Attacks on Water Systems Threaten Health and Peace, Experts Warn

Attacks on water systems increasingly undermine public health, intensify local vulnerabilities and can deepen cycles of conflict and recovery, according to a commentary by Rohit Ramchandani and colleagues at the United Nations University Institute for Water, Environment and Health published in The BMJ. The authors argue that damage to water infrastructure should be treated as an attack on health systems and counted, contested and prepared for accordingly. Their analysis is an expert commentary rather than a new clinical trial or epidemiological study, drawing on reported conflicts, water-system failures and public-health consequences. The commentary does not present a new population-based estimate of the global health effects of water-system attacks, and its examples come from specific conflict settings and reported events.

Water scarcity alone rarely initiates armed conflict. The commentary uses Syria’s 2007–09 drought as an example: it is often cited as a trigger for the 2011 uprising, but the authors note that agricultural production rebounded strongly in 2010, while much of the pre-war migration was internal, temporary and adaptive. They similarly point to Lake Chad, which shrank by as much as 90% between the 1960s and 2000, yet violence escalated after 2010 as water levels were stabilizing. These cases, the authors write, show that water is usually one factor in conflict rather than its sole cause. Their central concern is the unequal distribution of the costs of freshwater scarcity: when water systems fail, people with the least power may face disproportionate disruption, producing or deepening grievances. The commentary therefore distinguishes water as a potential contributing factor from water infrastructure deliberately targeted during war.

The authors cite data from the Pacific Institute recording 420 water-related violent events in 2024, 78% more than in 2022, with 61% involving direct attacks on water infrastructure. The figures indicate a rise in the number of recorded events, while the supplied evidence does not establish the reasons for that increase or describe the dataset’s collection methods. Ramchandani and colleagues interpret the pattern as showing that attacks on water systems are widespread enough to require explicit attention from health and policy leaders. Recent conflicts have exposed immediate consequences for drinking-water access and infrastructure. In Ukraine, millions struggled to obtain daily drinking water within months of Russia’s full-scale invasion. In the Persian Gulf, reported incidents included a US strike on an Iranian desalination plant that cut water to 30 villages on Qeshm Island, an Iranian drone attack that damaged a plant in Bahrain, and alleged targeting of two reservoirs in Sirik that supplied water to 20,000 homes. The examples include damage to production, treatment, storage and distribution infrastructure, although the commentary does not establish a single common mechanism or calculate their separate effects.

Damage to water and power infrastructure can be followed by serious health consequences. In Sudan in May 2025, damage to a power plant interrupted electricity supplied to Khartoum’s water-treatment stations; the authors report that this was followed by almost 500 cholera cases in a single day. In Gaza, roughly 57% of water infrastructure had been damaged or destroyed by the end of January 2024. During the three months after the conflict escalated, the World Health Organization recorded 136,400 cases of diarrhoea among children younger than five, 25 times the pre-war rate. These observations place infrastructure disruption alongside increased disease reporting, but they do not by themselves quantify how much of the illness was caused by each individual failure. The commentary also describes broad effects on health systems, including the loss of water availability, the need to monitor water quality and antimicrobial resistance, and the added pressure that damaged infrastructure places on recovery.

Ramchandani and colleagues propose that health leaders recognize water systems as critical health infrastructure and prepare for possible water loss before it occurs. Their stated priorities include tracking water quality, antimicrobial resistance and related health impacts, investing in resilient water and sanitation systems, maintaining backup supplies, and supporting sustained cooperation and transboundary governance. These are policy priorities advanced by the authors, not outcomes demonstrated by a prospective intervention study. The commentary’s conclusion is that “water bankruptcy” does not make conflicts inevitable, but responding to it requires honest accounting, fair renegotiation of competing claims and continued investment in peace and cooperative governance. “Attacking water is an attack on health, and attacking health undermines peace,” the authors write. Their position is that water should not become a weapon when it is not the underlying cause of a war, and that protecting water systems is relevant both to humanitarian health and to the maintenance of peace.

Subject of Research: Conflict-related attacks and failures of water infrastructure and their public-health consequences

Article Title: Attacks on water systems are attacks on health, warn experts

Article References: Attacks on water systems are attacks on health, warn experts. Original publication (Bibliographic details unavailable.)

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Keywords: water infrastructure, conflict and health, water security, cholera, diarrhoea, sanitation, public health, Ukraine, Sudan, Gaza, desalination, antimicrobial resistance