HEALTH EFFECT DUE TO POOR WASTEWATER TREATMENTS IN GAZA STRIP

Amani Alfarra and Sami Lubad

Amani Alfarra, Bank of Palestine Center Bldg. Gaza El Rimal, App.910/911, P.O.BOX:1388,
Gaza - Palestine, Email: alfarra1@dar-elkhebra.com
Sami Lubbad, Head of Water Department Public Health Lab. M.O.H, Gaza Palestine, email: samiLubbad@yahoo.com

Abstract:
In eastern Mediterranean countries including Palestine, the demand on water is growing rapidly due to rapid
population growth, urbanization and socioeconomic development. Both the West Bank and Gaza Strip are facing a
series of wastewater and sanitation-related problems, large-scale discharge of untreated wastewater, leaking of
collected wastewater from sewer systems and cesspits, water treatment plants that do not function or function only
badly and uncontrolled reuse of untreated wastewater by the irrigation sector.
This paper has three objectives:

To demonstrate the link between wastewater and health and show the profound influence of
water supply and quality on public health in Gaza.
To highlight the environmental and health impact resulting from poor wastewater treatment in
Palestine.
To describe the basic classification of water-related diseases in Palestine, mainly Gaza Strip.
To describe how improvement and proper management in water treatment will lead to
improvements in health and a reduction in morbidity and mortality rates.

The paper also assesses the environmental and human health impacts associated with the current practices of
wastewater management and sanitation in Gaza, especially:

Soil and groundwater pollution resulting from discharge of untreated wastewater.

Direct human health risks as a result of exposure to wastewater in open systems.
Indirect human health risks as a result of consumption of polluted crops and fish

In this paper I focus on the Gaza Strip only. Currently, about 70%-80% of the domestic wastewater produced in
Gaza is discharged into the environment without treatment, either directly at the source, after collection from
cesspits or through the effluent of the sewerage system or overloaded treatment plants. Most of the wastewater flows
into the sea; a small part infiltrates and contaminates the soil and the groundwater. Moreover, the discharge causes
public health risks through direct exposure as well as through reuse of untreated wastewater on irrigated lands.
Diseases related to contaminated drinking water (poor water treatment) constitute a major burden on the health of
people in Palestine and are among the leading causes of ill-health. Sustainable health, especially for children, is not
possible without an effective and adequate water supply and healthy water treatment.

Key words: health, poor treatment, Wastewater

water is the only source for drinking water

and agriculture. The groundwater is
recharged from different sources, including
rainwater, sewage irrigation; sewage

.Introduction

Gaza is situated in an arid area with scarce

water resources. There is no permanent
surface water in Gaza Strip; the ground
1

Electronic copy available at: http://ssrn.com/abstract=1457842

infiltration and seawater intrusion. The

estimated rain shortfall was about 50 million
cubic meters in 1992.(EPA, 1994).

A number of wastewater projects were

ongoing in several of the Gaza Governorates
in the years prior to the second intifada.
Most of these projects related to planning,
while a few were small implementation
projects. From seven treatments plants in
Palestinian territories there are three located
in Gaza Strip (Beit Lahia Gaza Rafah).
All have operational difficulties. These
plants are over loaded, under design or have
mechanical difficulties.

Two major aspects the present water

situation in Gaza strip includes groundwater
contamination of the main aquifer and
shortage of groundwater. Furthermore the
uncontrolled discharged of sewage at the
subsurface. Sewage is partly collected and
discharged to the natural drainage system.
The extraction of groundwater currently
exceeded the aquifer recharge rate. As a
result, the groundwater level is falling and
chloride concentrations are increasing,
making the water unfit for either human
consumption or irrigation. The uncontrolled
discharged of untreated sewage to the
ground surface and the excessive use of
fertilizer has further polluted groundwater
resources and led to high nitrate levels in
certain areas.

In Gaza, access to sewerage facilities at

present varies from areas where more than
80% of the household served by well
functioning sewerage systems, to areas
where no sewerage systems at all. On
average, it is estimated that about 70% of
the population is connected to a sewerage
network. Cesspits and boreholes are the
other waste water disposal system in the
area.
The larger urban centers, except Khan
Yunis, are equipped to some extent with a
sewerage net work. While camps with dens
population as El Nusirat, El Buriej, El
Maghazi and El Zawida do not have any
sewerage facilities, the only camp connected
to sewerage system is Jabalia.
The three treatments Plant in Gaza Strip not
functioning effectively. Approximately 70
80 % of the domestic wastewater produced
in Gaza is discharged into the environment
without treatment, either directly, after
collection in cesspits, or through leakage
and over loaded treatment plants. Most
wastewater is discharged into the
Mediterranean
via
18
different
pipelines.(UNEP, 2003)

Figure 1: Arial Photo for Gaza Strip

The effluent from Gaza and Rafah treatment

plants discharged into the Mediterranean,
while Beit Lahia treatment plant, a
substantial quantity of wastewater infiltrates
into the ground, contaminating soil and
ground water in the area.

High current and projected rates of

population growth will inevitably lead to
greater pressure on natural resources,
especially water.

Electronic copy available at: http://ssrn.com/abstract=1457842

Untreated wastewater discharge cause public

health risks through direct exposure, as well
as through being reuse on irrigated crops.
The total annual wastewater production in
the area is estimated to be 40 million m3, of
which 30 million m3 passes into sewerage
networks and the rest to cesspits or pit
latrines. Waste from vacuum tankers used to
clear out cesspits should be transported to a
treatment plant or disposal area designed
specially to deal with liquid waste. The
present practice is to dump the waste into
the nearest wadi, into agricultural drainage
channels, or onto open fields (EQA, 2002e)
1. Beit Lahia wastewater treatment
plant
Figure 2: Beit Lahia Wastewater Treatment Plant

The existing wastewater plant is basically

designed according to lagoon system with
polishing ponds but without any treatment
facility.

The plant located in closed depression

without natural outlet to sea, although the
distance to the sea is only 4.5 km. The
original design of the wastewater treatment
plant included four original effluent ponds
that would recharge the aquifer or evaporate.
However as time passed and the volume of
effluent overflow has formed a lake
covering 40 hectares (the inhomogeneous
pattern forming the lake in figure 2), which
has a significant pollutant of the aquifer and
a major environmental health problem for
the population surrounding the lake. As a
result 14 groundwater wells are no longer
being in used.

The wastewater plant located 1.5 km east of

the town of Beit Lahia in the northern part
of Gaza. The plant was serving the town of
Jabalia as well as nearby refugee camps and
the communities of Biet Lahia and Biet
Hanun. The areas total population amounts
to 190,000 people. The plant has no pretreatment facilities and has designed peak
flow capacity of 5,000 m3/ day. At present,
about 12,000m3/day passes through the
plant.
The major aim of the plant was to produce
an effluent quality of suitable for direct use
in irrigation. However the poor quality of
the treated wastewater; below World Health
Organization (WHO) guidelines for
agriculture use , plans for transporting
treated waste water to agricultural areas
were never complete.

A new wastewater treatment plant for the

Northern Governorate is planned at another
location some five kilometers from the
existing plant. The plant capacity designed
to provide treatment for 40100 m3 / day.
The Groundwater wells in Beit Lahia are
especially prone to pollution from the
wastewater treatment plant, since they are
located between 240 3000 meters, in the
vicinity of a wastewater treatment plant. In
the western area, it has been found that
certain wells are more polluted than in

others areas. This can be attributed to the

closeness of theses wells to the wastewater
ponds, the flow direction of the wastewater,
and the sandy nature of soil make quick
infiltration of wastewater to the aquifer.

normally
a
population
3000000).
Nevertheless the plant is still receiving more
wastewater than it has the capacity to treat,
and the most of the effluent is discharged to
the Mediterranean Sea.

Also Melad, K. 2002, clarify that there was

seasonal variation over the four seasons and
reach the peak during summer that can be
seen from the following graph and table.
This is over the limitation of WHO
standards which indicate that total coliform
has to be 0.0 and allowed in 95% of the
samples to be free and 5% of the samples
contained 5 colonies.

Rafah Wastewater treatment plant

Was designed for a capacity of 1800 m3 /
day (equivalent to what is normally a
population of 21000). At present the plant is
overloaded and receives in excess 4000
m3/day. The wastewater treatment plant has
reportedly sustained recent damage as a
result of the ongoing conflict
Wastewater from Israeli settlements in Gaza

Table 1: Number of wells in Beit lahia with

contaminated water samples over the four seasons
TC
FC
FS

Spring
14
8
4

Summer
17
13
6

Autumn
13
8
3

There is no sufficient information about the

settlements treatment plant. But on average,
the settlements use four times the amount of
water
per
capital
used
by
Palestinians.(UNEP, 2003)

Winter
18
11
7

Industrial wastewater in Gaza

Industrial use constitutes only 2% of overall
water demand in Gaza, and industrial
wastewater is correspondingly low as
proportion of overall discharge. At present,
most of the industrial wastewater generated
in Gaza is similar to domestic wastewater.
Samples

20
18
16
14
12

TC

10

FC

FS

6
4

Influence of water supply quality on

public health in Gaza Strip

2
0
Spring

Summer

Autumn

Winter

A strong relationship between the water

quality and human health was reported
through many studies around the world.

The fecal coliform (FC) and fecal

streptococci (FS) are forbidden to exist in
any sample according to WHO standards.

Statistics from CDC revealed there were

more than 17,000 cases of water illnesses
during the last two years, however since
many symptoms are often confused with
other sicknesses, some feel as many as 25
outbreaks go unreported for every one
reported .

Gaza City Wastewater treatment plant

The treatment plant is located to the
Southwest of Gaza City and has recently
been rehabilitated with an influent flow rate
of 42000 m3/day (equivalent to what is

Many people are exposed to potentially

harmful microbes and pesticides, drink from
tap water and showers.

Positive relationship between infants of age

3 to 6 months, mainly among infants had
supplementary feeding.

One reason for this increasing problem is

that we have troubles in our treatment
mainly disinfecting with chlorine that
produce harmful by- product, the
disadvantage of that we oxidize the organic
matters and trihalomethan produced as byproduct which is carcinogenic, at the
existence of ammonia, chloramines is
another carcinogenic by- product.

Nitrate also affected Hb level, weight

gaining and infants growth.
Another study by (Meilad, K. 2000) about
the effect of wastewater treatment plant on
the groundwater and health in Beit Lahia
area, indicates that the poor treatment of
wastewater (which depend on aeration in
wastewater lagoons, then effluent speeded
over sandy duns to recharge the
underground water) the main cause of the
high nitrates concentration (over 100 ppm.),
turbidity, nitrite, and ammonia. So the water
quality deteriorated rapidly, also poor
treatment was the main cause of
microorganisms , protozoa, facial coliform,
and fecal streptococci in the surrounding
area that affected the human health directly ,
also it causes diarrhea, gastroenteritis
problems and typhoid fever .

Researchers have seen twice the risk of

cancer in people who drink an average in
two and one half of chlorinated water daily
more than 30 years compared to those who
drink water disinfected by other processes.
The most common contaminates in water
system are chlorine by- products, lead,
microorganisms, nitrates, and residual
pesticides.
In Gaza Strip recent study by (Nasser, 2003)
about the relationship between nitrate
contamination of groundwater and met
hemoglobin level among infants under six
months age, indicates that:

Un published study by (Lubbad, S. 2004)

about the effect of the wastewater treatment
plant effluent on the groundwater in Gaza
city indicates that: poor treatment for
wastewater affected directly the quality of
groundwater in the area mainly with
surfactants as (Anionic Detergents LAS) and
nitrite in the surrounding area around the
infiltration basins with cycle diameter 800
m. which is very harmful to the human body
which cause gastroenteritis troubles and as
one of the carcinogenic factor.

The high Met- hemoglobin (Hb) level was

strongly
associated
with
nitrates
concentrations in drinking water wells, the
highest average of the observed nitrates
concentrations met- hemoglobin (Hb) level
had been detected in Khan Younis, as
response to the highest average of observed
nitrate concentration. This is due to the poor
treatment for wastewater.

Another Study in Gaza by (Abed Rabou, M.

2003) looked for the impact of wastewater
on the seashore, to study the microbial
pollution on fish and beach sand. Which
indicate that a high pollution rate in most of
mentoring points due to disposal of sewage
and wastewater directly to sea. Pollution
combined with over exploitation has
reduced fish stocks in the area with showing
infection and cysts acquit by fish pollution

The study demonstrates clearly that drinking

water resources is considered a main factor
for high level of Met- hemoglobin (Hb).
A strong relationship exists between the
high level of Met- Hb and tap water which
ranged from 100 ppm in Gaza to 350 ppm in
Khan Younis, where WHO standard is 45
ppm as ( No3).

of the marine environment also threatens the

survival of posidonia plant on bed.

hospitals, also kidney problems, renal failure

and reproductive problems.
3- Infectious diseases:
Water borne infectious diseases are diseases
caused by a number of different bacteria,
viruses and protozoa, which spread through
contaminated drinking water as example in
Gaza ( diarrheas, dysenteries, salmoellosis,
hepatitis, guardian, and amoeba histolytic).
The most common symptoms in Gaza for
those diseases: nausea, vomiting and bloody
diarrhea with or without fever.
Transmission of water borne infectious
diseases
Infectious diseases can be transmitted by
drinking contaminated water, water used in
food preparation, contact during washing or
bathing even inhalation of water vapor.
All major water borne diseases spread by the
same way if water has become contaminated
by infected human or animal fecal wastes, it
also can be transmitted directly hand to
mouth when there is not good sanitary
practices like hand washing are not
followed.
It often takes only a small number of
organisms to make a person sick.
Transmission chain
Contaminated water with faces (human or
animal origin) in the case of human fecal
coliform persisted, in the case of animal
fecal. Streptococci will be persisted.
The major source of both of them in
drinking water in Gaza is direct and indirect
contamination of raw or treated wastewater.
Through monitoring the results of water
samples collected from wells and net works
in the Gaza Strip by the Ministry of Health it
was indicated that wells for drinking water
are free from organisms except for some
cases of point source pollution.
Most of the contaminations in the network
samples are either point source of pollution
or non point source of pollution, as leakage
from wastewater pipes and negative pressure
and old networks that supplies water.

Classification of water- related diseases in

Palestine
Water borne diseases are diseases spread
through contaminated water, contamination
of water maybe directly (Point source
pollution) like aquifer recharging with poor
quality wastewater effluent or indirect point
source contamination from wastewater reuse
in agriculture or seepage from networks or
open system.
The ought diseases are spread either directly
through flies or fishes, all diseases spreads
through water termed as water born
diseases. Most enteric diseases are infectious
diseases and transmitted orally through
water we can divide the common water
borne diseases in Gaza as follow:
1- Acute diseases:
This has effects that occur within hours or
days of the time that a person consumes
contaminated water. People can suffer acute
health effects if they are exposed to
extraordinary high levels as in the case of a
spill. In drinking water parasites, bacteria
and viruses are the greatest contaminates
that cause acute health effects.
Acute contaminants dont have permanent
effects, when high level occur, they can
make people ill and can be dangerous for
persons whose immune system is already
weak due to HIV/AIDS.
2- Chronic diseases :
Which has a strong effect after people
consume contaminated water at levels over
safety standards for many years mainly
disinfection by products, pesticides and
solvents. Chemicals accumulation in human
body can have greatest effect to cause
chronic diseases like (cancer, liver closes,
renal failure, kidney problems and
reproductive difficulties).
According to the consuming bad quality
water in Gaza Strip for several years huge
number of
cancer cases registered in

Table 2: Public health laboratory-Drinking water Quality in Gaza Strip (2003)

Production (Wells)
Parameter
Class

WHO
1996

Test

Number
of
Analysis

Microbiologic
al Parameter

10
0
0
0
0

Total coliform
Fecal coliform
Fecal Strept.
Pseudomonas
Cholera

1463
1502
964
0
0

Number of
Analysis
not
complying
165
80
80
0
0

Distribution
(Network)
Number of
Number
Analysis
of
not
Analysis
complying
3087
469
3093
207
1587
123
211
5
48
0

Treated Drinking
Water
Number of
Number
Analysis
of
not
Analysis
complying
507
98
507
49
483
10
474
18
-

Table 3: Distribution of drinking water

Laboratory test by Governorate /Gaza Strip -2003
(reference WHO)

The contaminated water contains pathogens,

if the human or animal source is not infected
with pathogens no disease will result.
The pathogens survival in the water depends
on
the
environmental
conditions
(temperature. and duration of pathogens in
water).
Some pathogens will survive for only short
time in the water, so the chance to cause
illness is small. Others may survive for
months like guardian, amoeba and
cryptosporidium. If the water was not
treated or poorly treated for pathogens
susceptible person drinking this water will
suffer from illness.

Governorate

North
Gaza City
Mid-Zone
Khan Younis
Rafah
Total

No. of
samples

749
2907
714
350
385
5105

Tested water sample

Coliform Test
No. of
Contaminated
contaminated
%
samples

108
477
103
74
42
804

14.4
16.4
14.4
21.1
10.9
15.7

Relationship between pathogens and

diseases
Pathogens and diseases spread by the fecaloral route (water borne diseases) can be
caused by bacteria (salmoellosis, typhoid
fever and cholera), viruses (viral
gastroenteritis and hepatitis- A) and
protozoa
(amoebic
dysentery
and
cryptosporidiosis).
Many pathogenic bacteria, viruses and
protozoa are passed from one host to another
by oral fecal rout water usually serves as
carrier for those organisms.

It was recognized in the annual report of

Ministry of Health (MOH, 2002), the total
number of samples collected from water
wells and networks were 4915 in Gaza Strip
there was 629 contaminated samples , which
mean the contamination percentage was
12.8% . Most samples contaminated by
coliform. While during 2003 the total
numbers of analyzed samples from wells
and networks were 5105. There were 804
contaminated
samples,
which
mean
contamination percentage is increasing to
15.7%.

Concern to bacterial pathogens such as

(salmonella,
Shigella,
diarrheagenic,
Escherichia coli, campylobacter and Vibrio)
Many viruses can be transmitted by water as
(poliovirus, rotaviruses, Norwalk viruses
and hepatitis A, E)

WHO recommended that the percentage of

coliform
contamination
for
water
examination from water wells and networks
should not exceed 4%.

Protozoan pathogens that can be transmitted

by water include (Guardia, cryptosporidium
and amoeba)

replaced by vegetables that need inorganic

fertilizer, organic fertilizer, pesticides and
herbicides.

Many people who live in Beit Lahia suffer

from many gastrointestinal chronic diseases.

Conclusion and recommendations

Wastewater is considered as an important
element that contributes to solving the water
resources scarcity in Gaza Strip, if it was
treated in efficient way to be used in the
agricultural sector.
The focus of this paper was on the
biological aspects, although the chemical
aspects have dangerous impact on health
which was not touched here. This does
not mean that the Gaza Strip does not
suffer from diseases caused by Chemical
contamination as blue babies and others.
Wastewater issue should have priority in
the development of the area, because the
current trend and threats from the
untreated wastewaters undermine the
lifehood development and jeopardize the
quality of water.
It is important to strengthen the
wastewater management between Water
Authority,
Environment
Quality
Authority, Ministry of Health, Ministry
of agriculture and the Municipalities.
That is to improve the wastewater
legislation and law enforcement.
Repair the cesspits and networks to
minimize the uncontrolled flow of
wastewater to protect the groundwater
Pre-treat the industrial wastewater before
it connects to the collection Municipal
system.
Wastewater issues should be included in
the technical cooperation between Israeli
and Palestinian parties, and settlements
should treat their own wastewater before
charge it to Mediterranean Sea to ensure
reducing the environmental hazards.
Encourage the agricultural sector to
reuse the treated wastewater when it
reaches the WHO standards for treated
wastewater.

Table 4: Waterborne pathogens and their

associated illnesses(Melad, 2002)
Organisms
1.
Viruses
Echo
Norwalk
Hepatitis A
Hepatitis E
Astro
2.
Bacteria
Escherichia coil
Salmonella sp
Shigella sp
Campylobacter jejuni
Yersinia sp
Legionella sp
Vibrio Cholera
3.
Protozoa
Cryptosporidium
parvum
Giardia lamblia

Associated health effect

Respiratory disease, aseptic
meningitis
Gastroenteritis (vomiting, fever,
diarrhea)
Fever, nausea, jaundice, liver failure
Fever, nausea, jaundice, death
diarrhea
Gastroenteritis (diarrhea)
Gastroenteritis (diarrhea)
Enterocolitis (fever, diarrhea ,
vomiting)
Gastroenteritis, reactive arthritis
Gastroenteritis , Guillain Barre
syndrome
Diarrhea , reactive arthritis
Legionnarias disease , Pontiac fever,
death
Diarrhea, vomiting, death
Diarrhea
Chronic diarrhea

Randa ElKhodary, Head of Laboratories and

Blood Banks in the Palestinian Ministry of
Health, gave the following observation;
during the summer camps meningitis cases
are observed to increase. This is a direct
result of more people swimming in the
beach Camp shore
Soil Pollution
Contamination of soil often causes
groundwater pollution, where most of the
rural area in Gaza strip dumped their
wastewater on pore hall without sanitary
measures, which increase the risk of soil
pollution(EQA, December 2003).
Another main cause of the soil pollution is
the change in cultivation patterns in the area.
For example citrus fruits used to be one of
the most important profitable crops now it is
8

More research needed in the area of

health impact due to poor water and
wastewater treatment. Mentoring the
diseases and link their geographical
distribution with water quality
The important need to treat Beit Lahia
wastewater and the sewage lake , and
there can establish a mobile wastewater
treatment plant ensuring that it meets
standards for irrigation reuse, aquifer
recharge and or disposal to sea
Concentrate on protecting the Wadi
Gaza as wetland. Monitor the habitat in
the Wadi and the Sea trying to follow
RAMSRA Conservation.

EPA, E. P. A. (1994). Palestinian

Environmental Protection Authority.
EQA, E. Q. A. (2002e). Hot Spots in
Gaza Strip, Palestinina National Authority.
EQA, P. N. A. E. A. (December 2003).
Palestinian Integrated Rural Enivornmental
Protection Plan - Current status and analysis
(Vol. 1).
Melad, K. A. (2002). Evaluation of
Groundwater Pollution with wastewater
Microorganisms in Gaza Strip- Palestine. Ain
Shams University & Alaqsa University.
MOH, M. o. H. (2002). The Status of
Health in Palestine.
Nasser, A. A. (2003). The relation ship
between nitrate concentration in water and met
hemoglobin in Gaza Strip.
UNEP, U. N. E. P. (2003). Desk Study on
the Environment in the Occupied Palestinian
Territories.

10