{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T21:18:35Z","timestamp":1782335915806,"version":"3.54.5"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016263","name":"University Research Board, American University of Beirut","doi-asserted-by":"publisher","award":["URB # 103946"],"award-info":[{"award-number":["URB # 103946"]}],"id":[{"id":"10.13039\/501100016263","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Deficient water, sanitation, and hygiene (WASH) significantly account for a high burden of disease across the globe. Lebanon, an Eastern Mediterranean lower-middle-income country with a polluted environment, a fragmented healthcare system, and an ongoing severe economic crisis, faces serious challenges in sustaining safe water supplies, especially in vulnerable communities, while also hosting the world highest refugee population per capita. This study aimed to examine the mutagenicity, and the estrogenic and androgenic activities of water supplies, across both a Palestinian refugee camp and a Syrian informal settlement. Water samples were collected from two targeted camps in Dbayeh and Choueifat, North and South of the Capital City Beirut, respectively, between the months of September and October 2022. Microbial and physicochemical properties of samples were determined, including fecal contamination, total dissolved solids, and various minerals and salts. Organic pollutants were extracted using pre-packed solid phase extraction (SPE) columns, and then mutagenicity of extracts was examined using the Ames test in two <jats:italic>Salmonella typhi<\/jats:italic> bacterial strains. The estrogenic and androgenic activities of extracts were assessed using the yeast estrogen and androgen screen tests assays (YES\/YAS). Results show excessive levels of total coliforms and total dissolved solids (TDS) in samples from both sites. In addition, the water supply from the Dbayeh Palestinian refugee camp is mutagenic, while the water supply from the Choueifat Syrian informal settlement shows anti-androgen activity. Our findings provide valuable WASH baseline data in two major vulnerable communities in Lebanon, and highlight the importance of a water toxicity testing approach concomitant with a water safety plan, based on a holistic strategy that covers all stages of the water supply chain.<\/jats:p>","DOI":"10.1371\/journal.pone.0294679","type":"journal-article","created":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T18:55:34Z","timestamp":1704221734000},"page":"e0294679","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cytotoxicity of water supply in a Palestinian refugee camp and a Syrian informal tented settlement in Lebanon"],"prefix":"10.1371","volume":"19","author":[{"given":"Michelle","family":"El Kawak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0507-6299","authenticated-orcid":true,"given":"Jana","family":"Al 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journal of molecular sciences"},{"key":"pone.0294679.ref010","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.envint.2017.05.004","article-title":"Endocrine disrupting compounds in drinking water supply system and human health risk implication","volume":"106","author":"SY Wee","year":"2017","journal-title":"Environment international"},{"key":"pone.0294679.ref011","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.chemosphere.2017.07.066","article-title":"Mutagenicity and estrogenicity of raw water and drinking water in an industrialized city in the Yangtze River Delta","volume":"185","author":"S Xiao","year":"2017","journal-title":"Chemosphere"},{"key":"pone.0294679.ref012","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s10661-007-9646-x","article-title":"Assessment of domestic water quality: case study, Beirut, Lebanon","volume":"135","author":"SI Korfali","year":"2007","journal-title":"Environmental monitoring and 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Water safety plan manual (WSP manual) 2009 [https:\/\/www.who.int\/publications\/i\/item\/9789241562638."},{"key":"pone.0294679.ref014","unstructured":"UN. 2022 Lebanon Crisis Response Plan (LCRP) 2022 [https:\/\/lebanon.un.org\/en\/172232-2022-lebanon-crisis-response-plan-lcrp."},{"key":"pone.0294679.ref015","unstructured":"UNHCR. UNHCR Lebanon Fact Sheet 2022 [https:\/\/www.unhcr.org\/lb\/wp-content\/uploads\/sites\/16\/2023\/01\/UNHCR-Lebanon-FactSheet-October-2022.pdf."},{"key":"pone.0294679.ref016","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s13280-019-01272-0","article-title":"Refugees, water balance, and water stress: Lessons learned from Lebanon","volume":"49","author":"H Jaafar","year":"2020","journal-title":"Ambio"},{"key":"pone.0294679.ref017","article-title":"How COVID-19 has affected water, sanitation, and hygiene","author":"R Gine","year":"2021","journal-title":"SIWI"},{"key":"pone.0294679.ref018","unstructured":"UNICEF. Beirut Explosion: UNICEF with partners are restoring water infrastructure to hundreds of families. 2020."},{"key":"pone.0294679.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10661-018-6843-8","article-title":"Characterization of spatial and temporal patterns in surface water quality: a case study of four major Lebanese rivers","volume":"190","author":"C Daou","year":"2018","journal-title":"Environmental monitoring and assessment"},{"key":"pone.0294679.ref020","unstructured":"Ministry of Environment. Lebanon Environmental Assessment of the Syrian Conflict & Priority Interventions. Republic of Lebanon, Ministry of Environment\u2014UNDP\u2014EU; 2014."},{"issue":"8","key":"pone.0294679.ref021","doi-asserted-by":"crossref","first-page":"568","DOI":"10.26719\/2016.22.8.568","article-title":"Drinking water system treatment and contamination in Shatila Refugee Camp in Beirut, Lebanon","volume":"22","author":"S Khoury","year":"2016","journal-title":"EMHJ-Eastern Mediterranean Health Journal"},{"issue":"4","key":"pone.0294679.ref022","doi-asserted-by":"crossref","first-page":"670","DOI":"10.3390\/w11040670","article-title":"Impacts of intermittent water supply on water quality in two Palestinian refugee camps","volume":"11","author":"S Alazzeh","year":"2019","journal-title":"Water"},{"issue":"01","key":"pone.0294679.ref023","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4236\/jep.2015.61003","article-title":"The impact of Za\u2019atari refugee camp on the water quality in Amman-Zarqa Basin","volume":"6","author":"S Al-Harahsheh","year":"2015","journal-title":"Journal of Environmental Protection"},{"issue":"4","key":"pone.0294679.ref024","first-page":"157","article-title":"Groundwater quality assessment of Domiz refugee camp in Duhok governorate, Kurdistan region, Iraq","volume":"32","author":"NI Mohammed","year":"2020","journal-title":"Zanco Journal of Pure and Applied Sciences"},{"key":"pone.0294679.ref025","article-title":"Lebanon Water Forum Rethinking Water Service Provision in Lebanon","author":"Y. El Amine","year":"2016","journal-title":"Climate Change and Environment in the Arab World"},{"key":"pone.0294679.ref026","unstructured":"Klingbeil R. Lebanon Water Forum Report."},{"key":"pone.0294679.ref027","unstructured":"Baird R.B., E A.D. Standard Methods for the Examination of Water and Wastewater. 23rd Edition ed. Rice EW, editor: American Water Works Association (AWWA, WEF and APHA); 2017."},{"key":"pone.0294679.ref028","unstructured":"USEPA. Clean Water Act Analytical Methods. 2018."},{"key":"pone.0294679.ref029","unstructured":"WHO. Guidelines for drinking-water quality. 2008."},{"key":"pone.0294679.ref030","unstructured":"Association) AAPH, Association) AAWW, Federation) WWE. Standard Methods for the Examination of Water and Wastewater Washington, DC: American Public Health Association; 2012."},{"key":"pone.0294679.ref031","unstructured":"Xenometrix. Ames MPF\u2122 98\/100 AQUA Microplate Format Mutagenicity Assay for testing of water samples. 5.01_S ed. 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Guidelines for drinking-water quality: Fourth edition incorporating the first and second addenda 2022 [https:\/\/www.who.int\/publications\/i\/item\/9789240045064."},{"issue":"1","key":"pone.0294679.ref038","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3996\/112015-JFWM-111","article-title":"Effects of temperature, total dissolved solids, and total suspended solids on survival and development rate of larval Arkansas River Shiner","volume":"8","author":"JS Mueller","year":"2017","journal-title":"Journal of Fish and Wildlife Management"},{"issue":"11","key":"pone.0294679.ref039","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1002\/etc.5466","article-title":"A Novel Approach to Developing Thresholds for Total Dissolved Solids Using Standardized and Experimental Toxicity Test Methods","volume":"41","author":"RN Brent","year":"2022","journal-title":"Environmental Toxicology and Chemistry"},{"key":"pone.0294679.ref040","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-48717-1","volume-title":"Water resources of Lebanon","author":"A. Shaban","year":"2020"},{"key":"pone.0294679.ref041","first-page":"46p","article-title":"Assessment and management of water resources with an emphasis on prospects of climate change","author":"M Bakalowicz","year":"2009","journal-title":"GWP MED\/EUWI"},{"key":"pone.0294679.ref042","unstructured":"MoE\/UNDP. Climate Change Vulnerability and Adaptation\u2014Water. 2011."},{"issue":"4","key":"pone.0294679.ref043","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1002\/etc.5620170405","article-title":"Toward a better understanding of the bioavailability, physiology, and toxicity of silver in fish: implications for water quality criteria","volume":"17","author":"C Hogstrand","year":"1998","journal-title":"Environmental Toxicology and Chemistry: An International Journal"},{"key":"pone.0294679.ref044","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.scitotenv.2013.10.101","article-title":"Financial and environmental modelling of water hardness\u2014Implications for utilising harvested rainwater in washing machines","volume":"470","author":"T Morales-Pinz\u00f3n","year":"2014","journal-title":"Science of the Total Environment"},{"key":"pone.0294679.ref045","doi-asserted-by":"crossref","unstructured":"Sciacca S, Conti GO. Mutagens and carcinogens in drinking water. Springer; 2009. p. 157\u201362.","DOI":"10.3233\/s12349-009-0052-5"},{"issue":"12","key":"pone.0294679.ref046","doi-asserted-by":"crossref","first-page":"3567","DOI":"10.1093\/brain\/awv310","article-title":"The clinical and genetic heterogeneity of paroxysmal dyskinesias","volume":"138","author":"AR Gardiner","year":"2015","journal-title":"Brain"},{"key":"pone.0294679.ref047","unstructured":"Pelley JW. Elsevier\u2019s Integrated Review Biochemistry E-Book: with STUDENT CONSULT Online Access. 2011."},{"issue":"2","key":"pone.0294679.ref048","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.envpol.2008.10.004","article-title":"Genotoxicity of water from the Songhua River, China, in 1994\u20131995 and 2002\u20132003: Potential risks for human health","volume":"157","author":"J-R Liu","year":"2009","journal-title":"Environmental pollution"},{"key":"pone.0294679.ref049","doi-asserted-by":"crossref","first-page":"503449","DOI":"10.1016\/j.mrgentox.2022.503449","article-title":"Assessment of the mutagenic potential of the water of an urban river by means of two Tradescantia-based test systems","volume":"876","author":"A Khosrovyan","year":"2022","journal-title":"Mutation Research\/Genetic Toxicology and Environmental Mutagenesis"},{"key":"pone.0294679.ref050","doi-asserted-by":"crossref","first-page":"109385","DOI":"10.1016\/j.envres.2020.109385","article-title":"Genotoxicity of source, treated and distributed water from four drinking water treatment plants supplied by surface water in Sardinia, Italy","volume":"185","author":"D Feretti","year":"2020","journal-title":"Environmental research"},{"issue":"1\u20132","key":"pone.0294679.ref051","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.mrgentox.2011.09.019","article-title":"Mutagenicity and genotoxicity of suspended particulate matter in the Seine river estuary","volume":"741","author":"F Vincent-Hubert","year":"2012","journal-title":"Mutation Research\/Genetic Toxicology and Environmental Mutagenesis"},{"key":"pone.0294679.ref052","doi-asserted-by":"crossref","first-page":"116194","DOI":"10.1016\/j.envpol.2020.116194","article-title":"Marine protected areas in Latin America and Caribbean threatened by polycyclic aromatic hydrocarbons","volume":"269","author":"BZ Nunes","year":"2021","journal-title":"Environmental Pollution"},{"issue":"1","key":"pone.0294679.ref053","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1006\/bbrc.1999.0655","article-title":"Phosphorylation\/dephosphorylation of androgen receptor as a determinant of androgen agonistic or antagonistic activity","volume":"259","author":"LG Wang","year":"1999","journal-title":"Biochemical and biophysical research communications"},{"issue":"1\u20136","key":"pone.0294679.ref054","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0960-0760(98)00027-2","article-title":"An updated review of environmental estrogen and androgen mimics and antagonists","volume":"65","author":"C Sonnenschein","year":"1998","journal-title":"The Journal of steroid biochemistry and molecular biology"},{"issue":"2","key":"pone.0294679.ref055","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1006\/taap.1994.1117","article-title":"Environmental hormone disruptors: evidence that vinclozolin developmental toxicity is mediated by antiandrogenic metabolites","volume":"126","author":"WR Kelce","year":"1994","journal-title":"Toxicology and applied pharmacology"},{"key":"pone.0294679.ref056","doi-asserted-by":"crossref","first-page":"136317","DOI":"10.1016\/j.scitotenv.2019.136317","article-title":"Pilot study of global endocrine disrupting activity in Iowa public drinking water utilities using cell-based assays","volume":"714","author":"RR Jones","year":"2020","journal-title":"Science of The Total Environment"},{"issue":"8","key":"pone.0294679.ref057","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1016\/S0043-1354(01)00406-7","article-title":"Fish test for endocrine-disruption and estimation of water quality of Japanese rivers","volume":"36","author":"S Kashiwada","year":"2002","journal-title":"Water research"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T18:56:30Z","timestamp":1704221790000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294679"}},"subtitle":[],"editor":[{"given":"Wajdy Jum\u2019ah","family":"Al-Awaida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,2]]},"references-count":57,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0294679","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,2]]}}}