The United Nations recently reported that most Palestinians in Gaza are living steps away from open sewage or human waste, and the strip is overflowing with garbage and rubble. Disease is spreading rapidly, and humanitarian groups and some lawmakers are redoubling demands for the U.S. to pressure Israel to ease overcrowding and stop blocking aid.
Dire conditions for those living in Gaza have persisted despite the 2025 agreement brokered by the Trump administration between Israel and the Palestinian militant group Hamas. An assessment cited by the U.N. in early April found that 60 percent of Gaza’s population was exposed to sewage or human waste within about 10 yards of their shelters, while more than 900,000 Palestinians were exposed to accumulated garbage in residential areas.
Data gathered July 19-25 by the World Health Organization suggested the two top health problems among Palestinians — acute respiratory infections and acute diarrhea — stemmed from poor conditions of water, sanitation and hygiene, also known by the acronym WASH. The U.N. also reported “significant” numbers of skin disease cases driven by clean water shortages. A U.N. WASH report earlier in July said 86 percent of households struggle to access a toilet or latrine, while 17 percent have observed open defecation. And the Israeli human rights group B’Tselem reported this summer “an extreme outbreak of rats and pests” in camps packed with displaced families, noting the link to garbage overflow, cesspits and rodent-borne disease.
“Sanitation is a chain, and all the chain has been devastated,” said Roba Daour Ziara, a Gaza-based public health officer at the charity Oxfam. She noted waste should normally move from toilets to treatment facilities, but Israeli attacks have destroyed hundreds of those facilities. The ones that remain need maintenance and power, rendered out of reach because Israeli authorities have sharply limited deliveries of repair materials, fuel, lubricant oil and generators, according to Oxfam and the U.N.
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Earlier this month, 65 House Democrats — led by Reps. Andrea Salinas of Oregon and Kweisi Mfume of Maryland — wrote to President Donald Trump warning of “rodent and pest infestations throughout displacement camps … and insufficient rebuilding of the infrastructure needed for sewage, water and electricity.” The lawmakers blasted Israel’s restrictions on goods that it says have both civilian and military uses, as well as its limits on the normal operations of international aid groups. Tel Aviv’s approach “undermines a key component of the 20-point plan,” they wrote, referring to Trump’s stated roadmap for peace.
Even as Palestinians struggle, the Trump administration has said it will deliver stability and Israeli-Palestinian harmony through the president’s Board of Peace, most recently by announcing a plan for Hamas to disarm. Skeptics of the approach argue that the living conditions of Palestinians must be addressed to achieve meaningful progress toward regional peace.
“The President has a bold and ambitious plan to rebuild Gaza, which is well underway due to the efforts of the Board of Peace,” a State Department spokesperson told NOTUS via email. “US advocacy has enabled gains across key sectors: food assistance now reaches a majority of the population, health and nutrition services have expanded, and WASH support has scaled up, resulting in measurable improvements in food security, health outcomes, and access to safe water, along with temporary shelter support.”
Israel’s embassy in Washington did not respond to a request for comment. Israeli officials have said they are facilitating appropriate deliveries.
“Israel remains committed to the coordination of humanitarian aid to ensure the appropriate medical, nutritional, and WASH response remains available to the Gazan civilian population,” Israel’s Coordination of Government Activities in the Territories unit said in a statement on X last week. The post listed Israeli approvals of shipments of generator spare parts by the U.N. and water containers by the Red Cross.
But Ziara noted that Oxfam and other aid organizations say Palestinians in Gaza still effectively face a “blockade,” and that improvements in humanitarian conditions are fragile and irregular.
Humanitarian groups, Ziara said, are seeking consistent engine oil flow to support daily services, not just specific operations; advocacy to shield WASH infrastructure from Israeli airstrikes; and more generators since Gaza remains without electricity — which means water treatment facilities share generators, limiting their output. She also noted that the growing section of Gaza controlled by Israeli forces includes many landfills. Without the ability to reach those sites, groups that collect solid waste, including the U.N. and Palestinian municipal workers, are instead using temporary dumping stations that are often located between Palestinian encampments.
Rachel Norris, the Gaza response director at the nonprofit Mercy Corps, said Gaza residents’ makeshift solutions fall short.
“Instead of large waste management trucks or any of the sort of facilities that would normally run, you are seeing donkeys pulling carts filled with waste,” she said, while some Palestinians have also built trenches or other temporary sites to contain waste. The result is latrines that Norris compared to “using a porta-potty that is not being changed out.”
A July 23 U.N. report found that 69% of the 181 displacement centers it assessed had visible sewage. At some sites, families were resorting to using slipshod toilets, buckets or plastic bags.
Meanwhile, amid shortages of clean water, Norris said, families face “impossible choices” about whether to use it for drinking, cooking, bathing or cleaning.
Addressing WASH is “foundational” and arguably even more important than increases in food supplies, according to Stacy Gilbert, a former State Department official who worked on global crises for over 20 years.
“You can keep feeding food into the situation, but if you’ve got poor sanitation it literally comes out the other end,” she said.
Gilbert resigned from her State Department role in 2024, citing the U.S. backing of Israel’s Gaza offensive. She described how some of the most vulnerable groups face outsize risks: When mothers are malnourished, they often supplement breast milk with formula, but even if that is available, it is dangerous to make with contaminated water.
Amid continued Israeli strikes and a deepening humanitarian crisis, Gilbert said the most dangerous part for Palestinians could be the lack of global attention to what’s happening on the ground, with garbage or debris left to rot and unexploded bombs littering the landscape.
“In many ways,” she said, “it’s a more dangerous situation now because the world thinks the war is over.”
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