Conflict-Related WASH System Failure and Public Health Preparedness in the Middle East: A Policy-Oriented Narrative Review

Abstract

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.