outbreak as previously predicted, resulting in the CDC implementing a national surveillance program to track outbreaks. Beginning in October, cases of cholera were rising, attributed to the lack of drinkable water and sanitation measures from infrastructure damage. Between October 20th and November 9th, 7159 total cases of severe cholera were reported, with 61 deaths across seven hospitals (Walton, et. al, 2011). 

Healthcare infrastructure was significantly damaged in the earthquake, with thirty out of the forty-five total facilities in Haiti either partially or destroyed, leaving those infected with water-borne communicable diseases vulnerable to their effects and lacking treatment, contributing to fatalities and overwhelming remaining hospitals. The effects of the earthquake not only exacerbated the lack of clean water but also the lack of access to healthcare before the disaster, with only 47% of Haitians able to access basic medical services (Arnaouti, et. al, 2022). Moreover, Haiti’s capital, Port-au-Prince, as well as the majority of other towns had little to no urban planning before the hurricane, resulting in a shortage of housing and causing a greater number of the Haitian population to be displaced when disaster struck. Exacerbating the effects of the humanitarian crisis is Haiti’s lack of resources as a result of overfarming (Martin, et. al, 2011). Haiti demonstrates the catastrophic effects of a natural disaster on a society that began with lower access to resources and infrastructure and the risk factors that exacerbated the disaster’s effects on the Haitian population. 

Human Health Impacts of Impaired Water Sanitation:

Cholera was thought to have been reintroduced to Haiti after the earthquake, after almost a century of being cholera-free. Children were found to be most vulnerable to cholera infection, and also at the highest risk of death (Dube, et. al, 2018). Public health officials were left unprepared for the sudden cholera outbreaks in Haiti after the earthquake. The initial lack of cases and reappearance of cholera after a decade of being cholera-free took responders off guard, limiting the efficiency of action. Additionally, the epidemic struck rural Haiti rather than displacement camps as anticipated. 

Although efforts were initially focused on addressing immediate human health impacts and search and rescue efforts, subsequent humanitarian responses aimed to help those impacted by secondary health effects. In response to the cholera outbreak, community health workers were deployed to rural Haiti to provide water purifiers, and water filters, and to educate residents on hygiene, hand washing, and cadaver safety (Walton, et. al, 2011). The lack of freshwater complicated cholera treatment, as the most common intervention for cholera infection is gradual rehydration. Without the availability of drinking water, those afflicted with cholera were not able to receive adequate treatment (Bhattacharya, 2003).

Despite the evident need for immediate humanitarian relief, responders faced significant barriers to providing care, with congested roads and damaged infrastructure interfering with communication and aid resources (Margesson and Taft-Morales, 2010). Scientists theorized that the cholera outbreak in rural Haiti rather than the population-dense displacement camps was inevitable, due to Haiti’s poor sanitation system existing before the earthquake. However, following the earthquake, it was unknown how the strain of cholera infecting Haiti’s residents made it to the island after decades of its absence, although the most likely theory was human transmission with its origins traced to South Asia (Walton, et. al, 2011). 

Responses to Haiti’s Humanitarian Crisis:

The 2010 earthquake in Haiti required one of the largest-scale humanitarian aid efforts to respond to its substantial, far-reaching effects. (Widmer, et. al, 2014). Due to the unprecedented impacts of the cholera epidemic on rural Haitian communities, a coordinated healthcare response was required to provide emergency water access and awareness of hygiene and sanitation measures to locals. The Haitian earthquake demonstrates the formidable challenge natural disasters create and the destructive effects the breakdown of essential infrastructure can have on countries that already have difficulty providing necessary resources to civilians. Additionally, the infectious disease effects of the Haiti earthquake demonstrate the potentially far-reaching impacts of a humanitarian crisis, highlighting the need to employ preventative measures to decrease fatalities in the event of disaster. 

Background on Israel-Gaza Conflict:

The conflict between Israel in Gaza, although occurring a decade after the earthquake in Haiti, highlights similar issues that arise in light of a humanitarian crisis. Along with displacement and infrastructure damage leading to a lack of clean water, civilians of Gaza face the threat of imminent cholera outbreaks. Infrastructure damage has led to significantly decreased access to transportation and road access, and therefore severely restricts access to essential humanitarian aid to mitigate the crisis. 

Related to previous conflicts in the West Bank, the Gaza- Israel conflict of late 2023 demonstrates another similar humanitarian crisis that jeopardizes water sanitation and human health. The conflict in 2023 is one of the results of decades of tension and violence in the West Bank between Israel and Palestine, with both sides suffering damage. However, because of Israel’s occupation of Gaza and its isolated location on the West Bank, the residents of the Gaza Strip face unique threats to human health and safety with low access to international aid (Gordon, 2008). 

Water Supply in Gaza:

Gaza’s vulnerable position in the conflict also comes in part from its water 

supply. The main source of water in Gaza comes from groundwater, with both civilians and agricultural industries completely dependent on its supply (Mayla and Amr, 2010). Gaza is located downstream from its main source of water, while Israel is located upstream. Because of its location, Gaza is also dependent on Israel both for quality and quantity of freshwater (Weinthal, et. al, 2005). In the past, Gaza has received aid from Israel when groundwater supplies were low in exchange for halting waste dumping into the Mediterranean (Efron, et. al, 2019). However, due to conflict between Gaza and Israel, Gaza does not currently receive water from Israel. Because Gaza relies on Israel for treated groundwater, a humanitarian crisis like the Gaza-Israel conflict puts the livelihood of Gaza’s residents at risk for water shortages as well as diseases like cholera, as previously seen in Haiti.

Additionally, Gaza does not retain enough infrastructure or supplies to repair damages to water treatment and sewer systems, increasing the chances of contamination. Similar to Haiti, the water sanitation before the crisis was inadequate, with more than a quarter of all reported diseases in the territory a result of waterborne infection (Efron, et. al, 2019). Therefore, as observed post-hurricane in Haiti, in times of crisis, there is a significant risk of further water contamination and further incidences of waterborne diseases like cholera (Mayla and Amr, 2010). Infrastructure damage also has the potential to result in further fatalities due to lack of medical support and first aid, also seen in Haiti after the earthquake. The WHO has classified the conditions in Gaza as a health emergency, with a catastrophic lack of healthcare and medical access as of December 2023 (Farge, 2023). According to current news out of Gaza amid the conflict in late 2023, sewage systems have begun to fail, resulting in water contamination and the prospect of elevated cholera incidences. Currently, the WHO has recorded upwards of 44,000 cases of diarrhea in Gaza since the beginning of the conflict in October, although the actual number may be higher (Marsi and Amer, 2023). Additionally, due to orders from Israeli forces to evacuate, up to 80% of residents in Gaza have been displaced and are refugees in south Gaza (Al Jazeera, 2023). As observed in Haiti post-earthquake, displacement and the resulting close contact of refugees in camps exacerbates infectious disease outbreaks like cholera.

Comparing Effects of Man Made and Natural Humanitarian Crises:

As observed in Table 1, there are a multitude of similarities and differences between man-made crises like the conflict between Israel and Gaza and natural disasters like the earthquake in Haiti. For a natural disaster, it is extremely difficult to predict when exactly a severe climate event will hit, although there are a variety of programs that have been created to pinpoint who and what will be most heavily impacted (Cioffi-Revilla, 2014). In contrast, the majority of man-made disasters have historical implications and often build up over several years. Additionally, in the modern day, the number of man-made violent conflicts has decreased, and in contrast, the number of predicted natural disasters has been projected to increase due to global warming increasing the potential for severe weather events (Burkle, et. al, 2014). 

 

Table 1: 

Similarities and Differences Between Man-Made and Natural Humanitarian Crises

Man-Made

Natural

Both

  • Incidences decreasing in modern day with potential to increase due to climate change effects
  • Violence disproportionately impacts women
  • More challenging to receive aid due to political polarization 
  • Difficult to predict
  • More severe effects in the future due to more complex social and industrial structures which can incur greater damage
  • Frequency increasing due to climate change and global warming
  • Display compound effects across multiple facets of life
  • Cause an increase in disease incidence
  • Result in displacement for impacted populations
  • Cause infrastructure damage leading to secondary effects
  • Require robust humanitarian relief
  • Distinction between the two types of crisis is decreasing in importance due to similar effects on populations
  • Potential to increase in the future due to climate change.

Note: From “The Changing Face of Humanitarian Crises” by Frederick M. Burkle, Jr., Gerald Martone and P. Gregg Greenough, and “Seeing it Coming: A Complexity Approach to Disasters and Humanitarian Crises” by Claudio Cioffi-Revilla.

 

Despite their differences, both types of humanitarian crises have relatively similar impacts on their respective populations and it could be argued that both have the potential to increase in the future as a result of climate change; violent conflicts have been projected to increase with increased scarcity of natural resources as well as encroachment of land from sea level rise causing greater competition for land and resources (Burkle, et. al, 2014). Therefore, identifying mitigation methods for both types of humanitarian crises is essential due to similar human health effects, including cholera outbreaks.  

Regardless of the current lack of research on the Gaza-Israel conflict’s effects on 

human health from lack of disease surveillance and limited access to the Gaza territory, it could be hypothesized that Gaza is at significant risk for a similar disease outbreak to Haiti. Both experienced humanitarian crises that threatened the livelihood of their residents and resulted in significant infrastructure damage and impaired water supply. Both experienced catastrophic infrastructure damage and recorded fatalities attributed to a lack of access to adequate healthcare. Contributing to their similarities is their mirrored conditions before the respective disasters. Although Haitians may have had more unequal access to water, both areas had limited fresh water supply before disaster struck, exacerbating human health effects.  

Conclusion:

Due to the catastrophic conditions in Gaza which mirror similar hazards following the earthquake in Haiti, action must be taken to prevent further fatalities from contaminated water and resulting infectious disease outbreaks. Because of the blurring of lines between man-made and humanitarian disasters as displayed in Table 1, the similar effects on both populations spurs the need for greater research on human health impacts as well as mitigation measures that can address infrastructure damage. As various humanitarian crises become more commonplace, identifying similarities is becoming increasingly important to minimize human costs. 

 

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