Demand-Induced Scarcity
Population size is possibly the most contested statistic for Gaza. As no proper census has been taken since 1967, available figures are approximate at best, and they tend to vary markedly, depending on the source and the purpose of the data.
The size of Gaza's current population is largely the result of the original refugee influx from the 1948 war. Approximately 70 percent of Gaza's population is made up of these refugees and their descendants.52 Most contemporary sources place Gaza's current Palestinian population at 700,000 to 800,000, but these figures may underestimate the total by as much as 16 percent.53 Most estimates of the present Palestinian population growth rate range between 5.2 and 6 percent,54 among the highest rates identified for any group in the world. (Official Israeli estimates tend to be slightly lower; see Table 1.) Fertility tends to be higher for refugees than for residents, which means the fastest population growth is in the refugee camps - the areas that are also under greatest environmental stress.
Estimates of average population density range from 1,936 people per square kilometer (/km2) to 2,055 people/km2.55 Densities are, again, much higher in the refugee camps; Jabalya camp, where the intifadah originated, has one of the highest population densities in the world at 100,000 people/km2 in extremely poor living conditions.56
Gaza's growing population and limited water resources are driving down per capita water availability. The Swedish hydrologist Malin Falkenmark has identified one thousand cubic meters per person per year as a "water barrier" for agricultural and industrial development. She defines this barrier as "the level of water availability below which serious constraints to development will arise."57 The ratio in Gaza - even using low population estimates and optimistic estimates of sustainable water supply - is considerably less than one hundred cubic meters per person per year.
Gaza's limited resource base also supports a number of Israeli settlements, which occupy an estimated 10 percent of Gaza's cultivated area.58 Their residents are generally not incorporated in recent population figures. In 1993, the World Bank estimated that the Israeli population of Gaza was 4,000 to 5,000.59 Surprisingly, this number may still be increasing, despite the autonomy agreement. The American Foundation for Peace in the Middle East has reported a 20 percent increase in the number of settlers in Gaza. The Yesha, or grand council of Jewish settlements, also has reported an increase of 10 percent in overall Israeli settler population, though this figure does not differentiate between the West Bank and Gaza.60
The lack of water for agriculture and industry has hamstrung economic development in Gaza for years, and it is especially burdensome now because of pressure on the PA to improve living standards. Gaza's economy relies heavily on agriculture, and particularly citrus agriculture, which is water intensive. Although steadily declining due to limits on water use, today citrus still makes up 55 percent of the total irrigated area, consuming roughly half of Gaza's agricultural water supply.61
Consumption of groundwater in Gaza consistently outstrips the sustainable supply of around 65 mcm per year. Estimates of present consumption for Gaza Palestinians range from 100 to 140 mcm per year62 (85 to 100 mcm for agricultural purposes). Israeli consumption from Gaza's aquifer is a small fraction of total withdrawal; most sources estimate an average of between 4 and 10 mcm per year.63 Yet average per capita domestic water consumption by Palestinians is less than one-tenth that of settlers: 137 compared with 2,000 cubic meters per person per year.64 In general, consumption by settlements, promoted in part by subsidization, is thought to be excessive65 in the context of the local water supply.
However, once again, data on the size of the Gaza groundwater deficit are soft. Of the 3,000 wells thought to exist in Gaza, some 500 to 700 have been illegally drilled (many since autonomy was implemented) and are drawing unknown amounts.66 Decentralization of control makes accurate estimates of consumption almost impossible. In Gaza, administration of the water supply is the responsibility of a confusing hodgepodge of entities: individual operators of wells, Mekorot (an Israeli water company), the Gaza Agriculture Department, utilities, municipal and village councils, and the UNRWA, which supplies water to 20 percent of the population in the refugee camps.67
Some scholars suggest that with rapid population growth in Gaza, demand for drinking water alone may soon outstrip safe supply. It is also possible that Israeli settler demand will increase even if settlement population remains stable, due to "increasing per capita demands for both irrigated acreage and domestic amenities, such as grass and swimming pools."68 Even if demand remains stable, Gaza's present water inventory may be in far worse shape than is implied by official figures: some experts suggest that pumping rates in Gaza are 1.5 to 2 times officially declared levels.69
Supply-Induced Scarcity
Gaza's limited water supply has been overexploited (mined) since the early 1970s, and probably since the period of Egyptian control.70 The continuous mining of the Gaza aquifer, on average by an estimated 60 to 65 mcm per year, has caused falling water tables, salt intrusion, and chemical contamination.71
In its natural state, the top of the Israeli coastal aquifer, which is analogous to the neighboring Gaza aquifer, is 3 to 5 meters above sea level. Overpumping has reduced the Gaza aquifer to well below sea level and continues to draw it down by 15 to 20 centimeters per year.72 This decline reduces the aquifer's hydrostatic pressure, allowing the infiltration of saltwater from the Mediterranean and from saline aquifers below and to the east. Saltwater intrusion has already been detected as far as 1.5 kilometers inland. While levels of salinity vary geographically, Gaza's groundwater is generally classified as very saline, ranging from 650 to 3,600 parts per million (ppm).73 Salinity increases an average of 15 to 20 parts per million per year.74 This rapid increase has led some to predict the total salinization of the aquifer, if there is insufficient additional water to replace that lost to overpumping.75
Agricultural activity has resulted in chemical contamination of Gaza's groundwater.76 Unregulated use of pesticides, herbicides, and fertilizers contributes to severe pollution, especially since the aquifer is close to the surface. Chemicals banned from use in Israel and elsewhere, such as DDT, are often used in Gaza - and often misused because there are no Arabic labels on their containers.
As a result, Gaza's groundwater is often unsuitable for irrigation, as it can damage the soil and lower crop yields.77 Salinity is the greatest concern and in Gaza most groundwater is suitable only for use on highly salt-tolerant crops and highly permeable soil. Yet citrus is a significant agricultural crop and, in addition to being water intensive, citrus cannot tolerate high salinity. Farmers are already seeing declining crop yields and declining quality in many areas due to the use of high salinity irrigation water.78
Experience elsewhere shows that farmers can adapt to such contamination by shifting to more-salt-tolerant crops, adding gypsum and organic matter to the soil, and applying excess clean irrigation water to flush the soil of salt.79 However, with current limits on water consumption and a chronic lack of capital for the farming sector, these measures may not be feasible.
Inadequate disposal of waste matter has also contributed to the contamination of Gaza's aquifer. Ten percent of Gaza's population is not served by any wastewater management system, and is simply dumping raw sewage onto sand dunes.80 What systems are in place remain inadequate, particularly in the refugee camps (see Table 2). Public latrines are still widely in use, and the majority of the population throughout Gaza relies on septic tanks and soaking pits. These frequently overflow into lanes, streets, and homes and pose a significant health hazard.81 Furthermore, only one-third of Gazans outside of the refugee camps are served by solid waste collection; and while all of the refugee camps do have collection services, proper sanitary landfill sites have not been constructed anywhere in Gaza.82 As a result of inadequate infrastructure, both sewage seepage and leachate from solid waste disposal and have contaminated the aquifer.
According to one relatively optimistic analyst, 50 percent of Gaza's drinking-water supply is "murky," and 23 percent is not potable at all.84 The Applied Research Institute in Jerusalem (ARIJ) is far more pessimistic, maintaining that Gaza groundwater is simply not fit for human consumption. A water quality survey conducted by ARIJ in 1992 identifies concentrations of several key substances that far exceed what are generally regarded as acceptable levels for potability (see Table 3). A similar study conducted between 1987 and 1994 by UNRWA and the Palestinian Health Authority determined that every one of Gaza's 60 drinking water wells exceeded acceptable levels for at least two tested contaminants (see Table 4).85 While extensive testing for many toxins has not been conducted, several analysts have expressed concern about the infiltration of heavy metals, fuels, toxic organic compounds, fertilizers, pesticides, and herbicides into Gaza's drinking water supply.86 Some analysts estimate that the contamination is already irreversible and that Gaza's population will soon have to find alternate sources of drinking water. At present, however, there are few other sources.87 Overall, contamination and salinization have been costly, - politically, economically, and in terms of public health.
Health Impacts
Anthropologist Anna Bellisari argues that the routine consumption of contaminated or saline water by Gaza Palestinians contributes to deterioration of the overall health of the population:
The water crisis is very costly to Palestinians not only in the agricultural and industrial sectors, but especially in terms of public health, which depends largely upon adequate, safe supplies of domestic water. Water shortages and pollution are responsible for a major portion of the acute and chronic infections widespread throughout the Occupied Territories, and are likely to cause permanent health damage to a large segment of the population.88
This conclusion is supported by a recent World Bank report, which suggests that inadequate and contaminated water supplies contribute to the high incidence of gastrointestinal and parasitic infections found in Gaza. There are no studies that provide decisive proof, but preliminary evidence suggests a causal link between scarce and contaminated drinking water and Gaza's high levels of infant mortality, infectious disease, hypertension, and other health-related problems.
If the salinity of Gaza's aquifer continues to rise, eventually its water will be undrinkable. Salinity levels of Gaza groundwater range from 650-3,600 ppm. The U.S. standard for drinking water is 500 ppm, and water over 1,000 ppm is considered saline. Sea water has a salt concentration of 35,000 ppm. A maximum physiologically tolerable level of salinity in drinking water cannot be identified; sodium intake in water must be considered as a component of overall dietary intake. Ten grams per day is the maximum recommended salt intake for adults who are healthy, well-nourished, and not predisposed to hypertension or other salt-sensitive disorders. This level is also based on the presumption that the individual has access to sufficient fresh water to flush excess sodium: at best, human kidneys can concentrate urine to 6 grams of sodium per liter of water. Sodium intake in excess of this level must be flushed in order to keep plasma sodium levels normal. It is recommended that people with hypertension or cardiovascular disorders (both of which are common in Gaza) should not exceed 20 ppm sodium in their drinking water. Anything above that level is considered a major salt component of their diet. 89
Some experts think that high salt concentrations are already producing adverse health effects: "Gaza physicians are convinced that salty water is responsible for the high incidence of kidney and liver complaints among Gaza residents."90 Salinity has also been linked to hypernatremia,91 thought to be responsible for a large percentage of "crib deaths" and early brain damage.92 In recent years, nitrate contamination of Gaza's drinking water has increased rapidly: in 1987, 84 percent of Gaza's drinking water wells were considered suitable for drinking in terms of nitrate levels; by 1994, not a single safe well remained.93 Elevated nitrate levels are also suspected of contributing to infant mortality by causing acute anemia or "blue baby disease."94 Severe cases can result in anoxia (oxygen deprivation) and death. Nitrates have also been linked to cancer and to increased incidence of spontaneous abortion, both in humans and in animals.95
Gaza Palestinians are exposed to high fluoride concentrations in their groundwater and also in the fish and the tea that are staple foods. When consumed in large amounts, fluoride is toxic and contributes to ulcers, kidney failure, soft-tissue calcification, and skeletal and dental fluorosis.96 The effects in Gaza of groundwater chemical pollution from fertilizers, pesticides, and herbicides are hard to establish, because data on concentrations and health impacts are not available. However, studies in the West Bank show that absorption through the skin or ingestion of such chemicals can damage the nervous system.97 Similar products and practices are used in Gaza, so it follows that similar impacts may be present there. While aquifer concentrations are probably not high enough to produce extreme results, we should not rule out serious health effects because of sustained lowlevel exposures.
The most prevalent and serious health problem in Gaza is infectious disease caused by waterborne bacteria, viruses, and parasites. These diseases largely result from poor personal hygiene and inadequate sewage disposal, which are, in turn, exacerbated by insufficient water for washing and waste removal.98 Moreover, open sewers are common in urban areas. Thus in November 1994, heavy rains caused sewage to mix with freshwater supplies, producing an outbreak of cholera in Gaza City, with fifty cases and one death in a week.99
Although this outbreak received widespread attention, infectious disease is common in Gaza: "The Union of Palestinian Medical Relief Committees, which operates clinics in the Gaza Strip and in the West Bank, reported that three-quarters of all clinic patients suffered from infectious diseases, which were responsible for 74 percent of all childhood deaths."100 Intestinal parasites are prevalent. Researchers at Birzeit University found that 50 percent of Gaza children suffered from roundworms. However, according to Bellisari, these infections are often considered to be a fact of life rather than a pressing health concern, so many people may not seek treatment. Fungal infections and various other skin conditions due to poor personal hygiene are also common. These diseases are worst in refugee camps, where poor sanitation is magnified by overcrowding.101
The World Bank estimates that 7 percent of Gaza's GNP is allocated to health concerns, but there is little sign of improvement in overall population health.102 According to Bellisari, without clean and ample water supplies, disease will recur as fast as it is treated, and resources will remain focused on symptoms and not on prevention.103 Thus, Gaza's health care system will remain overburdened, producing strain on the limited resources of the PA and frustration among patients and health care workers.104