The widespread destruction of infrastructure has been a calamitous and common feature across many of the recent wars in the Middle East and North Africa and Ukraine—and urban landscapes such as Aleppo, Raqqa, Kharkiv, Mariupol, and Gaza City have borne the brunt of attacks. Without clean drinking water, electricity, treated sewage, food supplies, and medical services, cities become uninhabitable, disrupting the infrastructure upon which populations depend for basic services, and often leading to their forcible displacement. Civilians are also at risk of malnutrition, starvation, and preventable diseases that spread from dirty water and raw sewage in urban centers.

Using remote sensing, satellite imagery, mobile technology, and real-time monitoring of contamination in recent years, the international community has been able to document this destruction of infrastructure better than was possible in the wars of the 1990s and early 2000s. Indeed, environmental assessments in that era largely took place only during the “post-conflict” phase in places such as in Sudan and Afghanistan. As a result, organizations such as PAX, the Conflict and Environmental Observatory (CEOBS), and the Zoï Environment Network can document the immediate impacts of blowing up energy infrastructure, bombing hospitals, and burning agricultural land, especially in Syria, Ukraine, and now Gaza.

Holding belligerents accountable for damage to the environment and critical infrastructure at war’s end is one especially important role for such proximate assessment. Yet the ability to document attacks on infrastructure is vital for informing humanitarian responses during conflict and to plan for rebuilding amid and after conflict as well. For example, NGOs such as Ecoaction in Ukraine have not only documented the climate damage caused by Russia’s invasion of Ukraine, but have helped devise a policy plan for a green reconstruction of Ukraine. 

The recent wars in the MENA and Ukraine underscore that damage assessments and rebuilding plans cannot wait until a cessation of hostilities is in place. Tracking the devasting extent of environmental and infrastructural destruction is critical to prevent additional loss of life in deadly conflicts. In the absence of clean water and treated sewage, civilians are increasingly exposed to preventable diseases during war. Such conditions also can linger even after conflict ends if humanitarian interventions are unable to take place. As researchers Hazem Adam Ghobarah, Paul Huth, and Bruce Russett argued in a 2003 study of civil wars in the 1990s, civilian suffering “extends well beyond the period of active warfare.”

Gaza: The Power of an Early Look

In June 2024, the United Nations Environment Programme (UNEP) released its preliminary assessment of the “Environmental Impact of the Conflict in Gaza.” The extent of infrastructure destruction there is staggering. Gaza was highly urbanized; yet since Hamas’ deadly attacks in Israel on October 7, 2023, Israel’s military response has destroyed and damaged most of Gaza’s urban and critical infrastructure, including medical, cultural, and educational buildings as well as residential buildings.

Prior to the current war in Gaza, the Gazan population already was experiencing dire water shortages, as its coastal aquifer had become too salty to use. Much of its population depended upon Gaza’s desalination plants and piped water from Israel. The conflict intensified that dire situation. A March 2024 World Bank, European Union, and United Nations interim damage assessment found that 57 percent of Gaza’s water infrastructure was destroyed or partially damaged since October 2023. Without access to fuel, Gaza’s desalination facilities and sewage treatment plants have ceased to function.

What remains of the ongoing destruction is also an immense challenge. According to the UNEP assessment, there is more than 39 million tons of debris—some of which contains unexploded ordnances and asbestos. PAX has further reported on the “garbage crisis” in Gaza in July 2024, emphasizing the links to a burgeoning public health disaster. Without access to Gaza’s three official landfills, PAX found that civilians have had to rely upon improper disposal methods where waste is dumped in the open, creating dangerous conditions for children to engage in waste picking.

Dire Threats to Public Health

Compounding the environmental impacts is a mounting public health crisis. According to the World Health Organization (WHO), only 16 of Gaza’s 36 hospitals are even partially functional. Owing to continual attacks on medical facilities, vehicles, and staff, the Lancet reported that Gaza’s Ministry of Health has also struggled to maintain the most up to date data regarding civilian deaths and disease outbreaks such that the data that exists largely underestimate the loss of life.

Dr. Peter Hotez in his book Preventing the Next Pandemic cautioned that the “collapse of public health infrastructures and systems from war” were a major driver of disease in the MENA. The Syrian civil war, for example, exposed Syrian refugees to cutaneous leishmaniasis, often spread through sand flies. Inadequate water and sanitation services in Yemen contributed to a massive cholera epidemic.  

Thus, it should not have been surprising the WHO warned in July 2024 that polio had been detected in several sewage samples, despite no cases of paralysis being detected among the population at the time. As is known from other wars in the MENA, when infrastructure is destroyed such that clean water is unavailable and sewage is untreated, diseases that spread via fecal contamination, for example, are more likely to appear.

Before 2011, countries throughout the MENA were at the forefront of meeting their targets for ensuring access to clean water and proper sanitation. War not only has disrupted access to basic services, education, health care, and livelihoods, but it has reversed that progress in meeting sustainable development goals (SDGs). The destruction of health systems also has disrupted immunizations campaigns such that newborns are unable to receive critical vaccines for preventable diseases such as polio and measles.

The enhanced capacity to assess damage in real time—or closer to it—can aid the process of relief and reconstruction immensely. Donors cannot wait until there is a full cessation of hostilities to embark on rebuilding and addressing the humanitarian crisis in Gaza. The recent finding that a polio strain is present in Gaza must refocus attention on the importance of rebuilding hospitals and clinics, protecting medical and humanitarian staff, ensuring access to clean water and proper sanitation, and carrying out immunization campaigns. The health and environmental impacts of war unfortunately do not cease once conflict ends.