In the aftermath of October 7, 2023, continuous violence in Gaza has resulted in a significant loss of life in a short timeframe, multiple forced displacement, an alarming rate of reported infectious disease cases, concerning estimates of mental health issues, and an impending famine. The destruction of infrastructure, shortages of water, lack of shelter, and loss of basic amenities have led to numerous other health problems.

The health response led by UNRWA and other UN health agencies has faced hindrance and interruption by ongoing bombardments and the closure of aid routes and has been categorized as “woefully inadequate”. The international community and regional stakeholders have underscored the necessity to scale up the response in a manner commensurate with the context’s persistent challenges, calling for sustainable, innovative, and collaborative solutions to build a resilient future for the Gazans.

Amid such response challenges, a significant indicator of resilience has been observed. Community-based approaches in the model where non-health professionals take agency to address health challenges have been notable. Since the onset of the war, individuals with no prior background in the field stepped forward and assisted in the health response, with contributions cited in mental health support and nutrition services, among other areas. In fact, this community-led public health response existed long before the current situation, having been recognized in mental health, rehabilitation services, and health promotion and awareness raising. Community health workers have been well-established for years and existing community-based organizations have been useful in the provision of sexual and reproductive health services and disaster risk management planning.

Generally speaking, ample evidence documents the existing and potential impact of community-based public health, in the context of emergencies, and as a cost-effective and efficient response in low- and middle-income countries. Specifically for Gaza, similar recognition prompted recommendations to prioritize strengthening of community health workers.

Several crucial steps need to be taken to enhance the efficiency and effectiveness of this participatory response in Gaza. Firstly, it is essential to systematically document and gather data on community members involved in these interventions. This should be done through a centralized database to facilitate access and needs-based mobilization by all partners involved. In fact, this is critical to enabling community-led response as it can facilitate mapping existing networks and planning resources. Existing numbers should be increased considering the evolving health situation of Gaza and its concomitant demands. Fewer hospitals and health workers cannot accommodate these growing demands. In view of this, there must be increased advocacy to recruit community volunteers from Gaza’s sizeable youth population.

A corresponding investment must be accelerated into knowledge and skills building of this organized and growing network of community volunteers, especially through employment of distance learning and other innovative methods that overcome existing logistic and movement barriers.

Capacity building initiatives should not focus on responsibilities already undertaken by community health workers, which remain somewhat limited to areas such as mental health, sexual and reproductive health services, and rehabilitation services. There should be a focus on expanding the community’s scope of contributions to other priority areas. Infectious disease surveillance and immunization services are suggested areas among other urgent examples within the larger emergency response. This expansion should be informed by the success of community-based interventions in similar countries affected by emergencies and other humanitarian crises such as Afghanistan and Yemen. Moreover, it must be integrated with the formal response undertaken by local, regional, and international stakeholders.

It is imperative for organizations involved in support of community-led initiatives to have sufficient financial resources. It is also of equal importance for these organizations to possess other competencies, such as cultural awareness of the contextual peculiarities. Such awareness is critical not only to win the trust of the community, but also to develop community-informed response packages based on needs and priorities.

Resource and logistic constraints, continued violence, and health worker shortages are among the many challenges characterizing the health situation in Gaza. Community-led approaches are more urgent than ever in such an emergency context and action must be taken to maximize their impact.

This blog article was published in BMJ Global Health Blog