It’s not just bullets and bombs. I have never seen health organisations as worried as they are about disease in Gaza | Devi Sridhar

TThe war between Israel and Gaza has set several world records. It is the deadliest conflict for journalists in thirty years. It has caused the greatest loss of life United Nations staff in the history of the organization. It is expected to see the worst total number of attacks ever healthcare institutions and their staffand has destroyed schools 51% of educational facilities damaged. International rules such as the Geneva Conventions have not been respected: hospitals and ambulances are targeted, medical aid organizations such as Doctors Without Borders (MSF) and Save the children are under attack and have lost staff members.

The war between Israel and Gaza is also reportedly deadly for children deadliest conflict for children lately: approx 160 children were killed one day last month according to the World Health Organization. Compare this with three per day in the recent conflict in Syria, two per day in Afghanistan and 0.7 per day in Ukraine. The total number of murdered children is already more than 5,300 says UNICEF, the United Nations Children's Fund. They did not choose to be born there and are innocent, but they bear the brunt of these attacks.

Tragically, the almost unprecedented death and injury we have seen so far is likely just the beginning. From looking at similar conflicts around the world, public health experts know that we are likely to see more children die from preventable diseases than from bullets and bombs. Although the Israeli government has talked about safe zones for families to flee to, these are nowhere near what we would consider safe public health zones. They do not have clean water, functional sanitation and toilets, adequate food, or trained medical staff with medicines and equipment. These are the basic needs that every person, especially babies and children, need to stay healthy and alive.

The WHO spokesperson Dr. Margaret Harris has said that diarrhea rates among children in refugee camps (sheltered housing) in Gaza were already more than 100 times normal levels by early November, and that if treatments are not available, children can become dehydrated and die quickly. Diarrheal diseases are the second leading cause of death in children among five worldwide, and they are caused by contaminated water sources and lack of access to oral rehydration fluids. Upper respiratory tract infections, chickenpox and painful skin conditions have also increasedand there are fears that the recent floods could lead to untreated sewage mixing with fresh water used for drinking and cooking, causing a cholera outbreak.

Disease has played a role in the struggle for centuries. During the American Civil WarTwo-thirds of estimated soldier deaths were caused by pneumonia, typhoid fever, dysentery and malaria. In 1994, two diseases, cholera and dysentery, linked to unclean water and conflict zones, killed more than 12,000 Rwandan refugees in just three weeks in June 1994.

An estimated 85% of Gaza residents have already been displaced, according to the UN Relief and Works Agency. Experts analyze previous displacement of refugees estimate in the Lancet that crude mortality rates (i.e. deaths per 1,000 people) were on average more than 60 times higher than when each conflict began. This is extrapolated to the current situation in Gaza, where the crude death rate was before the conflict 3.82 in 2021 (relatively low due to the young demographic group) mortality rates could reach 229.2 by 2024 if conflict and displacement continue at current levels, and Gaza residents continue to lack access to sanitation, medical facilities and permanent housing.

Unless something changes, the world will ultimately face the prospect of nearly a quarter of its population Gaza's 2 million inhabitants – Nearly half a million people die within a year. These would largely be deaths from preventable health causes and the collapse of the medical system. It is a rough estimate, but one that is based on data, using the frighteningly real numbers of deaths in previous and similar conflicts.

International organizations are trying to raise the alarm about this situation Harris grieves: “It seems the world has lost its moral compass.” UNICEF has warned: “Lack of water, food, medicine and protection is a bigger threat than bombs to the lives of thousands in Gaza.”

I have worked in global public health for twenty years and I have never heard health and aid organizations so candid and concerned about the level of suffering and deaths in Gaza. It is an unprecedented conflict that breaks the most tragic records while experts could debate Whether it is a genocide or not, the truth is that we are witnessing the mass murder of a population, whether by bomb, bullet, hunger or disease.