Malnutrition, contaminated water, and post-infectious neuropathies: lessons from the Guillain-Barré syndrome outbreak in Gaza

Sep 29, 2026

Uploaded by Mabel

The article describes how malnutrition, water insecurity, and health-system breakdown intensified into a humanitarian crisis during the 2025 Guillain-Barré syndrome outbreak in Gaza. By late August 2025, reporting indicated over 90 cases and at least 10 deaths, driven by shortages of intravenous immunoglobulin, plasma-exchange resources, and ventilators. Enteric pathogens are linked to fecal water contamination, while micronutrient deficiencies can contribute to or worsen neuropathy. The response must combine nutritional surveillance and rehabilitation with acute care including immunotherapy, ventilatory support, and pathogen identification to prevent avoidable deaths and chronic disability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor

Guillain-Barré syndrome overview and triggers

Outbreak context in Gaza and reported outcomes

Mechanisms: infection, nutrition deficits, and immune vulnerability

Clinical and structural response recommendations

Letter to the Editor Malnutrition, contaminated water, and postinfectious neuropathies: lessons from the GuillainBarré syndrome outbreak in Gaza Ehtisham Haider, MBBSa , Tirath Patel, BS, MSb ,*, Christopher Hanani, DOc Abstract The cases of malnutrition, water insecurity, and the collapse of the health system, turning into a humanitarian crisis, have been illustrated by the 2025 outbreak of Guillain-Barré syndrome (GBS) in Gaza, which is a form of treatable post-infectious neuropathy. Toward the end of August 2025, there were reports of over 90 cases and at least 10 deaths due to shortages of intravenous immunoglobulin, plasma-exchange filters, and ventilators. GBS-inducing enteric pathogens such as Campylobacter jejuni are likely promoted by chronic food insecurity and fecal contamination of water, but micronutrient deficiencies (e.g. , thiamine) can also contribute to or exacerbate polyradiculoneuropathy. Nutritionally deficient patients cannot regenerate as well due to a reduced immune response that limits the ability to fight infections or repair nerve injuries. It is thus important to integrate nutritional surveillance and rehabilitation with the delivery of acute care that includes the administration of immunotherapy, ventilatory support, and the identification of pathogens. The Gaza experience makes it clear that an appropriate response to the outbreak must address both the urgent treatment of patients and the structural factors associated with malnutrition and water insecurity to prevent avoidable deaths and chronic disability from GBS and other post-infectious neuropathies. Keywords: Gaza, Guillain-Barré syndrome, malnutrition, post-infectious neuropathy, water contamination To the Editor, GuillainBarré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy most commonly occurring in the acute inflammatory demyelinating subtype form and is the leading cause of acute flaccid paralysis in the world. It is usually acquired following infection, primarily Campylobacter jejuni, influenza or other respiratory and enteric agents. Similar immune responses have also been determined to be linked to post-infectious neurological injury by other agents, such as the Zika virus and SARS-CoV-2 . The disorder is usually characterized by such symptoms as symmetrical weakness, tingling, and numbness of the limbs, which are typically associated with the absence of reflexes. It starts distally and progresses to the proximal muscles, attacking the respiratory muscles and resulting in paralysis and even death, or breathing difficulties. The primary aDepartment of Medicine, Punjab Medical College, Faisalabad, Pakistan, bDepartment of Surgery, Trinity Medical Sciences University School of Medicine, Saint, Vincent and the Grenadines and cDepartment of Neurology, Henry Ford Health System, Detroit, Michigan, USA Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Department of Surgery, Trinity Medical Sciences University School of Medicine, P.O. Box 885, Ratho Mill, Kingstown, Saint Vincent, Saint Vincent and the Grenadines. Tel.: +[17047751100. E-mail: Tirath.patel.24@tmsu.edu.vc](17047751100. E-mail: Tirath.patel.24@tmsu.edu.vc)[ ](17047751100. E-mail: Tirath.patel.24@tmsu.edu.vc)(T. Patel). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This isan open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Annals of Medicine & Surgery (2026) 88:1044–1045 Received 7 November 2025; Accepted 11 November 2025 Published online 24 November 2025 [http://dx.doi.org/10.1097/MS9.0000000000004396](http://dx.doi.org/10.1097/MS9.0000000000004396) mechanism of molecular mimicry involves the development of antibodies against microbial antigens that a

FAQs

What conditions and resource shortages are highlighted during the 2025 Gaza outbreak?

The text highlights malnutrition, water insecurity, and collapse of the health system, along with shortages of intravenous immunoglobulin, plasma-exchange filters, and ventilators. These factors coincided with reports of over 90 cases and at least 10 deaths by late August 2025.

How are contaminated water and enteric pathogens connected to Guillain-Barré syndrome?

The document explains that chronic food insecurity and fecal contamination of water likely promote enteric pathogens such as Campylobacter jejuni, which can induce immune responses associated with GBS. Sanitation and water infrastructure collapse increases exposure to these triggers.

Why are nutrition deficits considered important for diagnosis and outcomes?

Malnutrition undermines immune response and mucosal defenses, making infection more likely and slowing nerve repair. Micronutrient deficiencies (for example, thiamine) may mimic or exacerbate neuropathic syndromes, complicating diagnosis and potentially worsening outcomes.

Sep 29, 2026

Uploaded by Mabel