Meningitis outbreak in Gaza: the role of malnutrition, displacement and attacks on healthcare

SUMMARY BOX.

• The genocide in Gaza has resulted in conditions that foster detrimental public health conditions leading to infectious disease outbreaks.

• The meningitis outbreak of summer 2025 demonstrates how upstream drivers of health amplify epidemic risks and result in child morbidity and mortality for populations under siege, blockade and occupation.

• Meaningful efforts to improve the public health conditions in Gaza require structural approaches to improve health, including the immediate end to the siege of the Gaza Strip, the termination of the occupation of Palestine and the facilitation of restitution, reparations and return for the Palestinian people.

In the aftermath of 7 October 2023, Palestinians in the Gaza Strip have been subjected to a near-constant military assault, siege, mass displacement and the systematic destruction of critical civilian infrastructure. These conditions have been widely recognised by legal scholars, human rights organisations and medical experts as genocide.^{1 2} This genocide has had both direct and indirect health effects, with detrimental ramifications for future generations of Palestinians. To take one illustrative example, a meningitis epidemic during June–August 2025 demonstrated how the systematic destruction of public health infrastructure provides the conditions for epidemic outbreaks. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported 484 suspected cases in June 2025, a marked increase as compared with previous years.³ In July 2025, OCHA reported 420 suspected cases of meningitis, with numbers likely higher given the limited diagnostic and surveillance capability in the Gaza Strip.⁴ In August 2025, there were 119 cases of meningitis reported, bringing the total during May–August 2025 to 1043, with most cases occurring in children below 1 year of age.^{5 6} The extent of underreporting and aetiological differentiation is unclear, given the resource and personnel limitations, though most of these cases are believed to be viral in origin. For comparison, in 2022, there was a total of 1050 cases of meningitis recorded for the entire year.⁷ While rates of meningitis vary seasonally, in the context of the current genocide, significant attention has been brought to the structural, social and environmental determinants of health imparted by systematic destruction of Gaza—the denial of basic nutrition, the destruction of healthcare systems leading to the lack of disease surveillance infrastructure, the disruption of immunisation programmes and basic access to medical care. Between 2005 to 2022, reports from the Palestine Ministry of Health demonstrated that the incidence of viral meningitis in the Gaza Strip has never dropped below rates in the West Bank.⁸ This spans multiple years during which outbreaks were recorded in the Gaza Strip, including in 1997, 2004 and 2013–2014.⁹ During the 2013–2014 outbreak, incidence rates increased dramatically—reaching 247 per 100 000 in Gaza, nearly 30 times higher than the West Bank.¹⁰ Epidemiological studies conducted during these outbreaks found that 80% of meningitis cases in 2014 were viral. Most cases were attributable to enteroviruses, which thrive under conditions of poor sanitation and overcrowding.⁹ Despite the Gaza Strip’s public health system outperforming the global average childhood vaccination coverage prior to 2023—particularly for Haemophilus influenzae type b and pneumococcal conjugate vaccine coverage—conditions of displacement and crowding, intermittent breakdown in health systems and water, hygiene and sanitation (WASH) failures that facilitate the spread of non-vaccine preventable disease are well described in conflict and war settings.¹¹

Nearly the entire population of 2.2 million in Gaza has been internally displaced by the war at least once, with families forced into overcrowded shelters and makeshift encampments.¹² By July 2025, over 86% of Gaza was under displacement orders or within militarised zones.¹² According to a United Nations High Commissioner for Refugees report, the Israeli military has targeted and destroyed WASH infrastructure. Furthermore, over 80% of water and sewage facilities are in areas now inaccessible or non-functional,³ leaving clean water scarce and raw sewage overflowing in camps. Overcrowded tent shelters with poor ventilation facilitate the transmission of droplets of meningococcus and other meningitis-causing pathogens, which spread efficiently in these conditions, creating a scenario for epidemic transmission. Human Rights Watch, United Nations experts and other human rights organisations have concluded that Israel has weaponised starvation as a tool of war which has led to widespread childhood malnutrition, significantly increasing children’s vulnerability to contracting infectious diseases.¹³ For example, between January and May 2025, 16 736 children under five were admitted for treatment of acute malnutrition—5119 in May alone, including 636 cases of severe acute malnutrition, the most life-threatening form.^{14 15} Famine was confirmed in the Gaza Strip in August 2025, according to experts from the Famine Review Committee.¹⁶ Health officials warn that vitamin deficiencies and protein starvation have severely weakened children’s immunity. Malnutrition increases the risk of disease spread and progression through a variety of mechanisms, including impaired host defenses and the breakdown of mucosal and skin barriers to infection, coming at a time when treatment resources are minimal. Gaza’s healthcare system has been relentlessly targeted by the Israeli military since October 2023. As of May 2025, the WHO had recorded 697 attacks on healthcare.¹⁷ Only 17 of Gaza’s 36 hospitals were partially operational as of June 2025,¹⁸ while the partially functioning hospitals faced limited and fluctuating access to energy sources and supplies due to the siege imposed by the Israeli military.¹⁹ Over 1400 doctors, nurses, paramedics and other staff have been killed during Israel’s ongoing military assault.²⁰ Additionally, hundreds of healthcare workers have been arrested or abducted, with at least five dying in detention.²¹ The few functioning paediatric wards are crowded well beyond capacity, with patients treated in hospital corridors. Critical supplies are exhausted; severe shortages of antibiotics are reported.²² Many children receive care in improvised field clinics—school classrooms or tented shelters repurposed as makeshift hospitals—which lack sterile environments, proper isolation and paediatric resuscitation equipment. Gaza’s laboratory infrastructure continues to be severely limited by the ongoing siege, including restrictions on fuel and supplies, rendering essential diagnostic capabilities largely unavailable. Surveillance systems that once enabled early detection have collapsed: health records are fragmented or lost, and reporting networks have ceased to operate. The WHO warns that without laboratory confirmation, clinicians cannot reliably distinguish between viral and bacterial meningitis.²³ This diagnostic paralysis obscures the true extent of the outbreak, delays targeted interventions and hampers international awareness. The absence of microbiological data likely indicates that current figures may grossly underestimate the scale and severity of Gaza’s meningitis epidemic.

This outbreak carries implications far beyond the Palestinian territories. The meningitis epidemic in Gaza isone example of broader structural forces—including de-development, occupation, siege and genocide—impact the health sector and result in adverse health outcomes. It also highlights the downstream multisectoral vulnerability of systems for infectious disease prevention and control¹¹ described in similar global contexts.²⁴ Since October 2025, Israel has continued to restrict the entry of nutritional supplies, medical supplies and other necessary forms of aid into the Gaza Strip. Ongoing airstrikes, siege and occupation have limited the ability for Palestinians to respond to urgent health crises, further impeding the process of health systems reconstruction.

The current reality in Gaza should underscore the urgency and reinforce the moral imperative to act through multiple immediate steps. First, guarantee unhindered access to humanitarian aid so that immediate and long-term health threats, such as meningitis, can be addressed. Protection of aid convoys and health workers must be guaranteed. Second, support epidemiological documentation of specific outbreaks and other health crises in Palestine. This would require empowering Gaza-based clinicians, researchers and epidemiologists, as well as supporting international collaborations and resource sharing during reconstruction. These data—which should clearly delineate the health effects of genocide, including the destruction of civilian infrastructure—will be critical to understanding and preventing future outbreaks in Gaza and in other war-affected settings around the world. The international medical and public health community has a responsibility to support the recovery of the Palestinian healthcare system and to recognize the root causes of these disease outbreaks as unfair, avoidable and predictable consequences of war. Finally, meaningful progress in controlling infectious diseases requires an immediate end to the siege of the Gaza Strip, the termination of the occupation of Palestine and the facilitation of restitution, reparations and return for the Palestinian people.

Data availability statement

There are no data in this work.