Gaza’s Blue Baby Syndrome and Brittain’s Bad Blood

Victoria Brittain’s Dec. 9 column in the Guardian has all the elements that typify the newspaper’s simplistic, distorted accounts of the Arab-Israeli conflict. There are the innocent Palestinian victims and aggressive Israeli culprits; the falsehoods; the failure to consider any Palestinian responsibility for their state of affairs; and the brazen omission of information essential for understanding the situation.

The particulars of Brittain’s article, entitled “Who will save Gaza’s children?,” are especially dramatic. Gazan babies are being poisoned, and the antidote is as simple as one Israeli phone call, which, for no apparent reason, Israel refuses to make. In the columnist’s own words:

Among all the complex and long-term solutions being sought in Copenhagen for averting environmental catastrophe across the world, there is one place where the catastrophe has already happened, but could be immediately ameliorated with one simple political act.

In Gaza there is now no uncontaminated water; of the 40,000 or so newborn babies, at least half are at immediate risk of nitrate poisoning – incidence of “blue baby syndrome”, methaemoglobinaemia, is exceptionally high; an unprecedented number of people have been exposed to nitrate poisoning over 10 years; in some places the nitrate content in water is 300 times World Health Organisation standards; the agricultural economy is dying from the contamination and salinated water; the underground aquifer is stressed to the point of collapse; and sewage and waste water flows into public spaces and the aquifer.

The blockade of Gaza has gone on for nearly four years, and the vital water and sanitation infrastructure went past creaking to virtual collapse during the three-week assault on the territory almost a year ago.

What would it take to start the two UN sewerage repair projects approved by Israel; a UN water and sanitation project, not yet approved; and two more UN internal sewage networks, not yet approved? Right now just one corner of the blockade could be lifted for these building materials and equipment to enter Gaza, to let water works begin and to give infant lives a chance. Just one telephone call from the Israeli defence ministry could do it – an early Christmas present to the UN staff on the ground who have been ready to act for months and have grown desperate on this front, as on so many others.

The most disturbing message of the column is 1) the assertion that there is a high incidence of methemoglobinemia or “blue baby syndrome” in the Gaza Strip, 2) the implication that this is a result of “the blockade of Gaza,” and 3) the central premise that Israel is responsible for this public heath disaster because it refuses to make “just one telephone call” to allow building materials and equipment into Gaza, and thus “immediately ameliorate” the catastrophe.

If the first point is true, the latter two can only be described as an attempt by Brittain to sharply mislead readers.

“Methemoglobinemia” is a blood condition characterized by unusually high blood levels of Methemoglobin. One environmental cause of methemoglobinemia is excessive exposure to nitrates, for example, as a result of drinking water with high levels of nitrates.

No Full-Blown Cases

When discussing methemoglobinemia in the Gaza Strip, it is first important to note that, according to an October 2009 BBC report, “the World Health Organization has not discovered any recent, full-blown cases in Gaza.” Tellingly, Brittain doesn’t share this essential point with her audience.

Nor does she let on that Marianne Stuart of the British Geological Survey believes the reported levels of nitrate in Gaza’s groundwater are “worrying but not exceptional.”

Still, even without “full-blown” methemoglobinemia, there is reason for concern about the prevalence of milder cases of the disorder in the Hamas-run territory. Studies have found higher-than-normal levels of methemoglobin in the blood of Gaza children. And while mild cases of methemoglobinemia are not fatal, they can lead to skin discoloration around the hands, feet and mouth, as well as diarrhea, vomiting, or lethargy. (See, e.g., here, here and here.)

In other words, even if methemoglobinemia in Gaza isn’t a “catastrophe,” it is a problem that deserves honest examination. But Brittain does a disservice by letting her fervent anti-Israel ideology trump fair-minded concern for public health. (Brittain’s ideology involves tireless calls for a boycott of Israel, which she labels an apartheid state, while devoting sympathetic words to Hamas, Hezbollah and other unsavory characters.)

In her zeal to blame Israel, the truth is thoroughly abused. The problem goes beyond outright falsehoods — such as her credulous relaying of UNRWA director John Ging’s bogus claim that “we have 80 percent unemployment” in Gaza, or her assertion that there is “no uncontaminated water” in Gaza.
(In fact, according to the Palestinian Central Bureau of Statistics’ most recent figures, unemployment in Gaza is about half that number — 42.3 percent. And according to a UN report cited in her column, which she presumably read, there is indeed good quality water in the Strip. An analysis of tankered water from Rafah “indicated good quality water that met WHO guidelines for drinking water.” The report further points out that “distribution tanks like the one the sample came from were observed all over the Gaza Strip.”)

Such notable misstatements of fact are problemat ic, but even worse in this piece is the Brittain’s broader obfuscation of the problem, driven by grave errors of omission.

The Farmers’ Role

The main environmental cause of methemoglobinemia in Gaza is high levels of nitrates in the groundwater. And the main cause of nitrates in Gaza’s groundwater, it turns out, would not be ameliorated by an Israeli phone. The main contributors to the pollution are Palestinian farmers.

Dr. Karsten Osenbrück, a researcher for Germany’s Helmholtz Centre for Environmental Research who studied Gaza’s groundwater, explained that while wastewater from human sewage plays a role, an analysis of nitrogen isotopes revealed “the nitrate in the Gaza groundwater comes primarily from manure used as fertilizer.”

Dr. Awni Al Absi, a researcher at Gaza’s Al Aqsa Univeristy who studied methemoglobin levels in the territory, argues that Gaza farmers “usually apply an excess of manure to the crop to ensure that [there is] enough nitrogen available for growing,” a harmful practice exacerbated by “over-irrigation of [the] agriculture area.” Gaza’s “over-use of organic manure” has likewise been noted in the Western press.

Remarkably, the role of Palestinian agricultural practices is ignored by Brittain, even though, insomuch as there is any “simple” solution to Gaza’s complex environmental problems, that solution might be for Palestinian farmers to cut back on the excess manure.

Other Factors

Similarly, Brittain says nothing about other causes of environmental degradation affecting Gaza’s water. While she notes that Gaza’s “underground aquifer is stressed to the point of collapse,” she neglects to explain why, instead lumping the problem together with methemoglobinemia as another issue supposedly in Israel’s control.

According to researchers in Gaza, though, one of the most common causes of groundwater pollution in the Gaza Strip is “over-pumping from wells for domestic and agricultural use leading to diminishing groundwater levels and hence seawater intrusion….”

This over-pumping is intimately tied to the hundreds or even thousands of illegal wells drilled by Gaza Palestinians after Israel’s withdrawal from the territory. Add to this “several years of drought, ” and the result, according to the UN Environmental Programme, is that “at least three times more water is extracted [from Gaza’s aquifer] than is replenished each year.” 

Palestinian Water Authority ecologist Nahed Abu Dayyia has highlighted another phenomenon related to nitrate concentrations in Gaza’s groundwater. “The quantity of fresh water available has been severely reduced because new tarmac roads are preventing rainwater from filtering through sand to replenish groundwater levels,” the UN-affiliated IRIN news service paraphrased him as saying. This water, if allowed to run its natural course, would have diluted the pollutants, including nitrates, in Gaza’s aquifer.

In other words, as with a cutback in the amount of manure used to fertilize Gaza’s agricultural fields, Gaza’s water quality would benefit from increased Palestinian control over illegal wells and better land management to maximize recharge of the aquifer.


As long as high levels of nitrates in Gaza’s water continue to be an issue, there is another straightforward solution to the methemoglobinemia problem, also beyond the control of Israel, that is highlighted in the aforementioned report by Al Absi of Al Aqsa University. The “recommendations” section of the report notes:

Breast feeding is considered the best solution to avoid infant methemoglobinemia, and for those women who are not breast feeders, the use of bottled water in infant formula preparation offers the safest solution.

Other research validates this conclusion. (See, e.g., here.)


Brittain, however, ignores any Palestinian responsibility for contributing to and protecting against the methemoglobinemia problem. To promote her preferred narrative of Israeli culpability and Palestinian helplessness, she omits entirely from her column the role of manure and over-pumping in causing, and of breast-feeding and cautious water intake in staving off, the methemoglobinemia problem.

The journalist instead focuses mainly on wastewater. In this way, she can apportion blame — all of the blame — on Israel by suggesting that its restrictions on imports into Gaza are responsible for the poor state of its wastewater infrastructure and, by extension, the methemoglobinemia.

But even if one goes along with this selective focus on wastewater — undoubtably a (secondary) source of nitrate contamination in Gaza’s groundwater — Brittain’s story of Israeli responsibility for the crisis doesn’t hold up.

The consistent closure of Gaza’s border crossings began in June 2007, when Hamas took full control of the Gaza Strip by routing Fatah in a bout of internecine fighting. (See details here.) But studies have found an incidence of methemoglobinemia matching the levels described by Brittain, and high levels of nitrates, long before the closure. (See, e.g., this study of data from 2002, this one of data from 1998, and this one of data from 2001-2007)

Likewise, Gaza’s wastewater infrastructure was in disrepair long before Israel’s lockdown of its Gaza border (and long after Palestinians gained full control over the infrastructure in 1994). According to the UN report mentioned above, it has been a major environmental problem for decades. The challenge was made worse by the fighting in Gaza, but even before Operation Cast Lead, the environment in the Strip was degraded “due to underinvestment in environmental systems, lack of progress on priority environmental projects and the collapse of governance mechanisms.” Other sources reveal the problem was exacerbated by the theft of sand from sensitive sewage installations by Palestinians who then sold the sand to local companies.

According to a UN official quoted by the BBC, it was clear even before Hamas’s 2005 electoral victory that sewage treatment plants were likely to fail, and that improvements were stymied by Gaza’s precarious security situation:

Fadel Kawash, head of the Palestinian Water Authority, told AP several sewage projects, including one in the village, had been halted after international funding dried up in the wake of the election victory of Hamas in January last year.

“We had a project to treat sewage in north Gaza, it was worked on for two years,” he said.

“We built a pressure pipeline and pumping station but it was stopped after… troubles began.”

Hamas also blamed the flood on the withdrawal of foreign aid.

But Stuart Shepherd, the UN’s humanitarian aid officer in Gaza, said the Umm al-Naser plant had not been affected by the aid boycott, noting there had long been warnings about the plant.

A UN report in 2004 had warned that the sewage facility was at its maximum capacity, and flooding was inevitable unless a new waste treatment plant was constructed.

Mr Shepherd said foreign investment had been secured to build the treatment plant, but construction had not gone ahead because of security risks in the area.

So while Hamas and the head of the Palestinian Water Authority blamed the international community for withholding funding, and a UN official suggested that the problem preceded the boycott, and improvements were held back due to the security situation, neither Kawash nor Shepherd told the BBC reporter that Israel is responsible.

Perhaps this is because, contrary to Brittain’s innuendo, Israel has taken some steps meant to help Gaza overcome its water issues, and building material has entered the territory.

Israel’s Ministry of Foreign Affairs said of a sewage project in Beit Lahiya that “Israel approved drilling to conduct treated wastewater to the aquifer, and the required equipment was brought in to construct the facility, including cement, iron and aluminum.”

To be sure, Israeli and Egyptian restrictions on what enters the Gaza Strip have an effect on the territory. Cement and metal, which could be used for improvements to Gaza’s wastewater infrastructure, are especially sensitive, as they are likely to be diverted by Hamas to military uses. Yigal Palmor, spokesman for Israel’s foreign ministry, recently explained that “Hamas has used cement for fortifications and bunkers,” and that “[i]n the past, a lot of cement has been diverted from civilian use to purely military use as instructed by Hamas.”

Any fair-minded journalist discussing the issue would take this into account, along with the fact that metal in Gaza has been used to make Qassam rockets that kill and terrorize Israeli civilians, before claiming, as did Brittain, that a decision to allow cement and steel into Gaza is a “simple political act.”

Cement Still Reaches Gaza

Brittain is also predictably silent about the estimated 600 tons of concrete that is smuggled into Gaza. As Hamas controls not only the territory, but also the tunnels through which the concrete is smuggled, they could surely requisition this cement and direct it to be used for improvements to the wastewater infrastructure. Or better yet, they could purchase that cement with money that until now has gone to replenishing and improving their supply of rockets which have been fired at civilian targets in Israel. Considering that the most basic of the rockets can cost $400 or much more, it could have been helpful for Brittain to call on Hamas to take the simple political decision to apply that money to improving Gaza’s environment and health situation.

Water Rejection

Brittain’s column also conveniently omits another remarkable and relevant point related to Gaza’s water crisis. A recent Israeli offer to supply water to Gaza was rebuffed by Palestinian authorities. Uri Schor, a spokesperson for the Israeli Water Commission, told IRIN that Israel “offered 20 million cubic metres a year of water from our Ashkelon desalination plant” to be transferred to Gaza.” An official from the Palestinian Water Authority acknowledged the offer was rejected, citing the cost of the water and displeasure with the fact that the water was desalinized.

If Brittain truly took seriously the UN report she cites in her article, and if her overriding concern was the health of Palestinian babies, one would have expected her to urge that the Palestinians accept the Israeli water, just as forcefully as she upbraided Israel for not transferring concrete and metal to Gaza. After all, that report points to desalinization as a potential solution to the water crisis. And unlike concrete and metal, the transfer of desalinized water would not put at risk the lives of Israelis.

But it seems clear, based on the egregious omissions in her column, that Brittain is not driven by concern for the environment, or even by a desire to improve the health of Gaza’s children. The piece is just another dishonest attempt by the veteran activist to delegitimize Israel.
For more on the Victoria Brittain piece, see here. And for more on Israeli-Palestinian water issues, see here.

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