I remember seeing for months, when I was just eight years old, the footage of 9/11 first responders coated in fine dust as they ran in and out of the collapsing towers and pulled victims from the rubble.
This dust, we would later learn, was highly toxic, containing high levels of carcinogens like asbestos and lead, pulverised concrete that causes a pulmonary condition called silicosis, and thousands of other contaminants.
The deleterious effects of this exposure became a recurring story simmering in the background of my young adulthood as the first responders began grappling with their health issues and the fight to be compensated.
Two decades later, I am now watching footage almost daily of Palestinian men pulling bodies from the rubble in Gaza, their skin grey with the same toxic dust.
Ashen figures emerge from clouds of smoke and limp dazed down bombed-out streets. The United Nations that throughout the 37 million tonnes of debris within Gaza likely lurks 800,000 tonnes of asbestos and other contaminants.
Asbestos exposure causes a range of pulmonary conditions from asbestosis and pleural disease to lung cancer and mesothelioma. The first signs of these conditions can be delayed by as much as 20 to 40 years from exposure.
The fight is far from over
The acute health crisis in Gaza is already horrifying enough. Over 36,000 people are estimated to have been killed so far, and this is likely an underestimation; the healthcare infrastructure that would allow for accurate estimations has almost entirely collapsed.
Thousands more are unaccounted for or buried under the rubble. Famine has set in, and potable water has been scarce for months. And yet another disastrous health crisis looms on the horizon: Palestinians face a wave of long-term health effects from Israel's assault on Gaza that will extend well beyond any “day after.â€
The young, the elderly, and those with complex medical needs are particularly vulnerable to famine and often serve as canaries in the coal mine.
Already in March, , a six-year-old with cystic fibrosis, emerged from Kamal Adwan Hospital in northern Gaza. The pale, translucent skin on Fadi’s chest was stretched thin over his tiny ribs. Now dozens of children have been confirmed to have died from starvation, an agonising death in which organs are stripped of energy until the heart gives out.
For those who survive, the prognosis is still grim. Numerous studies on famines such as the and the show early life malnutrition has numerous long-term health effects.
These include poorer cognitive performance in adulthood, , and increased risk conditions such as type 2 diabetes, schizophrenia, and hypertension.
These effects may even be through epigenetic and social processes. When famine is experienced in utero, , with increased risk of cardiovascular disease, metabolic disease, muscular-skeletal deficiencies, and hearing impairments. Males seem to be more impacted by early malnutrition than females.
Multiple times a week I read reports or see images out of Gaza that threaten to undo me psychologically. From the comfort of my home thousands of miles away, I struggle to comprehend horrors like carrying the remains of loved ones in plastic bags or swords launched from drones slicing off limbs.
One cannot imagine the psychological state of those who have been trapped in these conditions for well over 200 days. Predictably, the bulk of studies on the effects of war on psychological health focus on those with their fingers on the trigger, specifically American service people.
There is, however, an abundance of research on post-traumatic stress disorder (PTSD) in survivors of genocide. PTSD is prevalent amongst those who have survived a genocide event and
Silent killers raise hell in Gaza
The relationship between PTSD and suicide is complex, and the research is conflicting and difficult to parse. It seems that a variety of factors, including the nature of the trauma, can influence the risk of suicide in people with PTSD.
That being said, published on October 5 was already sounding the alarm bells about rising suicide rates in Gaza.
The author notes that the number of reported suicide cases between 2015 and 2018 — the years immediately following the 2014 Israeli war on Gaza — had already doubled. Time will only tell what the psychological toll of violence on this scale will be.
What is more, suicide is not the only means by which PTSD can kill. Multiple studies have shown that PTSD is associated with a decrease in life expectancy.
, using a tool for predicting lifespan from epigenetic markers showed predicted shorter lifespans for people with PTSD diagnoses compared to people who had experience trauma but did not suffer from PTSD.
These epigenetic differences were accompanied by a thinning of brain regions associated with emotional regulation, and cellular-type differences were most marked for cells involved in inflammatory response.
of PTSD and mortality had similar findings: an increased risk of death for people with PTSD and an association with cancer and cardiovascular disease-related deaths. Chronic inflammation from persistent activation of fight or flight pathways is considered a likely causal factor for many of the diseases associated with PTSD.
None of this begins to address the plight of those in Gaza with preexisting conditions. Early diagnosis and treatment is vital for successful treatment of many diseases.
Closer to home, of the potentially deadly consequences for cancer patients as NHS wait times have jumped dramatically. Over a third of patients are waiting more than 18 weeks, with each passing day impacting prognoses.
In Gaza, cancer patients have no access to treatment and have not for months on end. Vital medicines have not been getting in, and where they have there is often no means of getting them to the displaced. It would be impossible to estimate at this point how many deaths will be caused by delays in treatment and a lack of access to care.
The 9/11 first responders have had to fight for years for congressional funding for the Victims Compensation Fund after the chorus of plaudits for their heroism died down.
Republicans attempted multiple times over the past decades since the illnesses began to block efforts to reopen and appropriate more money for the fund.
Prior to a 2019 bill, the fund was set to expire in 2020, and it took excoriating testimony from comedian Jon Stewart to ensure it was extended to 2090.
This for America’s supposed heroes, subjects of country music songs and campaign stump speeches. I dread to think what hurdles Palestinians will face in the coming years and decades when seeking aid from a world that has largely abandoned them.
It feels wrong to even contemplate these secondary and tertiary health impacts when the acute crisis is so dire and the stakes are so high. But these downstream effects are not a separate issue from the current violence; they are a direct consequence of the brutal methods Israel has employed in its assault on Gaza, and they need to be considered when contemplating the human toll.
Thankfully, there has been a flurry of fundraising efforts for organisations like Medical Aid for Palestinians and the Palestinian Red Crescent Society since October 7.
A fundraiser for MAP making the rounds on Instagram had reached well over $2 million the last time I saw it. But this is a fraction of what will be needed in the coming years and it will take a coordinated, protracted, international effort to ensure victims receive the care they deserve.
Alex Foley is an educator and painter living in Brighton, UK. They have a research background in molecular biology of health and disease. They currently work on preserving fragile digital materials related to mass death atrocities in the MENA region.
Follow them on X: @foleywoley
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