{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:58:03Z","timestamp":1790686683902,"version":"4.1.0"},"reference-count":50,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"unspecified","delay-in-days":271,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Conflicts in the Middle East have intensified public health emergencies through progressive failure of water, sanitation, and hygiene (WASH) systems. This policy-oriented narrative review synthesizes peer-reviewed and humanitarian evidence published between January 2020 and March 2026 on WASH system failure and related public health consequences in Gaza and the occupied Palestinian territory, Yemen, Syria, Lebanon, and Iraq. Across these settings, four recurring mechanisms emerged: physical damage; loss of electricity, fuel, chemicals, and spare parts; restrictions on access and workforce safety; and governance, financing, and coordination failures. These mechanisms impaired water treatment and distribution, wastewater and waste management, and hygiene in health care facilities. The evidence documented plausible pathways connecting these failures to diarrheal illness, cholera, hepatitis A, environmental exposure, and weakened infection prevention and control, although disrupted surveillance limited causal attribution. The settings also showed distinct patterns, ranging from acute infrastructure damage in Gaza to protracted institutional attrition in Yemen and Syria, conflict spillover and economic stress in Lebanon, and episodic vulnerability in Iraq. The review advances a cross-setting failure-to-harm pathway and a phased preparedness framework. Immediate priorities are protecting WASH workers and assets, sustaining energy and critical inputs, and linking WASH indicators with health surveillance; medium-term recovery requires service restoration, workforce capacity, and coordinated financing; and long-term resilience requires decentralized, redundant, conflict-resilient systems.<\/jats:p>","DOI":"10.1017\/dmp.2026.10457","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:21:05Z","timestamp":1790684465000},"source":"Crossref","is-referenced-by-count":0,"title":["Conflict-Related WASH System Failure and Public Health Preparedness in the Middle East: A Policy-Oriented Narrative Review"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3353-6747","authenticated-orcid":false,"given":"Abdullah Yaseen","family":"Shihab","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/007f1da21","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Baghdad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-1078","authenticated-orcid":false,"given":"Chiara","family":"Cadeddu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/057w15z03","id-type":"ROR","asserted-by":"publisher"}],"name":"Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiba","family":"Mohammad","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02q2d2610","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e0 degli Studi di Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2212-6969","authenticated-orcid":false,"given":"Jamla","family":"Rizek","sequence":"additional","affiliation":[{"name":"Adventures with Nurse Jamla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssem Eddine","family":"Ben-Ahmed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03c4mmv16","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Ottawa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohanad","family":"Ghaleb","sequence":"additional","affiliation":[{"name":"WRKfor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadeq","family":"Al-Fayyadh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/007f1da21","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Baghdad"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"S1935789326104571_r12","first-page":"104355","article-title":"Rise of cholera in Iraq: a rising concern","volume":"81","author":"Qamar","year":"2022","journal-title":"Ann Med Surg (Lond)."},{"key":"S1935789326104571_r38","unstructured":"38. World Health Organization Regional Office for the Eastern Mediterranean. Cholera Preparedness and Response Strategy for the WHO Eastern Mediterranean Region 2025\u20132028. Published October 2025. Accessed April 7, 2026. https:\/\/applications.emro.who.int\/docs\/Cholera-Strategy-EMR-RC72-2025-eng.pdf"},{"key":"S1935789326104571_r14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17165746"},{"key":"S1935789326104571_r47","unstructured":"47. European Commission Directorate-General for European Civil Protection and Humanitarian Aid Operations. Humanitarian Implementation Plan (HIP): Syria Regional and Lebanon Crises. Version 8. Published December 6, 2024. Accessed April 10, 2026. https:\/\/ec.europa.eu\/echo\/files\/funding\/hip2024\/echo_syr_bud_2024_91000_v8.pdf"},{"key":"S1935789326104571_r40","unstructured":"40. UNICEF. Syrian Arab Republic Humanitarian Situation Report No. 12: Reporting Period 1 January to 30 June 2025. Published August 1, 2025. Accessed April 2, 2026. https:\/\/www.unicef.org\/syria\/media\/20661\/file\/Syria-Humanitarian-situation-report-June-2025.pdf"},{"key":"S1935789326104571_r31","unstructured":"31. World Health Organization. Situation Report: Iraq. Week 25 (Ending 26 June 2022). Published June 26, 2022. Accessed January 23, 2026. https:\/\/www.emro.who.int\/images\/stories\/iraq\/WHO_Iraq_SitRep_Week25.pdf"},{"key":"S1935789326104571_r41","unstructured":"41. International Committee of the Red Cross. Water and Habitat: Safeguarding Public Health. Accessed April 5, 2026. https:\/\/www.icrc.org\/en\/what-we-do\/water-and-habitat"},{"key":"S1935789326104571_r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijregi.2023.06.005"},{"key":"S1935789326104571_r21","unstructured":"21. World Health Organization. Public Health Situation Analysis (PHSA): Hostilities in the Occupied Palestinian Territory (oPt), 10 September 2025. Published September 10, 2025. Accessed January 30, 2026. https:\/\/cdn.who.int\/media\/docs\/default-source\/documents\/emergencies\/who-phsa-opt-100925.pdf"},{"key":"S1935789326104571_r13","unstructured":"13. World Health Organization; United Nations Children\u2019s Fund. Essential Services for Quality Care: Water, Sanitation, Hygiene, Health Care Waste and Electricity Services in Health Care Facilities: Global Progress Report. Published September 24, 2025. Accessed January 31, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240114463"},{"key":"S1935789326104571_r20","unstructured":"20. UNICEF. Syria Cholera Situation Report, 4 October 2022. Published October 4, 2022. Accessed January 31, 2026. https:\/\/www.unicef.org\/syria\/reports\/cholera-situation-report-4-october-2022"},{"key":"S1935789326104571_r28","unstructured":"28. Global Task Force on Cholera Control. Syrian Arab Republic PAMI Report. Published September 2025. Accessed January 25, 2026. https:\/\/www.gtfcc.org\/wp-content\/uploads\/2025\/09\/pami-report-syria.pdf"},{"key":"S1935789326104571_r7","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2025.308140"},{"key":"S1935789326104571_r2","first-page":"3269","article-title":"Conflict resilience of water and energy supply infrastructure: insights from Yemen","volume":"12","author":"Al-Saidi","year":"2020","journal-title":"Water (Basel)."},{"key":"S1935789326104571_r11","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf428"},{"key":"S1935789326104571_r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2023.03.042"},{"key":"S1935789326104571_r17","doi-asserted-by":"publisher","DOI":"10.1002\/wat2.1480"},{"key":"S1935789326104571_r27","unstructured":"27. UNICEF. Syrian Arab Republic appeal. Humanitarian Action for Children, 2026. Accessed January 31, 2026. https:\/\/www.unicef.org\/appeals\/syria"},{"key":"S1935789326104571_r9","unstructured":"9. United Nations Office for the Coordination of Humanitarian Affairs. Yemen Humanitarian Needs and Response Plan 2025. Published January 15, 2025. Accessed January 31, 2026. https:\/\/www.unocha.org\/publications\/report\/yemen\/yemen-humanitarian-needs-and-response-plan-2025-january-2025-enar"},{"key":"S1935789326104571_r36","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.13.03004"},{"key":"S1935789326104571_r1","doi-asserted-by":"publisher","DOI":"10.1017\/S1816383121000667"},{"key":"S1935789326104571_r8","doi-asserted-by":"publisher","DOI":"10.18356\/9789211071733c005"},{"key":"S1935789326104571_r44","doi-asserted-by":"publisher","DOI":"10.1021\/acsestwater.3c00184"},{"key":"S1935789326104571_r48","unstructured":"48. World Health Organization Regional Office for the Eastern Mediterranean. Cholera: Risk Communication and Community Engagement Guidance. Accessed April 5, 2026. https:\/\/www.emro.who.int\/cpi\/publications\/cholera-risk-communication-and-community-engagement-guidance.html"},{"key":"S1935789326104571_r16","unstructured":"16. World Health Organization. WHO Water, Sanitation, Hygiene and Waste Strategy 2026\u20132035. World Health Organization; 2026. Accessed April 5, 2026. https:\/\/www.who.int\/publications\/i\/item\/B09661"},{"key":"S1935789326104571_r19","article-title":"State of Palestine Humanitarian Situation Report No. 42: 31 August 2025","volume":"31","year":"2025","journal-title":"Published August"},{"key":"S1935789326104571_r30","doi-asserted-by":"publisher","DOI":"10.33073\/pjm-2023-008"},{"key":"S1935789326104571_r39","unstructured":"39. World Health Organization; UNICEF. Final Whole of Syria Cholera Operational Review Report. Whole of Syria Health and WASH Clusters; 2023. Published July 2023. Accessed April 2, 2026. https:\/\/www.emro.who.int\/images\/stories\/syria\/WOS-Cholera-Intra-Action-Review-Report-July_23-2023.pdf"},{"key":"S1935789326104571_r22","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1664850"},{"key":"S1935789326104571_r33","unstructured":"33. World Health Organization Regional Office for the Eastern Mediterranean. Infectious Disease Outbreaks Reported in the Eastern Mediterranean Region in 2022. 2023. Accessed January 31, 2026. https:\/\/www.emro.who.int\/fr\/pandemic-epidemic-diseases\/information-resources\/infectious-disease-outbreaks-reported-in-the-eastern-mediterranean-region-in-2022.html"},{"key":"S1935789326104571_r18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-002064"},{"key":"S1935789326104571_r23","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-025-01161-0"},{"key":"S1935789326104571_r34","unstructured":"34. World Health Organization. Syrian Arab Republic: WHO Syria Situation Report #11: Cholera Outbreak: W43 (23-29 October 2022). Published November 2, 2022. Accessed January 25, 2026. https:\/\/www.emro.who.int\/images\/stories\/syria\/Cholera-Sitrep_11.pdf"},{"key":"S1935789326104571_r32","unstructured":"32. World Health Organization Regional Office for the Eastern Mediterranean. Yemen Reports the Highest Burden of Cholera Globally. Published December 23, 2024. Accessed January 29, 2026. https:\/\/www.emro.who.int\/media\/news\/yemen-reports-the-highest-burden-of-cholera-globally.html"},{"key":"S1935789326104571_r5","unstructured":"5. UNICEF. Fast Facts: Water, Sanitation and Hygiene in Conflict. Published November 3, 2023. Accessed January 31, 2026. https:\/\/www.unicef.org\/stories\/fast-facts-water-sanitation-hygiene-conflict"},{"key":"S1935789326104571_r37","doi-asserted-by":"publisher","DOI":"10.26719\/2025.31.7.423"},{"key":"S1935789326104571_r6","unstructured":"6. World Health Organization; United Nations Children\u2019s Fund. State of Systems for Drinking-Water, Sanitation and Hygiene: Global Update 2025. World Health Organization; 2026. Accessed April 1, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240118980"},{"key":"S1935789326104571_r24","doi-asserted-by":"publisher","DOI":"10.59117\/20.500.11822\/48536"},{"key":"S1935789326104571_r42","unstructured":"42. International Committee of the Red Cross. Syria Water Crisis: Up to 40% Less Drinking Water After 10 Years of War. Published October 1, 2021. Accessed April 6, 2026. https:\/\/www.icrc.org\/en\/document\/syria-water-crisis-after-10-years-war"},{"key":"S1935789326104571_r45","unstructured":"45. United Nations Development Programme. Syrian Arab Republic: Access to Electricity and Humanitarian Needs. Published March 2022. Accessed April 6, 2026. https:\/\/www.undp.org\/sites\/g\/files\/zskgke326\/files\/2022-08\/Electricity%20Impact%20on%20Humanitarian%20Needs_Syria_ISC-final.pdf"},{"key":"S1935789326104571_r49","unstructured":"49. Global Task Force on Cholera Control. Cholera Outbreak Response Field Manual. Published 2019. Accessed April 2, 2026. https:\/\/www.gtfcc.org\/wp-content\/uploads\/2020\/05\/gtfcc-cholera-outbreak-response-field-manual-2024.pdf"},{"key":"S1935789326104571_r3","unstructured":"3. World Health Organization. Burden of Disease Attributable to Unsafe Drinking-Water, Sanitation and Hygiene: 2019 Update. World Health Organization; 2023. Accessed February 10, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240075610"},{"key":"S1935789326104571_r50","unstructured":"50. World Health Organization. Cholera. Published December 5, 2024. Accessed April 3, 2026. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera"},{"key":"S1935789326104571_r4","unstructured":"4. World Health Organization; United Nations Children\u2019s Fund. Progress on Household Drinking Water, Sanitation and Hygiene 2000\u20132024: Special Focus on Inequalities. World Health Organization; United Nations Children\u2019s Fund; 2025. Accessed February 5, 2026. https:\/\/www.who.int\/publications\/m\/item\/progress-on-household-drinking-water--sanitation-and-hygiene-2000-2024--special-focus-on-inequalities"},{"key":"S1935789326104571_r46","unstructured":"46. European Commission Directorate-General for European Civil Protection and Humanitarian Aid Operations. Yemen. Updated September 29, 2025. Accessed April 10, 2026. https:\/\/civil-protection-humanitarian-aid.ec.europa.eu\/where\/middle-east-and-northern-africa\/yemen_en"},{"key":"S1935789326104571_r43","doi-asserted-by":"publisher","DOI":"10.1021\/acsestwater.2c00323"},{"key":"S1935789326104571_r25","unstructured":"25. Norwegian Refugee Council. Yemen Fact Sheet. Published May 2025. Accessed January 28, 2026. https:\/\/www.nrc.no\/globalassets\/pdf\/fact-sheets\/2025\/factsheet_yemen_may2025.pdf"},{"key":"S1935789326104571_r26","unstructured":"26. United Nations Office for the Coordination of Humanitarian Affairs. Yemen Humanitarian Needs and Response Plan 2026 (March 2026). Published March 18, 2026. Accessed April 3, 2026. https:\/\/yemen.un.org\/en\/312711-ocha-yemen-yemen-humanitarian-needs-and-response-plan-2026-march-2026"},{"key":"S1935789326104571_r15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000648"},{"key":"S1935789326104571_r35","unstructured":"35. World Health Organization. Public Health Situation Analysis on Hostilities in the Occupied Palestinian Territory (oPt), 19 May 2025. Published May 19, 2025. Accessed January 29, 2026. https:\/\/cdn.who.int\/media\/docs\/default-source\/2021-dha-docs\/who-phsa-opt-190525.pdf"}],"container-title":["Disaster Medicine and Public Health Preparedness"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1935789326104571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:21:19Z","timestamp":1790684479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1935789326104571\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":50,"alternative-id":["S1935789326104571"],"URL":"https:\/\/doi.org\/10.1017\/dmp.2026.10457","relation":{},"ISSN":["1935-7893","1938-744X"],"issn-type":[{"value":"1935-7893","type":"print"},{"value":"1938-744X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e173"}}