Summary ........................................................................................................................... 1
Recommendations ............................................................................................................ 31
Methodology .................................................................................................................... 35
Background ...................................................................................................................... 37
I. Water Deprivation as a Deliberate Act ............................................................................ 43
II. Cutting Off and Restricting Water, Fuel, and Electricity Supply ..................................... 47
Limited Operability of Water Pipelines ...................................................................................... 52
Inoperable Desalination Facilities and Wells ............................................................................. 58
Inoperable Wastewater Facilities and Sewage Pumping Stations ............................................... 61
III. Destruction of Water and Sanitation Infrastructure ...................................................... 63
Destruction of Most Water, Sanitation and Hygiene Infrastructure in Gaza ................................ 64
Deliberate Attacks on Wastewater Treatment and Sewage Facilities .......................................... 67
Central Gaza Wastewater Treatment Plant............................................................................. 68
North Gaza Wastewater Treatment Plant ................................................................................ 71
Khan Younis Wastewater Treatment Plant .............................................................................. 73
Sheikh Ejleen Wastewater Treatment Plant ............................................................................ 75
Damage and Destruction of Water Reservoirs ............................................................................ 76
Damage to Desalination Plants and Wells ................................................................................. 78
IV. Obstruction of Repairs and Aid and Attacks on Water Workers ..................................... 80
Attack on the Gaza Coastal Municipalities Water Utility Warehouse ......................................... 80
Attacks on Water and Sanitation Repair Workers ....................................................................... 83
V. Obstructing the Entry and Movement of Water-Related Materials and Infrastructure ..... 87
Attacks on Humanitarian Aid .................................................................................................... 91
VI. Deaths and Illnesses Caused by Israeli Obstruction of Water ....................................... 95
Dehydration ............................................................................................................................ 99
Infants ................................................................................................................................ 103
Pregnant and Postpartum Women ....................................................................................... 104
Impacts on People with Chronic Health Conditions and Disabilities ..................................... 105
Water-borne Diseases ............................................................................................................ 108
Skin Diseases, Infections from Lack of Water for Hygiene ........................................................ 112
Water and Sanitation in Healthcare Settings ........................................................................... 116
Unreported Deaths and Cases of Disease ............................................................................... 118
VII. Destruction of Health Care, Housing, Agriculture; Forced Displacement ..................... 125
Health Care ............................................................................................................................ 126
Housing ................................................................................................................................. 128
Agriculture ............................................................................................................................. 129
Forced Displacement .............................................................................................................. 130
International Law ............................................................................................................. 134
International Humanitarian Law and War Crimes ...................................................................... 134
International Human Rights Law .............................................................................................. 135
International Criminal Law and the Genocide Convention ......................................................... 136
Recent Court Rulings ............................................................................................................... 137
International Humanitarian Law ............................................................................................... 139
Facilitating Access to Humanitarian Aid and Assistance ......................................................... 139
Attacking, Rendering Useless Objects Indispensable to Survival ............................................ 141
Starvation as a Method of Warfare ........................................................................................ 143
International Human Rights Law .............................................................................................. 147
The Right to Water ............................................................................................................... 147
The Right to Health .............................................................................................................. 149
International Criminal Law and the Genocide Convention ......................................................... 150
Crimes Against Humanity ..................................................................................................... 150
The Crime Against Humanity of Extermination ....................................................................... 152
Genocide ............................................................................................................................ 160
Acknowledgments ........................................................................................................... 178
Annex I. Letter to Israeli Authorities (June 10, 2024) ........................................................ 180
Annex II. Letter to Israeli Authorities (November 29, 2024) ............................................. 184
