Lice, scabies, rashes plague Palestinian children as skin disease runs rampant in Gaza's tent camps

KHAN YOUNIS, Gaza Strip (AP) — A steady stream of miserable children and worried parents flowed into the dermatology office at Nasser Hospital in central Gaza.

A toddler with a blue hair bow sobbed as her mother showed how the red and white spots covering her face have spread to her neck and chest. Another woman lifted her little boy’s clothes to reveal the rashes on his back, butt, thighs and stomach. On his wrists, he had open sores from scratching. A father stood his daughter on the desk so the doctor could examine the lesions on her calves.

Skin diseases are running rampant in Gaza, health officials say. The cause, they say, is the appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes, along with the summer heat and the collapse of sanitation that has left pools of open sewage amid 10 months of Israel’s bombardment and offensives in the territory.

Doctors are wrestling with more than 103,000 cases of lice and scabies and 65,000 cases of skin rashes, according to the World Health Organization. In Gaza’s population of some 2.3 million, more than 1 million cases of acute respiratory infections have been recorded since the war began, along with more than half a million of acute diarrhea and more than 100,000 cases of jaundice, according to the United Nations Development Program.

Cleanliness is impossible in the ramshackle tents, basically wood frames hung with blankets or plastic sheets, crammed side by side over wide stretches, Palestinians say.

“There’s no shampoo, no soap,” said Munira al-Nahhal, living in a tent in the dunes outside the southern city of Khan Younis. “The water is dirty. Everything is sand and insects and garbage.”

Her family’s tent was crammed with her grandchildren, many of whom had rashes. One little boy stood scratching the red patches on his belly. “One child gets it, and it spreads to all of them,” al-Nahhal said.

Palestinians in the camp said clean water was almost impossible to get. Some wash their children in salt water from the nearby Mediterranean. People have to wear the same clothes day after day until they’re able to wash them, then they wear them again immediately. Flies are everywhere. Children play in garbage-strewn sand.

“First it was spots on her face. Then it spread to her stomach and arms, all over her forehead. And it hurts. It itches. And there’s no treatment. Or if there is we can’t afford it,” said Shaima Marshoud, sitting next to her little daughter in a cinder block structure they’d settled in among the tents.

More than 1.8 million of Gaza’s 2.3 million people have been driven from their homes, often moving multiple times over the past months to get away from Israeli ground assaults or bombardment. The vast majority are now crowded into a 50-square-kilometer (20-square-mile) area of dunes and fields on the coast with almost no sewage system and little water.

The distribution of humanitarian supplies, including soap, shampoo and medicines, has slowed to a trickle, U.N. officials say, because Israeli military operations and general lawlessness in Gaza make it too dangerous for relief trucks to move.

Israel launched its campaign vowing to destroy Hamas after its Oct. 7 attack on southern Israel, in which some 1,200 people were killed and 350 abducted. Israel’s assault has killed more than 39,000 people, according to Gaza health authorities.

“The solid waste management system has collapsed,” said Chitose Noguchi, the deputy special representative of the U.N. Development Program’s Programme of Assistance to the Palestinian People.

In a report released Tuesday, the UNDP said Gaza’s two pre-war landfills were unreachable amid the fighting and it had set up 10 temporary sites. But Noguchi said there were more than 140 informal dumping sites that have cropped up. Some of them are giant pools of human waste and garbage.

“People are having tents and living next to dumping sites, which is really, really critical situation in terms of the health crisis,” Noguchi said.

Nassim Basala, a dermatologist at Nasser Hospital, said they get 300 to 500 people a day coming in with skin diseases. After the most recent Israeli evacuation orders, more people have crowded into agricultural fields outside the city of Khan Younis, where insects are rife in the summer.

Scabies and lice are at epidemic proportions, he said, but other fungal, bacterial and viral infections and parasites are also running wild.

With the flood of patients, even simple cases can because dangerous.

For example, Basala said, impetigo is a simple bacterial infection treatable with creams. But sometimes by the time the patient gets to a doctor, “the bacteria have spread and affected the kidneys,” he said. “We’ve had cases of kidney failure” as a result. Scratched rashes get infected in the pervasive dirt.

He said creams and ointments were in short supply at the hospital.

Children are the most affected. But adults suffer as well. At the hospital’s dermatology office, one man untied his dirt-covered shoes to show the painful looking sores on the tops of his feet and ankles where his rash had rubbed open. A woman held up her hands, chapped raw and red.

Mohammed al-Rayan, several of whose children in a tent outside Khan Younis, have rashes or spot, said he has taken them to doctors.

“They give us creams, but it’s no use when you don’t have anything to wash with,” he said. “You put a cream and it gets better but then the next day it’s back the same.”

Parents are left struggling to comfort children with painful conditions that won’t go away.

Manar al-Hessi’s toddler cried as she spread cream on her forehead and chest, covered in scabs, sores and spots.

“It’s horrible,” al-Hessi said. “There are always flies on her face. She goes in the toilet or the garbage, and it gets in her hands. The filth is huge.”

Shurafa reported from Deir al-Balah, Gaza Strip. AP correspondent Julia Frankel in Jerusalem contributed to this report.

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Displaced child Toleen Marshoud, who suffers from skin disease, sits at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Displaced child Mohammed Abu Obaid, who suffers from skin disease, is seen carried by his sister, at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Displaced child Mohammed Abu Obaid, who suffers from skin disease, shows scars on his skin, at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Displaced child Mohammed Abu Obaid, who suffers from skin disease, poses for a picture next to his father, at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Displaced child Sham al-Hessi, who suffers from skin disease, sleeps at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Palestinian Manar al-Hessi, who was displaced by the Israeli bombardment of the Gaza Strip, sits next to her children, at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

Displaced child Sham al-Hessi, center, who suffers from skin disease, is covered with skin cream as she poses for a picture, at a makeshift tent camp in Deir al-Balah, central Gaza Strip, Monday, July 29, 2024. Skin diseases are running rampant in Gaza, health officials say, from appalling conditions in overcrowded tent camps housing hundreds of thousands of Palestinians driven from their homes. (AP Photo/Abdel Kareem Hana )

TOPEKA, Kan. (AP) — The head of the U.S. Postal Service expressed frustration Thursday with ongoing criticism by election officials of how it handles mail ballots while also seeking to reassure voters that it's ready to handle an expected crush of those ballots this fall.

U.S. Postmaster General Louis DeJoy told reporters that it's difficult for the Postal Service to address “generalities” about perceived problems and said some election officials don’t fully understand its efforts to deliver ballots in time to be counted.

He said the service will collect and deliver mail ballots more frequently in the days before the Nov. 5 presidential election and would keep processing centers open the Sunday before Election Day. The Postal Service, he said, would take extraordinary measures to “rescue” ballots that are mailed late and at risk of missing state deadlines to be received by election offices.

Elections officials have said for weeks that they are concerned about the Postal Service's readiness. They've cited ballots arriving late or without the postmarks required by some state laws during the primary season.

"We engage in heroic efforts intended to beat the clock,” DeJoy told reporters during a virtual news conference.

"These efforts are designed to be used only when the risk of deviating from our standard processes is necessary to compensate for the ballot being mailed so close to a state’s deadline,” he added. “This is commonly misunderstood in the media and even by election officials.”

DeJoy and state and local election officials do agree on one thing: They are urging voters who want to use mail ballots to return them as early as possible and at least seven days before a state's deadline. DeJoy also encouraged voters to go to post office counters to get their ballots postmarked.

“I want to see high turnout and low drama,” Minnesota Secretary of State Steve Simon, a Democrat and the president of the National Association of Secretaries of State, said Thursday.

In 2020, amid the coronavirus pandemic, election officials reported sending just over 69 million ballots in the mail, a substantial increase from four years earlier.

While the numbers this year may be smaller, many voters have embraced mail voting and come to rely on it.

NASS and the National Association of State Election Directors told DeJoy in a letter last week that the Postal Service had not fixed persistent problems that could disenfranchise some voters.

“It's extremely troubling that the USPS dismissed our concerns about disenfranchising voters by failing to postmark and timely deliver ballots, rather than working with us to find solutions,” Kansas Secretary of State Scott Schwab, a Republican and the past NASS president, said this week.

On Thursday, DeJoy cited a report from the Postal Service’s inspector general at the end of July saying about 98.2% of the 10.3 million ballots mailed to election officials from Dec. 1, 2023, through April 1, 2024, arrived on time. The Postal Service's standard for on-time delivery of first-class mail is three to five days, and DeJoy has said the average is 2.7 days.

Schwab has said about 1,000 mail ballots from the state's Aug. 6 primary election couldn't be counted because they arrived too late or were not postmarked.

In Lawrence, in northeastern Kansas, Jamie Miller discovered that her primary election ballot took more than three weeks to go from the mailbox outside her home to her local election office, only 3.4 miles away.

She filled it out and left it for her mail carrier on July 20, the morning after she received it. The ballot envelope was postmarked July 22 but didn't get to election officials until Aug. 12, three days after the deadline for counting it.

Miller, a 53-year-old disabled Army veteran, plans to vote in person in November.

“I’m not going to give another person the opportunity to silence my voice again,” she said. “And it definitely should not be silenced by my federal government.”

DeJoy told reporters that if postal workers see a “stray” ballot, “they jump on it," but the service's monitoring systems might miss it if it's handled outside normal processing.

He also noted the difficulty of keeping pace with vastly different state election laws, regarding everything from postmark requirements to deadlines for returning mailed ballots.

“To operate successfully and even legally, we must have consistent policies nationwide,” DeJoy said Thursday. “But there are 8,000 election jurisdictions and 50 states who are far from uniform in their election laws and practices.”

In Kansas' most populous county, Johnson County, in the Kansas City area, Election Commissioner Fred Sherman said it's probably unrealistic to expect that no ballots will arrive late or without postmarks.

But he added: “If it’s your ballot, it’s not acceptable.”

Associated Press writer Steve Karnowski in St. Paul, Minnesota, contributed to this report.

FILE - U.S. Postal Service trucks park outside a post office in Wheeling, Ill., Monday, Jan. 29, 2024. (AP Photo/Nam Y. Huh, File)

FILE - Postmaster General and CEO Louis DeJoy speaks in the East Room of the White House in Washington, March 6, 2024. (AP Photo/Susan Walsh, File)