Children suffer from the spread of diseases due to an acute shortage of medications inside the Kuwaiti Hospital in Rafah in the Gaza Strip. (Loay Ayyoub for The Washington Post)
Political concerns about U.S. support for Israel delayed the deployment of experts charged with preventing the spread of infectious disease from Gaza to neighboring regions, according to four health experts, including three who spoke on the condition of anonymity to share internal discussions.
The Centers for Disease Control and Prevention plans to start sending experts to support the World Health Organization’s Cairo office next week after nearly three months of discussions with the WHO, which seeks to remain neutral in global conflicts and avoid the politicization of health issues. The delay drew consternation within the CDC as outbreaks of disease began to ravage a displaced population, according to internal communications shared with The Washington Post.
The CDC, which has a long history of collaborating with WHO, had reached out to the international health organization to offer support in October, about two weeks after the Hamas attack on Israel and Israel’s subsequent declaration of war and bombardment of Gaza, according to a CDC official. But WHO officials raised concerns that the international community would view the U.N. agency as taking sides if U.S. government experts were assigned to WHO’s regional office in Cairo because of the United States’ military aid to Israel, according to WHO and CDC officials. The Biden administration’s unwavering support for Israel’s military campaign has drawn widespread international condemnation.
The question was whether there would be “a perception of a lack of neutrality from WHO if we got support from CDC,” said Rick Brennan, a public health physician and emergency director of the WHO region headquartered in Cairo, which covers 22 countries in the Middle East and northern Africa.
Brennan downplayed the role political sensitivities played in the delay, saying logistics amid humanitarian crises take time to work out, especially over the holidays. He said the WHO regional office had requested five CDC experts to bolster infectious-disease surveillance in Gaza and the neighboring countries of Egypt, Jordan, Syria and Lebanon. But WHO was able to get personnel from elsewhere, including its Geneva headquarters, and narrowed its request to the CDC to one epidemiologist for the time being, Brennan said.
CDC Director Mandy Cohen announced at an internal meeting last week that the agency would deploy an Arabic-speaking epidemiologist to Cairo to support WHO. The expert is scheduled to leave next week and stay for up to six months.
The Israel-Gaza conflict has been a particularly sensitive issue within the CDC. Cohen, who speaks frequently about the importance of her Jewish faith, sent an agency-wide email five days after the Hamas attack describing her sadness and anger. “Seeing tragic loss of life and escalating war has been very hard,” she wrote. She made no mention of Gaza, where the civilian toll from several days of Israeli bombing was already extensive and rapidly increasing, according to the Oct. 12 email.
More than 160 employees at the agency signed two letters to Cohen expressing frustration at her silence and the lack of a more visible CDC role in Gaza. They also urged the CDC to call for a cease-fire, support the restoration of access to safe drinking water, food, electricity and emergency services, and halt further “distribution of funding and armaments used to perpetrate violence and destruction of public health infrastructure,” according to copies of the letters shared with The Post.
During a town hall in early December that Cohen hosted with agency staff, one person pointed out Cohen’s remarks about Israel and asked for her comments about the violence in Gaza and Palestinian territories. Cohen responded: “We want to be reaching everyone in every corner of the world to make sure they are safe and healthy and protected,” according to a recording of the session shared with The Post. “I’m not the one who makes foreign policy for our government. But we’ll do whatever we can to provide the resources of CDC to make sure folks continue to be healthy around the world,” she added.
Four days later, on Dec. 8, Cohen sent an agency-wide email saying, “The conflict in Israel and Gaza is tragic, sad, and complex. Israelis and Palestinians deserve safety and security. … My heart is with every impacted family.” She said she and colleagues from the Department of Health and Human Services have offered “deepest condolences to health officials for the Palestinian Authority and Israel.” She said the U.S. Agency for International Development “continues to work to deliver food, medicine, water, and fuel to civilians in Gaza.”
A spokesperson for Cohen said she was not available for an interview in response to repeated requests for comment.
CDC employees say the agency’s lack of visibility in the Gaza war contrasts sharply with its responses in other humanitarian crises. CDC experts have worked with the agency’s offices in Ukraine, Eastern Europe and Central Asia to provide training on epidemiology in emergencies, rapid response teams, and mental health and psychosocial support.
But CDC officials say the agency does not typically deploy staff to active conflict zones, and it is not the lead agency during the earliest stages of disaster or humanitarian responses.
After more than 100 days of Israel’s military campaigns against Hamas, conditions in the Gaza Strip are fertile ground for disease to spread rapidly, public health experts have said. Hundreds of thousands of people are in makeshift shelters, with little access to toilets or clean water, aid workers have said. The United Nations is warning about looming famine. The WHO predicts the death toll from sickness and starvation in coming months could eclipse the number of Palestinians killed in Gaza so far — more than 25,700, according to the latest count from the Gaza Health Ministry, with the majority of them women and children.
Public health experts are monitoring a hepatitis A outbreak, as well as a surge in acute respiratory infections and cases of jaundice and diarrhea. There have been more than 80,000 cases of diarrhea in children under 5 years old, a 23-fold increase from the 2022 baseline, according to WHO.
Cases of bloody diarrhea or dysentery can be life-threatening. Shigella, a type of bacteria that spreads easily and in recent years has become drug-resistant, is one of the most feared common culprits, health experts said. Another toll of poor sanitation: thousands of cases of scabies, lice, chickenpox and skin rashes, according to WHO.
Experts are also worried that “massive levels of wound infections” from shrapnel and blast injuries could allow bacteria to become deeply embedded, Brennan said. Lack of proper treatment could lead to a spike in antibiotic-resistant pathogens, he said.
Public health experts say the Gaza situation is particularly challenging because it is impossible for aid groups to gain safe access to a population under siege and trapped within its borders.
“The limitations of humanitarian space, and the lack of water, sanitation, medicines, medical personnel and the collapse of the health system mean that if and when a real big epidemic comes, like a waterborne disease, such as cholera, we’re not going to be able to respond,” said Paul Spiegel, director of the Center for Humanitarian Health at Johns Hopkins University’s Bloomberg School of Public Health.
Spiegel, a physician who has worked extensively in humanitarian emergencies in Afghanistan, Democratic Republic of Congo and Ethiopia, recently spent a month in Cairo supporting the U.N. response to the Gaza humanitarian crisis.
“Because of increasing food insecurity and malnutrition, these diseases will spread much more quickly and there’ll be a higher mortality, especially for children under 5,” Spiegel said.
Dan Diamond and John Hudson contributed to this report.
