War and chronic illness: a health center-based study of Palestinians with non-communicable diseases in Gaza

Abstract

Background: The war in the Gaza Strip has put immense strain on the infrastructure and health services. As a consequence, the population faces increased risks of morbidity and mortality, not only from violence but also from lack of access to healthcare. This study examines how the war affected Palestinians with non-communicable diseases (NCDs) in the Strip.

Methods: This cross-sectional survey employed a structured questionnaire to recruit 968 patients with six common NCDs from seven leading PHC clinics located in northern and southern Gaza between October and November 2024. The survey collected sociodemographic data, assessed direct war impacts on participants, evaluated accessibility to PHC and medications, and examined health impacts on participants during the war. Following descriptive statistics, inferential analysis investigated the relationships between participants' perceptions of PHC and their areas of residence or displacement.

Results: Hypertension (64.9%), type II diabetes mellitus (44.4%), and cardiovascular disease (17.1%) were the most frequently reported NCDs. 98.0% of participants were displaced during the war, and 68.1% were still displaced. 29.9% had lost a first-degree relative, and the majority suffered inaccessibility to adequate food and drinking water, lost property and income, and suffered adverse impacts on their sleep and physical exercise habits. 92.8% rated their pre-war quality of life (QoL) as excellent or good, while 81.3% rated their QoL during the war as poor. Adherence to regular follow-ups decreased from 96.7% before the war to 40.7% during the war (p < 0.001). Satisfaction with PHC dropped from 92.9% to 57.33% (p = 0.002). In terms of access to PHC, more than 93% changed their PHC doctor or clinic, and most stated that reaching the clinic was dangerous and necessitated long journeys. Medication unavailability or high cost were the most frequently reported reasons for non-compliance during the war, reported by 42.7% and 18.1%, respectively. Nearly one in five participants spent two or more consecutive months without medication. Participants from the southern enclave were significantly less satisfied with PHC and medications (p = 0.001), and their subjective QoL was significantly worse (p = 0.007).

Conclusions: The study offers important insights into the impacts of high-intensity armed conflicts on people with NCDs. The war in the Gaza Strip has profoundly impacted patients with NCDs and hampered their access to healthcare, leaving the population at risk for higher morbidity and excess mortality rates now and well into the future.

Keywords: Access to primary care; Armed conflict; Gaza Strip; Humanitarian crises; Low-income countries; Non-communicable diseases.

Fig. 1

Venn diagram illustrating the frequency (%) and overlapping of the three commonest NCDs reported

Fig. 2

Comparison between participants from the northern and southern Governorates in terms of medication satisfaction and rated QoL during the war (Chi square test, ***indicates p value < 0.01)