WEBVTT - Infectious Disease Risk in Palestine 0:00:01.800 --> 0:00:06.720 Also media, Hello everyone, and welcome to It Could Happen 0:00:06.760 --> 0:00:10.399 Here podcast, returning from our holiday break to discuss the 0:00:10.440 --> 0:00:14.400 exciting topic of infectious diseases in Gaza, and for that 0:00:14.520 --> 0:00:18.759 we're joined by an all star cast of experts. We 0:00:18.920 --> 0:00:22.680 have joining us today Saskia Popescu, who's an infectious disease 0:00:22.680 --> 0:00:26.280 epidemiologist and assistant professor at the University of Maryland. 0:00:26.960 --> 0:00:28.280 Welcome Saska, Thank. 0:00:28.120 --> 0:00:28.840 You for joining us. 0:00:29.920 --> 0:00:30.920 Thanks so much for having me. 0:00:31.720 --> 0:00:33.960 Yeah, of course, yeah, you're welcome. It's not just you. 0:00:33.960 --> 0:00:40.280 We've also got Cave carves back, come back baby. 0:00:40.760 --> 0:00:43.080 It's actually my first time. This is Sharene. Also, i'm here. 0:00:43.400 --> 0:00:45.120 This is my first time meeting cave so this is 0:00:45.320 --> 0:00:45.880 a real trick. 0:00:46.400 --> 0:00:49.040 Yeah, sure, I've done you wrong, Sharen, I'm sorry I 0:00:49.040 --> 0:00:49.760 didn't introduce you. 0:00:49.920 --> 0:00:52.000 That's okay, it's probably in the description or something that 0:00:52.040 --> 0:00:52.440 I'm here. 0:00:53.000 --> 0:00:57.040 No one, Yeah, make a valuable contributions. People will know 0:00:57.080 --> 0:00:57.440 you're here. 0:00:57.480 --> 0:00:58.800 But yeah, it's it's all of us. 0:00:58.880 --> 0:01:03.560 And yeah, we talked today because like I think the origin, 0:01:03.640 --> 0:01:05.880 sorry of this particular episode is that, like a few 0:01:05.880 --> 0:01:08.360 weeks ago, there was a very funny thing on the 0:01:08.360 --> 0:01:12.959 internet about people in the i d F getting diarrhea, 0:01:13.480 --> 0:01:14.080 which is funny. 0:01:14.080 --> 0:01:15.880 Object what the d i F stands for? 0:01:16.120 --> 0:01:22.520 Actually, all the kids are saying, but sorry, no, it's funny. 0:01:22.959 --> 0:01:27.399 Don't you ever apologize? Yeah, you do, not apologize for. 0:01:27.360 --> 0:01:30.759 You any opportunity just to ship on them. 0:01:32.680 --> 0:01:33.199 You're good. 0:01:33.680 --> 0:01:36.480 Yeah, expect many. It's half an hour at least of this. 0:01:37.920 --> 0:01:40.840 Don't be driving because you might laugh too much and crash. 0:01:40.840 --> 0:01:42.920 But no, it's very funny. It's the name of our 0:01:42.959 --> 0:01:46.440 group chat it's as Ready Diarrhea Forces. But aside from that, 0:01:47.480 --> 0:01:50.080 like this raises a more important question, right, which is 0:01:50.120 --> 0:01:54.840 that people in Gaza don't have access to very many 0:01:54.880 --> 0:01:57.560 medical supplies to begin with. 0:01:57.520 --> 0:01:58.440 Were things are. 0:01:58.320 --> 0:02:00.360 Embargoed like torny K's which is spoken out in this 0:02:00.360 --> 0:02:04.800 podcast before. They also have obviously a very resource constrained 0:02:04.880 --> 0:02:07.680 environment to begin with, and then a number of their 0:02:07.720 --> 0:02:11.560 hospitals have been bombed since then, which obviously further reduces 0:02:11.560 --> 0:02:14.799 their access to medical care. Also, they have less acklos 0:02:14.840 --> 0:02:17.560 to things like running water now because they're being bombed 0:02:17.639 --> 0:02:22.240 to an incredible degree. And so Saskia has joined us 0:02:22.280 --> 0:02:25.360 today to like explain the risk of the spread of 0:02:25.360 --> 0:02:28.079 infectious disease, maybe give us an update on like what's 0:02:28.120 --> 0:02:30.920 already happening and the risks of what could happen. So 0:02:31.040 --> 0:02:33.400 I guess maybe we should start off with really basic 0:02:33.440 --> 0:02:37.040 stuff and explain what infectious diseases are and like how 0:02:37.080 --> 0:02:40.359 they're different from non communical diseases gets people aren't familiar, 0:02:40.520 --> 0:02:41.880 would one if you like to do that. 0:02:42.600 --> 0:02:45.760 Yeah, I'm happy to. So infectious diseases, you know, when 0:02:45.800 --> 0:02:48.280 we talk about diseases in general, as you mentioned, there 0:02:48.280 --> 0:02:51.560 are chronic diseases, things like diabetes, cancer. When we talk 0:02:51.600 --> 0:02:54.639 about infectious diseases, meaning they're communicable for the most part, 0:02:54.760 --> 0:02:58.040 that means that they are spread through various sources human 0:02:58.080 --> 0:03:01.800 to human, like influenza. There's things like anthrax that you 0:03:02.000 --> 0:03:07.200 can equali Campelobacter that you can get from soil, from food, 0:03:07.520 --> 0:03:11.639 and the zoonotic diseases that they are also spread through animals, 0:03:11.639 --> 0:03:15.760 so things like Ebola mirors which is Middle East respiratory 0:03:15.800 --> 0:03:21.359 syndrome coronavirus. So infectious diseases are viruses, bacteria, fungi, parasites, 0:03:21.800 --> 0:03:24.760 and they really love to take advantage of high stress 0:03:24.880 --> 0:03:28.600 environments for bread and unfortunately this is one of them. 0:03:28.720 --> 0:03:32.040 So this is a very what we see with infectious diseases. 0:03:32.040 --> 0:03:36.920 A lot is that conflict and environments where people are stressed, 0:03:36.960 --> 0:03:41.640 resources are stressed, and the environment is under a continuous bombardment. 0:03:42.120 --> 0:03:48.240 There's densely populated spaces, no access to health, clean food, 0:03:48.280 --> 0:03:50.160 and water, et cetera. I mean, I could probably go 0:03:50.200 --> 0:03:52.520 on for five minutes about what makes an infectious disease spread, 0:03:52.880 --> 0:03:55.440 is going to amplify it. So these are diseases that 0:03:55.520 --> 0:03:57.600 take advantage of these environments. 0:03:58.960 --> 0:04:02.720 I'll add that the situation is just a perfect setup 0:04:02.760 --> 0:04:07.800 for infectious disease to run rampant. There's over one point 0:04:07.880 --> 0:04:11.760 nine million people that have been displaced. Of that, one 0:04:11.800 --> 0:04:15.160 point four million are living in overcrowded shelters at this point. 0:04:15.640 --> 0:04:19.280 And in the best scenario from what I've seen, there's 0:04:19.320 --> 0:04:22.160 one toilet for every two hundred and twenty people. Now, 0:04:22.160 --> 0:04:23.719 if you ever lived in like a house of like 0:04:23.839 --> 0:04:27.839 five people and there's like one case of diarrhea, you'll 0:04:27.880 --> 0:04:30.839 realize how terrible that is. Now you amplify that to 0:04:30.880 --> 0:04:33.120 two hundred and twenty at the minimum, and that's the 0:04:33.120 --> 0:04:35.320 best case scenario. I've heard its highest one per seven 0:04:35.400 --> 0:04:38.719 hundred people in some places. And then you know, people 0:04:38.760 --> 0:04:40.360 have to go in the streets, they have to go 0:04:40.440 --> 0:04:43.679 where there's water supplies, and you're going to be infecting 0:04:43.760 --> 0:04:46.520 those areas. There's one shower for every like four five 0:04:46.560 --> 0:04:49.679 hundred people again in best case scenario. So it's a 0:04:49.800 --> 0:04:53.760 huge number of people getting concentrated into smaller and smaller 0:04:53.800 --> 0:04:57.640 areas and without the infrastructure there to handle that in 0:04:57.680 --> 0:05:00.520 any way. And when that happens, I mean, we are 0:05:00.560 --> 0:05:03.440 going to see I am really worried about seeing in 0:05:03.480 --> 0:05:07.159 the end of this more depth from infectious disease than 0:05:07.200 --> 0:05:08.600 from the bombardments. 0:05:09.360 --> 0:05:12.800 Yeah, well, that's that's like a it almost feels like 0:05:12.839 --> 0:05:16.600 a double another weapon that they're that that they're that 0:05:16.640 --> 0:05:18.560 they've used because they're not letting them have a chance 0:05:18.600 --> 0:05:22.200 to recuperate or have a sanitary place to do surgeries 0:05:22.279 --> 0:05:27.479 or anything. Because if they're doing surgery with unsanitary conditions, 0:05:27.560 --> 0:05:29.720 they can get infect like the wounds can get it affected, 0:05:29.720 --> 0:05:32.120 and that's a whole nother thing, or even just like 0:05:32.240 --> 0:05:35.560 having waste in the street, like making it like having 0:05:35.640 --> 0:05:39.359 it fester. It just it's it's really I think people 0:05:39.400 --> 0:05:43.800 forget that it's not just like a building was destroyed 0:05:44.160 --> 0:05:47.839 or people were killed. It's there's lasting effects that linger 0:05:48.320 --> 0:05:50.960 for probably generations. You know, it's just it's just I 0:05:50.960 --> 0:05:52.640 don't know. It really is infuriating. 0:05:53.720 --> 0:05:56.520 I think the crazy part is the World Health Organization. 0:05:56.560 --> 0:05:59.600 So the WHO recently released some data as to what 0:05:59.760 --> 0:06:02.520 is reported to them in terms of disease, and they said, 0:06:02.560 --> 0:06:05.239 so far not keep in mind, these are just reported numbers, 0:06:05.320 --> 0:06:07.239 and that means it's just the tip of the iceberg. 0:06:07.240 --> 0:06:11.160 In most cases, one hundred thousand cases of diarrhea and 0:06:11.200 --> 0:06:13.760 those are in young children. So half of those are 0:06:13.760 --> 0:06:15.520 in young children out of the age of five, which 0:06:15.520 --> 0:06:18.120 means it can be deadly. And this number is just 0:06:18.160 --> 0:06:21.640 twenty five percent higher than what we have seen reported 0:06:21.680 --> 0:06:26.000 pre conflict. And in terms of respiratory infections, the things 0:06:26.040 --> 0:06:30.159 like covid, influenza and pneumonia, one hundred and fifty thousand cases. 0:06:30.839 --> 0:06:33.680 And that's just the numbers that we know about. But 0:06:33.720 --> 0:06:36.640 we're also seeing cases and outbreaks of things like meningitis, 0:06:36.720 --> 0:06:41.360 skin rashes, babies, LCE, chicken pox, which is highly infectious. 0:06:41.800 --> 0:06:45.320 And you know, we worry in those cases about when 0:06:45.320 --> 0:06:47.560 people are in these close quarters and their bodies are 0:06:47.560 --> 0:06:49.720 already strained. Because one thing we do know is that 0:06:49.800 --> 0:06:55.240 when your bodies physiologically under stress, meaning no sleep, malnutrition, 0:06:55.839 --> 0:06:59.479 you know, not access to clean water to wash your hands, 0:06:59.560 --> 0:07:02.880 not dehydrated, et cetera, you're at an increased risk for 0:07:02.960 --> 0:07:06.159 disease and severe disease. So that means that people are 0:07:06.200 --> 0:07:08.039 at higher risk to get it and then to spread 0:07:08.080 --> 0:07:10.520 it in these environments. And that's what's really scary because 0:07:10.560 --> 0:07:13.360 it becomes a hot spot for transmission. And you mentioned 0:07:13.360 --> 0:07:16.440 that this feels like a secondary effect in many ways. 0:07:16.680 --> 0:07:20.680 It's almost like a secondary conflict, if you will, and 0:07:21.080 --> 0:07:24.040 one that will leave lasting implications because what we do 0:07:24.120 --> 0:07:27.160 know is that disease and conflict go hand in hand. 0:07:27.160 --> 0:07:29.440 And when I think about it a lot, and we've 0:07:29.440 --> 0:07:33.000 seen this unfortunately throughout time, is that conflict can bring 0:07:33.040 --> 0:07:36.240 disease and it can amplify disease. When I say bring disease, 0:07:36.320 --> 0:07:39.680 we know that people in these spaces soldiers can bring 0:07:39.680 --> 0:07:42.000 in diseases that are being spread around. But we've also 0:07:42.080 --> 0:07:45.560 seen sexually transmitted diseases in the past being spread through 0:07:45.600 --> 0:07:48.600 sexual assault and sexual violence, and that's one thing I 0:07:48.640 --> 0:07:52.640 definitely worry about, and unfortunately we know that's happening and 0:07:52.760 --> 0:07:55.120 it's not something we're going to see reported for a while, 0:07:55.200 --> 0:07:58.040 but things like that can and do occur, and it's 0:07:58.080 --> 0:07:59.400 a very scary situation. 0:08:00.680 --> 0:08:02.440 If I can tack on a little bit to the 0:08:02.480 --> 0:08:06.480 diarrhea subject here, because I am a GI and liver doc, 0:08:06.640 --> 0:08:09.640 I mean, in a typical month in Gaza, there is 0:08:09.680 --> 0:08:12.720 about two thousand cases of diarrhea and kids under five, 0:08:13.120 --> 0:08:16.040 and in the last month there was over forty thousand cases. 0:08:16.240 --> 0:08:19.040 And for kids that aren't getting water, they're not getting 0:08:19.360 --> 0:08:22.800 the recommended amount of like daily water, like it's like 0:08:22.840 --> 0:08:25.840 seven to eight leaders in refugee situations is what's recommended. 0:08:26.160 --> 0:08:28.560 These people are getting like one to two leaders per 0:08:28.560 --> 0:08:31.720 whole families, so they're not staying hydrated. And these are 0:08:31.800 --> 0:08:34.520 kids that are most vulnerable. That's the part that is 0:08:34.600 --> 0:08:37.079 really hard for me. And I've actually seen people sort 0:08:37.120 --> 0:08:39.040 of downclay it like just like, well, diarrhea, you know, 0:08:39.040 --> 0:08:41.600 that's what you get, but in these situations, it's going 0:08:41.679 --> 0:08:44.280 to be very serious for these kids. And the other 0:08:44.320 --> 0:08:46.880 thing we're seeing is cases of jaundice. They're noting that 0:08:47.160 --> 0:08:50.040 people are becoming that, which to me suggests that there's 0:08:50.080 --> 0:08:53.599 hepatitis A and hepatitis E, which is you know, you 0:08:53.679 --> 0:08:58.000 get through fecal oral contamination and hepatitis E in particular 0:08:58.280 --> 0:09:02.320 is what concerns me because there's pregnant women and when 0:09:02.320 --> 0:09:05.920 pregnant women get hepatitis E, it's worse for them that 0:09:06.480 --> 0:09:10.000 that's a really bad situation. And when that happens, I mean, 0:09:10.040 --> 0:09:12.880 these are these are women who are already not getting support, 0:09:13.240 --> 0:09:16.360 They're already under nourished, They're not able to produce breast milk, 0:09:16.760 --> 0:09:18.319 They're going to be sick, They're not going to be 0:09:18.320 --> 0:09:22.679 able to feed their kids. It's I mean, I can't 0:09:22.720 --> 0:09:25.679 I can't imagine, honestly. I mean, I know it's funny. 0:09:25.720 --> 0:09:28.640 We can say these things, we can talk about the numbers, 0:09:28.720 --> 0:09:31.440 but it is like to actually wrap my brain around 0:09:31.440 --> 0:09:35.800 it breaks my brain. I cannot, like imagine the numbers 0:09:35.840 --> 0:09:39.319 of people that are sick and are in these hospitals, 0:09:39.520 --> 0:09:43.080 not just being treated, but like the NASA Hospital, which 0:09:43.120 --> 0:09:46.480 is one of the two hospitals in Gaza, you know, 0:09:47.040 --> 0:09:49.920 they they are like a three hundred and fifty bed hospital. 0:09:50.679 --> 0:09:53.120 They are already over like a thousand patients and not 0:09:53.240 --> 0:09:57.400 to mention the many thousands, over seventy thousand people just 0:09:57.440 --> 0:10:01.960 staying there, you know, for refuge. It's absolutely a nightmare. 0:10:02.000 --> 0:10:03.800 I can't I can't write my brain around it. 0:10:04.960 --> 0:10:07.440 Yeah, Like often I know when I speak to colleagues 0:10:07.440 --> 0:10:09.480 who are there or at the journalistic they'll go to 0:10:09.559 --> 0:10:12.120 hospitals a in the hope that they'll be safe, which 0:10:12.120 --> 0:10:14.720 hasn't proven to be true sadly, which is pretty messed up. 0:10:14.760 --> 0:10:17.079 But be you know, they have many generators, right, so 0:10:17.160 --> 0:10:21.040 they can charge and and tell the world what's happening, 0:10:21.160 --> 0:10:22.839 or try to. It seems like some of the word 0:10:22.880 --> 0:10:26.479 isn't listening. But yeah it there cost blows are incredibly overgrowded. 0:10:26.559 --> 0:10:30.000 I wonder like if we could go back to diarrhea 0:10:30.480 --> 0:10:32.960 and there's not like a fun topics talk about it. 0:10:34.640 --> 0:10:37.840 Score, Yeah, it's time to shine. 0:10:37.960 --> 0:10:39.880 Yeah, this life's work. 0:10:40.160 --> 0:10:42.319 So like I think it was diarrhea that I read 0:10:42.360 --> 0:10:44.080 kills more people than conflict annually. 0:10:45.000 --> 0:10:48.640 Oh yeah worldwide sure, yeah, yeah, well, I mean Saskia 0:10:48.640 --> 0:10:50.440 probably has better numbers on it than I do, actually, 0:10:50.440 --> 0:10:54.199 but worldwide, yeah, it's probably the number one, number one killer. 0:10:55.440 --> 0:10:58.760 So like let's just break that because I most of 0:10:58.920 --> 0:11:01.640 like by the very hus being a podcast, right best, 0:11:01.640 --> 0:11:05.679 so people listening in the in the kind of the 0:11:06.480 --> 0:11:08.439 in the neoliberal core or the global north, whatever you 0:11:08.480 --> 0:11:10.360 want to call it. Right, Like, they have a smartphone 0:11:10.400 --> 0:11:13.840 and they've downloaded this, and it might be difficult to 0:11:14.880 --> 0:11:17.480 understand how you die from diarrhea, which is like an 0:11:17.520 --> 0:11:21.800 inconvenience in a lot of places. So can you just 0:11:21.920 --> 0:11:24.920 explain that for people so they can they can understand 0:11:24.920 --> 0:11:29.240 and how the conditions that we see in Gaza would compound. 0:11:28.840 --> 0:11:31.920 That Saska, Do you want me to go first? 0:11:32.280 --> 0:11:32.480 Oh? 0:11:32.640 --> 0:11:36.440 All you, I'll talk about spreads, you can talk, okay. 0:11:36.520 --> 0:11:39.280 So, I mean, the there's a couple of issues that 0:11:39.320 --> 0:11:42.400 can happen. There's a lot, but I mean dehydration is 0:11:42.400 --> 0:11:44.760 going to be a major one, and loss of electrolytes. 0:11:45.240 --> 0:11:49.120 I mean, these people can get so badly dehydrated that 0:11:49.320 --> 0:11:52.440 the circulatory system isn't working properly, or they can lose 0:11:52.520 --> 0:11:54.840 the amount of electrolytes that they need and they're not 0:11:54.880 --> 0:11:59.120 replacing and that can cause cardiovascular issues as well. So 0:11:59.760 --> 0:12:02.960 it's a terrible way to die. I mean, you know, 0:12:03.400 --> 0:12:08.280 cholerara and these terrible like diarrheal epidemics that you know 0:12:09.600 --> 0:12:12.760 we think of of mostly in the past. They're terrible. 0:12:13.000 --> 0:12:15.400 They're terrible ways to go, and especially if you don't 0:12:15.520 --> 0:12:19.720 have the I mean it's treatable. Usually it's treatable. You know, 0:12:19.760 --> 0:12:24.240 you get fluid rehydration, you get electrolyte management. It's it's 0:12:24.280 --> 0:12:27.360 pretty manageable in the right situation. But if you don't 0:12:27.440 --> 0:12:32.480 have that, it's gonna be a devastating thing to the 0:12:32.520 --> 0:12:35.840 body over time, and for young kids, sooner rather than later. 0:12:36.880 --> 0:12:39.520 Yeah, so maybe we should explain how it spread. 0:12:40.800 --> 0:12:44.959 Yeah, I mean the scary parts. So there's multiple pathogens 0:12:45.000 --> 0:12:47.839 that can cause diarrheal illness, and for the most part, 0:12:47.920 --> 0:12:53.000 we see bacteria and viruses. If you've had neurovirus, which 0:12:53.040 --> 0:12:56.680 is the cruise ship bug, that is highly transmissible, meaning 0:12:56.800 --> 0:12:59.960 it just goes through households and environments very very quick. 0:13:00.600 --> 0:13:04.679 During outbreaks. You can't just use hand sanitizer and a 0:13:04.760 --> 0:13:07.880 simple disinfectant. You need bleach. And if you're if we're 0:13:07.880 --> 0:13:10.760 thinking about the best case scenario, and I've seen you know, diarre, 0:13:10.760 --> 0:13:13.960 real illnesses go through schools, hospitals, you name it. We 0:13:14.000 --> 0:13:16.400 still struggle to contain those. Now, put yourself in an 0:13:16.520 --> 0:13:19.600 environment with this level of stress, and you know, the 0:13:19.640 --> 0:13:23.240 thirty six hospitals in Gazda Gaza twenty six have been damaged, 0:13:23.640 --> 0:13:27.360 twenty one are not functional at all, thirteen are partially functioning, 0:13:27.440 --> 0:13:30.640 and two are barely functioning. So we know that access 0:13:30.679 --> 0:13:33.600 to care is a challenge. Resources I can't even imagine. 0:13:33.600 --> 0:13:38.200 So that means the capacity to treat patients with antibiotics, 0:13:38.200 --> 0:13:41.360 with fluids, everything, and now contain it, which is the 0:13:41.440 --> 0:13:46.280 disinfection you know, all the infection prevention essentially, And I 0:13:46.280 --> 0:13:48.400 don't even want to think about contact tracing in public 0:13:48.440 --> 0:13:51.480 health interventions because it doesn't exist. It's an entirely collapsed system. 0:13:51.559 --> 0:13:55.200 You know, this is a humanitarian crisis. So when you know, 0:13:55.280 --> 0:13:57.920 when you have people in close quarters and there's a 0:13:57.920 --> 0:14:00.520 lot of high touch items because a lot of direal 0:14:00.600 --> 0:14:04.560 illness is spread through touch. It's you know, contaminated hands 0:14:04.559 --> 0:14:07.480 and objects, and then you know, you touch your mouth, 0:14:07.520 --> 0:14:09.360 you eat with your hands, et cetera. That's how these 0:14:09.400 --> 0:14:13.720 things are spread. So between the bathroom not having access, 0:14:13.960 --> 0:14:15.960 you know, not having access to restrooms. You know, we 0:14:16.040 --> 0:14:18.960 mentioned the toilet situation, there's also one shower for every 0:14:19.040 --> 0:14:21.880 forty five hundred people, so we know that people are 0:14:21.920 --> 0:14:26.160 not able to clean themselves effectively. And this is a 0:14:26.360 --> 0:14:29.560 ripe condition for direal illness to spread, and they it 0:14:29.600 --> 0:14:33.160 spreads very quickly, very efficiently, and it is exceedingly hard 0:14:33.520 --> 0:14:35.560 to get rid of. And it worries me because a 0:14:35.560 --> 0:14:37.360 lot of these diseases, it's not just like you get 0:14:37.360 --> 0:14:39.320 it one time and you have immunity to it. It 0:14:39.320 --> 0:14:43.440 can keep going around and if you have a situation 0:14:43.560 --> 0:14:46.680 like that where you cannot clean effectively, you can't treat effectively, 0:14:46.720 --> 0:14:49.120 then we're just going to see it continuously compound. And 0:14:49.160 --> 0:14:53.800 that's absolutely terrifying because you know, we were talking about 0:14:53.960 --> 0:14:56.640 pregnant women earlier. There's fifty thousand pregnant women right now 0:14:56.920 --> 0:15:00.400 in Gaza and they are malnourished. That's just the tip 0:15:00.440 --> 0:15:02.680 of the iceberg. And we see that so many children 0:15:02.680 --> 0:15:08.080 there are malnourished, and these are very dangerous infections for 0:15:08.160 --> 0:15:10.760 vulnerable people. And on the best of days, we struggle 0:15:10.760 --> 0:15:13.880 to contain diarreal illness. So my big concern is this 0:15:14.000 --> 0:15:16.560 and respiratory viruses. To be honest with you, because when 0:15:16.560 --> 0:15:20.560 you have this many people in close quarters and ignore 0:15:20.600 --> 0:15:24.720 the fact that they're extremely you know, physically strained and 0:15:24.760 --> 0:15:27.160 stressed right now, which is when your immune system struggles, 0:15:27.680 --> 0:15:30.000 it's going to spread and it's going to be exceedingly 0:15:30.040 --> 0:15:33.080 hard to contain it. So this is an environment where 0:15:33.120 --> 0:15:35.360 we're going to see diarreal illness spread and it's going 0:15:35.480 --> 0:15:39.720 to unfortunately kill a lot more people then we will 0:15:39.760 --> 0:15:42.440 even realize. It's going to take years to understand implications 0:15:42.440 --> 0:15:45.480 of this, you know, if we even consider that access 0:15:45.520 --> 0:15:49.080 to clean water and food. We've been talking a lot 0:15:49.080 --> 0:15:52.720 about malnourishment, which is huge, but I'm also concerned to 0:15:52.760 --> 0:15:55.480 the quality of food that they're getting too, and the water, 0:15:55.760 --> 0:15:58.000 all of it. Everything about the situation is going to 0:15:58.040 --> 0:16:01.440 spread disease. It's you know, I know that sounds quite dramatic, 0:16:01.520 --> 0:16:02.800 but it's entirely true. 0:16:03.800 --> 0:16:05.920 No, I mean, I'm glad you're emphasizing that, because I 0:16:06.160 --> 0:16:10.520 don't think people realize the gravity of of like a 0:16:10.560 --> 0:16:13.520 second wave of death like that that happens like not 0:16:13.560 --> 0:16:17.800 even not with weapons. Uh, but no, I'm glad you 0:16:17.920 --> 0:16:21.560 emphasize that. Let's uh, let's take our first break. We'll 0:16:21.600 --> 0:16:22.520 be right back. 0:16:33.480 --> 0:16:36.040 And it reminds me too of when we saw U 0:16:36.160 --> 0:16:40.080 N peacekeepers in Haiti and they introduced polera, and you know, 0:16:40.160 --> 0:16:44.680 and that's it's an unfortunate reality when you are bringing 0:16:44.760 --> 0:16:47.480 in groups of people to and this you know, for 0:16:48.080 --> 0:16:50.760 in Haiti, they were trying to help the situation. In 0:16:50.800 --> 0:16:53.960 this case, it's not surprising. I mean, there's there's a 0:16:54.000 --> 0:16:57.440 really good book called Contagions and Chaos that actually talks 0:16:57.480 --> 0:17:02.120 about how infectious diseases can amplify conflict or create it. 0:17:02.160 --> 0:17:04.359 And ultimately, I think we're just going to see this 0:17:04.480 --> 0:17:07.640 as a rolling in health issue until there's a ceasefire 0:17:07.680 --> 0:17:14.080 and until there's really substantial work in there to resource 0:17:14.080 --> 0:17:14.960 and to take care of people. 0:17:14.960 --> 0:17:17.880 I mean, it's scared any Kave. You mentioned that you 0:17:17.960 --> 0:17:19.840 had a question for Saskia I. 0:17:19.760 --> 0:17:22.000 Do you know you've written and you talked a lot 0:17:22.040 --> 0:17:25.800 about the intersections of science and policy, particularly in terms 0:17:25.800 --> 0:17:29.600 of COVID nineteen. We've seen that global threats elsewhere can 0:17:29.680 --> 0:17:34.320 affect Americans, and I'm wondering, is there a way to 0:17:34.440 --> 0:17:38.600 try and appeal to Westerners who aren't that interested yet 0:17:39.000 --> 0:17:43.120 and why they should care about infectious diseases that are 0:17:43.240 --> 0:17:46.320 rising or become rampant in other places. Is there an 0:17:46.400 --> 0:17:49.840 argument you can make to these people who may not 0:17:50.560 --> 0:17:53.600 care that much about the Palestinian people per se. 0:17:54.440 --> 0:17:58.320 Oh, there's the political answer. I should give you. And 0:17:58.320 --> 0:18:01.800 then there's the real answer, which is political answer saying 0:18:01.840 --> 0:18:04.000 that you know people do care and you know we're 0:18:04.040 --> 0:18:05.800 just having the console in your mind them. But the 0:18:05.840 --> 0:18:08.600 real answer is, look, we just came out of three 0:18:08.600 --> 0:18:10.600 and a half years of a pandemic and at this point, 0:18:10.600 --> 0:18:12.520 if people don't give a shit, they're not going to. 0:18:12.640 --> 0:18:14.399 And I know that's crude for me to say, but 0:18:14.480 --> 0:18:17.479 it's I've been working in this and we've seen it 0:18:17.520 --> 0:18:24.119 from Ebola to mers too, empocs, and in now coming 0:18:24.160 --> 0:18:26.800 out of COVID. I think we can safely say that, 0:18:27.240 --> 0:18:29.440 you know, it's not a matter of if, but when. 0:18:29.480 --> 0:18:32.600 But people really like the saying that is infectious disease 0:18:32.680 --> 0:18:35.120 knows no borders, and to a certain extent that is true. 0:18:35.160 --> 0:18:38.520 Infectious diseases they don't know that, but it ignores the 0:18:38.520 --> 0:18:42.200 fact that some countries are more equipped to handle them, 0:18:42.960 --> 0:18:46.359 and that borders are a pores concept. So in this case, 0:18:46.520 --> 0:18:51.720 I think from an American perspective, where it is a 0:18:51.880 --> 0:18:56.280 very complicated relationship Americans have and I'm not getting into 0:18:56.280 --> 0:18:59.440 that when it comes to Israel. The reality is that 0:19:00.119 --> 0:19:02.440 it shouldn't matter if it's a conflict. If you see 0:19:02.480 --> 0:19:05.760 an outbreak somewhere. You should be worried for those people, 0:19:05.880 --> 0:19:07.919 and it shouldn't matter if it's going to impact you. 0:19:08.600 --> 0:19:11.800 But now that we have lived through a pandemic, a 0:19:11.960 --> 0:19:15.320 historical event, I would like to think people would see 0:19:15.320 --> 0:19:19.119 this and realize any one of these diseases can come 0:19:19.240 --> 0:19:23.400 to the States, it can strain global resources. And I'm 0:19:23.480 --> 0:19:25.879 hopeful that with the amount of attention that's coming to 0:19:25.960 --> 0:19:28.679 this and that the work that the WHO and the 0:19:28.800 --> 0:19:32.120 UN have been drawing attention to it, that will change. 0:19:32.400 --> 0:19:35.520 But I get a little nervous every time we talk 0:19:35.560 --> 0:19:39.120 about infectious diseases and conflict areas because I find that 0:19:39.840 --> 0:19:41.760 Americans and it's not just us, that people in high 0:19:41.760 --> 0:19:45.640 income countries disassociate because that is a conflict related issue, 0:19:45.720 --> 0:19:48.919 but it's not Conflict can mean many different things, and 0:19:48.960 --> 0:19:52.000 it's essentially saying, this is an issue that's going to 0:19:52.040 --> 0:19:54.760 bubble out of control. And if we were in a 0:19:54.880 --> 0:19:57.280 situation where there was no clean food and water, we 0:19:57.320 --> 0:20:00.280 had no access to health services, in medicine, well was 0:20:00.320 --> 0:20:03.280 an issue in power, no communication and I just read 0:20:03.320 --> 0:20:06.000 that three Palestinian internet providers went down, so they have 0:20:06.080 --> 0:20:09.360 no way to contact outside world. They have housing, safe passes, 0:20:09.359 --> 0:20:12.000 et cetera. Any one of those impacted US, we would 0:20:12.000 --> 0:20:15.240 be experiencing it. And I will leave that question with 0:20:15.280 --> 0:20:18.320 one comment. That's to say we are a very well 0:20:18.359 --> 0:20:22.080 resourced country. The US invests so many resources into health, 0:20:22.640 --> 0:20:26.400 global health, security, biopreparedness, all of the above, and we 0:20:26.400 --> 0:20:28.480 were one of the worst performers when it came to 0:20:28.560 --> 0:20:32.160 COVID response. And I say that having worked in health 0:20:32.200 --> 0:20:36.400 care during that and doing epidemiology, and I think this 0:20:36.400 --> 0:20:40.639 should be a continuous wake up call that it's we're 0:20:40.680 --> 0:20:43.480 one disease away from an international crisis, and when we 0:20:43.520 --> 0:20:45.720 see this, it should really speak to the fact that 0:20:46.000 --> 0:20:49.680 it is global health. It's not national health, not local health, 0:20:49.720 --> 0:20:51.960 it is global health. That's my ted talk. 0:20:53.240 --> 0:20:53.720 The good tech. 0:20:54.920 --> 0:20:57.720 I guess if I could piggyback on that, there is 0:20:57.800 --> 0:21:01.160 not a single war that I have covered, either remotely 0:21:01.359 --> 0:21:04.240 or in person, where I have not then seen those 0:21:04.280 --> 0:21:07.919 people arrive our border where I live, Like I was 0:21:08.040 --> 0:21:12.800 in Syrian Kurdistan in October. I am seeing people leaving 0:21:12.960 --> 0:21:17.000 Turkey more and more Turkish Kurdistan, but also Syrian Kurdistan, 0:21:17.240 --> 0:21:19.320 or people who went to Syria went back to Turkey 0:21:19.359 --> 0:21:22.200 at our southern border right now. I am seeing people 0:21:22.240 --> 0:21:25.280 from conflicts all over the world at our southern border 0:21:25.359 --> 0:21:29.679 right now, and every single conflict, because we tend to 0:21:29.880 --> 0:21:33.120 stick our nose into every single conflict, it ends up here, 0:21:33.200 --> 0:21:35.000 right because we tell people we support them and then 0:21:35.040 --> 0:21:36.800 we abandon them, and they come here thinking that we 0:21:36.800 --> 0:21:39.160 were going to support them. I'll also add that every 0:21:39.200 --> 0:21:43.040 time there is an infectious disease outbreak going forward, it 0:21:43.080 --> 0:21:45.639 will be used in the same way that COVID was 0:21:46.240 --> 0:21:50.520 to prevent asylum. The title forty two that was used 0:21:50.560 --> 0:21:53.000 to like quote unquote catch and release migrants at the 0:21:53.000 --> 0:21:57.400 southern border allowed border patrol to reject people without processing 0:21:57.440 --> 0:22:00.880 their asylum came. That's a public health floor, it's migration law. 0:22:01.320 --> 0:22:03.679