Environmental Health in Gaza Strip

1.  Environmental Health in GazaStrip

2. Contents 1- Introduction 2- Definition of Environmental Health 3- Background of E. H. in Gaza Strip 4- Water5- Waste Water  6- Solid Waste 7- Pesticides & Toxic Substances Pollution 8- Air Pollution9- Food Hygiene 10-How the environment affect health?11- Environment-related killers in children 12- Tackle the environmental risks to our children 13- Strategic objectives  14- Recommendations  15- Conclusion and Comments

3. Historical perspective • "If you want to learn about the health of a population, look at the air they breathe, the water they drink, and the places where they live.“ • Hippocrates, the Father of Medicine

4. The Hippocratic Oath ''well being of man is influenced by all environmental factors: the quality of the air, water, food, the winds and the topography of the land''. • Environmental improvements and efforts toward the control of communicable disease continue in the 20th century with the wide spread use of immunization and the discovery of antibiotics. However: • New set of environmental concerns result from the introduction of new technology and chemicals combined with lifestyle risks and stresses {cancer, heart disease, CVA}

5. Introduction* Understanding the effect of environmental factors on health and disease requires studying many factors like social, cultural, political, economical and physical factors that interact with psychological and physiological rhythms that form the foundations of human existence. * Studying this issue will assist in recognizing theEnvironment as an important contributor to health and well being of the population. * Environmental health is a state of health that exists as a result of the force and conditions that surround and influence human being. * Due to rapid growth of industrial countries, the environmental hazards increase.

6. Definition of Environmental Health byWHO • Environmental health comprises those aspects of human health that are determined by physical, chemical, biological, social and psychosocial factors in the environment. • It also refers to the theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations.

7. Definition of Environmental Health by National Institute of Environmental Health SciencesEnvironmental healthis the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health.

8. Environmental health problems in Palestineresemble the major environmental health problems in the Middle East region. Subjects or problems of Environmental Health in Gaza Strip are Water quality and quantity, Waste water, Solid waste, Pesticides and toxic substances pollution, Air pollution and Food hygiene.

9. Background of Environmental Health in Gaza StripGaza Strip is a semi-arid region of roughly 365 km2 which lies on the Mediterranean Sea. On this narrow strip, almost 1.8 million of the Palestinian people live and work. A " Catastrophic" water shortage, water pollution with high salinity and micro-pollutants, lack of sewage and solid waste treatment, maritime pollution, overcrowding, poverty and uncontrolled use of pesticides are the most pressing environmental problems in Gaza Strip. Internationally suspended, banned and canceled pesticides which considered mutagenic and carcinogenic are still used in the agricultural environment.  

10. Mediterranean Sea is used for the disposal of sewage water, solid wastes, agricultural and industrial waste water. In general these environmental problems have multiplied the Palestinians human environment problems, socio-economic problems and increasing health hazards.Therefore, the environment in Gaza Strip requires a more thoughtful and comprehensive policy and planning of awareness and conservation.

11. WaterImportance Water is one of the essential components of the human body. It plays active role in the physiological process that is necessary to human life. Water is essential for heat regulation, acid-base balance, excretions to toxins and waste material and metabolism of all food material.Sources of waterThe underground water is the main source of water in Gaza Strip. Wells are used to get the underground water.

12. Raining water is used in West Bank. The water is collected in private store under each house. The family uses this water during all the year. Surface water could be from rivers or lakes. Tabria lake is one of the main water store in Palestine. The main source of water in Gaza Strip is the ground water which is used for irrigation, industrial and domestic purposes. In Fact, per capita water consumption in Gaza Strip is less 4 – 5 times other countries. This has led to the depletion of available quantities in Gaza Strip and reduction of ground water storage as well as the degradation of water quality.

13. Water Characters:1- Physical: the water should be colorless, tasteless and odorless. Change of odor, color or taste indicates water pollution or contamination. 2- Biological: Drinking water should be free from all microorganisms. The best indicator for water contamination is the presence of E. Coli indicates fecal contamination. 3- Chemical: The accepted level of chemical concentration is referred to the maximum concentration of specific material in water that if exceeded it will endanger human heath .

14. Water pollution Types of water pollution:1- Organic wastes from domestics.2- Infectious agents contributed by domestic sewage. 3- Plant nutrients as algae. 4- Synthetic organic chemicals as pesticides, detergents… etc. 5- Inorganic chemicals and minerals substances. 6- Sediments that fill stream channels and reservoirs. 7- Radio – active pollution

15. Health Hazards of WaterWater Sources in Gaza Strip are subjected to excessive over- exploitation and over - pumping , this has led to degradation of water quality in Gaza Strip , where severe water shortage are experienced and where the situation has become catastrophic. Water Pollution with different pollutants (Salinity such as Chloride and Nitrate and Micro - pollutants such as Pesticides, Fertilizers & Detergents).

16. Palestinian and German scientists have recommended to the Palestinian Authority to take immediate measures to combat excessive nitrate levels in the drinking water. 90 % of Gaza Strip water samples were found to contain nitrate concentrations that were between two and eight times higher than the limit recommended by the (WHO).Over the long term they recommend that the best protection would be provided by quality management for groundwater resources. In babies younger than six months, nitrate can lead to, to diarrhea and to acidosis.

17. Waste Water Unfortunately about 50% the raw sewage is discharged untreated in the Mediterranean Sea where the biological oxygen demand increases. The rest of sewage is treated with semi treatment such as the first step of primary treatment which is the aeration and sometimes the secondary treatment. When these pools filled with sewage water, it's flooded aside and pollutes the ground water because our aquifer is shallow.

18. Sewage networks cover no more than 70 % of total residential areas in the Gaza Strip. Open sewage channels spread in some parts of the Gaza Strip, particularly in refugee camps, creating health hazards through the accumulation of garbage and wastes.

19. Health Hazards of Waste Water * Disease transmission: most of enteric diseases could be transmitted from one person to another through contaminated environment such as Cholera, Dysentery, Parasites and Hepatitis. * Bad smell resulted in psychological disturbance. * Sewage collection is a breading place for insects as mosquitoes and flies. * Contamination of underground water by biological and chemical pollutants.Management of Sewage: Treatment: Biological treatment is performed by these mechanisms:a. Filtration b. Aeration (تَرْوِيح , تَهْوِيَة ) c. Disinfection

20. Solid WasteThere are no enough dumping sites, sanitary landfills, containers and vehicles. Therefore, the solid waste is sometimes thrown everywhere. Gaza Strip utilizes the old method of landfills for disposal thus negatively affecting the environment. This leads, in turn, to the spread of diseases and increases the difficulties encountered for disposal.

21. Sources of Solid Wastea-Houses are the main source of the solid waste and are the main place, which necessitate proper waste disposal.b-Streets this is mainly dust and the amount of solid wastes depends on the population orientation to their health. Healthy communities have clean streets.c-Industries result in huge amount of solid waste mainly metals, containers and carton, this waste could be dangerous if it contains chemicals or poisonous material.

22. d-Hospitals, domestic wastes and medical wastes are thrown daily from hospitals. Hospital wastes should be managed carefully where it contains contaminated syringes, gloves, cotton and utensils of patients. This material could be a source of infection for the community if not managed properly.

23. Solid Waste disposal Extensive development of incinerators, improved collection trucks and procedures, solid wastes collection and disposal has assumed its place as protective measures for the public health.Hazards of Solid Wastes1-Socio – psychic: The population does not accept the sight of wastes. The waste could result in fire with all the hazards associated with this unsatisfactory event.2-Economic: Disposal of the waste without proper utilization is an economic loss. Recycling is one of the ways were the material could be used again .

24. 3-Health Hazards:1- Fly & Rodent: Garbage is a good media for breading of flies and rodents. Both of them are harmful for human health.2- Mechanical injuries: Where children are exposed to wounds and injuries if they handle the refuse un- properly.3- Chemical pollution: Chemical hazards are common in factory waste.4- Bacterial contamination: The chance of bacterial contamination is higher when hospital is present whih results in production of a great number of pathogens that could influence human. 

25. Management of Solid wastes: Management of solid wastes includes these items: 1- Collection 2-Transport 3- Disposal a- Dumping b- Incineration c- Recycling

26. Pesticides & Toxic Substances Pollution More than 350 metric tons of formulated pesticides (more than 100 pesticides) are used annually in Gaza Strip. Such heavy use of pesticides causes water pollution and soil degradation and contamination of the agricultural products which finally affect seriously the human and animals.It was found that 19 of these pesticides, that have been used, are internationally suspended, cancelled and banned pesticides, according to their mutogencity, carcinogencity and delayed neurtoxicity.

27. Air PollutionDefinition of Air Pollution: Concentration of foreign matter in the air which adversely affect the health and welfare of the people or their enjoyment. The most severe pollution is the chemical pollution. In Gaza Strip there is a large number of transportation means constitute the major source of air pollution. Car exhausts release to the air large quantities of carbon monoxide, carbon dioxide, nitrogen oxides, hydrocarbons and lead that are considered very poisonous and some may be carcinogenic and may affect the respiratory and nervous system. Melting Lead and burning solid wastes are other major sources of air pollution in Gaza Strip.

28. Food Hygiene The primary objective of sanitary supervision over all places where food is prepared and served to the public is to prevent illness and possibly death from spoiled or contaminated foods. The local health department is responsible for protecting the public’s health against food contamination. Salmonella and staphylococci gastroenteritis germs are very prevalent and multiply rapidly in food and thus and food poisoning are the predominant infections transmitted by food. Other diseases transmitted by food include typhoid fever, amebic dysentery and bacillary dysentery.

29. FOOD – BORNE DISEASES:I. Biological Agents 1.Food intoxication and bacterial infections: 1-1 Botulism: performed toxins produced by the growth of (Clostridium botulism) in food under anaerobic conditions cause Botulism. Symptoms develop in 2 hs to 8 days. 1-2 Staphylococcus food poisoning: The onset is 1-6 hours after ingestion 1-3 Amine poisoning:Cheese and certain tranquilizers can result in such poisoning 1-4 Salmonellosis: Contamination of food by salmonella poses a significant public health problem

30. Viral Infections:-Infectious hepatitis • Parasitic infections:- Amebiasis - Tenia - Tape worm diseases - Trichinosis from pork food - Giardiasis - Ascariasis

31. Chemicals and Radiation: Zinc, lead, Nicotinic acid, mercury acid, lithium chromium, iodine, silicon, magnesium .. etc. are known source of health hazards that endanger human life. For better or worse, chemicals and other contaminants have become a part of everyday life. They exist in every aspect of our lives even before we are born. Hundreds of new chemicals are created every year. Exposure to large amounts of any substance can be harmful to one’s health.

32. There are many types of toxicity : a chemical’s ability to cause or promote cancer, or cause neurological problems (damage to the brain and nervous system), respiratory problems (like asthma), and reproductive problems (chemicals that may harm the developing fetus, or an individual's ability to conceive).

33. It is important to remember that some chemicals in small amounts can improve or protect one’s health. Chlorine, which is used to purify drinking water, can be toxic in large quantities. In small quantities it protects us from cholera and other diseases.

35. Major environment-related killers in children under five years of age (WHO)Diarrhea kills an estimated 1.6 million children each year, caused mainly by unsafe water and poor sanitation.Air pollution kills nearly one million children annually, mostly as a result of acute respiratory infections.Malaria, which may be exacerbated as a result of poor water management and storage, inadequate housing, deforestation and loss of biodiversity, kills an estimated one million children under five annually, mostly in Africa.Unintentional physical injuries, which may be related to household or community environmental hazards, kill nearly 300 000 children annually.

36. The solutionsIn many cases, low-cost solutions for environment and health problems exist. For instance, simple filtration and disinfection of water at the household level dramatically improves the microbial quality of water, and reduces the risk of diarrhea disease at low cost. Education is also a key - mothers who receive the information they need to understand the environmental risks present in their homes and communities are better equipped to take appropriate action to reduce exposure.

37. Better storage and safe use of chemicals at community level reduces exposures to toxic chemicals, especially among toddlers, who explore, touch and taste the products found at home.

38. What can we do to tackle the environmental risks to our children?The Healthy Environments for Children Alliance (HECA) promotes a number of simple, low-cost, effective and sustainable measures to combat the environmental risks to our children.Household water securitySafe water storage at home – and treatment of water in the home when its quality is in doubt - reduces water contamination and leads to proven health benefits.

39. Hygiene and sanitationWash hands with soap before food preparation, before meals and after defecating significantly reduces the risk of diarrhea disease. • Follow the WHO Five Keys to Safer Food to reduce the risk of food borne disease: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials.

40. Air pollutionGood ventilation in the home, clean fuels and improved cooking stoves decrease indoor air pollution and the exacerbation and development of acute respiratory infections.Disease vectorsAs children usually go to bed earlier than adults at the time mosquitoes become active, the use of insecticide-treated mosquito nets and the screening of windows and doors provide a very effective means of protecting them against malaria.

41. Chemical hazardsEnsure safe storage, packaging, use and clear labeling of cleaners, fuels, solvents, pesticides and other chemicals used at home and in schools. • Unintentional injuries Advocate for safer roads and organized traffic

42. Housing and HealthHousing is a basic determinant of health, and many organizations, including the World Health Organization (WHO) and the American Public Health Association (APHA), have developed standards for healthy housing.The most important role of housing is to provide shelter from the elements. At its most basic level, housing needs to keep its inhabitants dry, warm (or cool), and safe.

43. Recommendations1- Making environmental assessment by: a. Identifying the hazards present. b. Assess the effect of these hazards on the health of Individual, families and communities. c. Assess the risk factors. d. Diagnose and reasoning the environmental influence at health 2- Playing to control environmental hazards by primary, secondary, and tertiary prevention by increase health Education, treatment and rehabilitation.

44. Conclusion and CommentsThe environmental health is very important topic in relation to health and disease.Clean air and water and effective waste management remains critical issues for 21st century.Increase scientific knowledge will decrease the hazards, which result from the environment.

45. So the use of preventive measures also decrease such hazards.Good health education and programs contribute in large benefit in the preventive measures.Increase awareness among population also decreases the hazards and deceases the number of risks people.

46. The environment we personally create for ourselves, through our habits, diet and lifestyle are now seen as very important