There is a lack of knowledge about the existing national anti-smoking legislation among university students in Gaza, Palestine. Smoking cessation centres also seem non-existent in Gaza. Multi-level interventions and actions are required by policy makers, educators and non-governmental agencies to prevent smoking among university students in Gaza, and to educate them on tobacco cessation counselling, on the dangers of tobacco use, and about effective stress management strategies to help them to cope with stressors. Smoking cessation interventions are required to address both cigarette and narghile use. Efforts need to be invested in ensuring compliance with legislation and for follow-up activities to enforce the anti-smoking laws through coordinated actions across ministries and departments.

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Contamination of water resources with nitrate is an increasing worldwide phenomenon that requires attention, particularly in areas with high vulnerability such as Gaza, Palestine. The study presented the areas where nitrate concentrations are expected to impose health risks using Geographic Information System (GIS) application to present the most at risk areas. The highest risk areas, located in the North and Khan Younis governorates of Gaza Strip, were shown on maps based on a proposed vulnerability criteria that consider the potential health risk (hazard quotient for nitrate >1), the level of poverty (>50%), and the level of water salinity (TDS<1000 mg/l). Residents of those areas, particularly infants, are more prone to health risks due to their higher vulnerabilities, and therefore, special advisory need to address them by the designated municipality. In addition, more strategic interventions to ensure the provision of alternative safe water supply need to be undertaken.

BACKGROUND Antimicrobial resistance (AMR) is a growing global phenomenon; however, its link to water, sanitation, and hygiene (WASH) remains underexplored, particularly in health care facilities where humanitarian crises prevail. OBJECTIVE This study aimed to identify AMR bacteria in samples collected from WASH services in 2 hospitals in Gaza and to investigate the presence of AMR genes. METHODS A hospital-based cross-sectional study to detect and identify antimicrobial resistance bacteria was conducted. Random samples from water, wastewater, soap, and surface swabs (n=345) were collected from Al-Shifa and European Gaza hospitals and screened for the presence of <i>Enterobacteriaceae</i>, <i>Pseudomonas</i>, <i>Enterococcus</i>, and <i>Staphylococcus</i> <i>aureus</i>. Antimicrobial susceptibility, extended spectrum beta-lactamase (ESBL) production, carbapenem resistance, and AMR genes were investigated. RESULTS High levels of bacterial contamination were detected in water and surface swab samples with an overall percentage of 34.1%. Moreover, 22% of the identified <i>Enterobacteriaceae</i> was positive for ESBL, and 14% was positive for modified Hodge test. Over 2/3 of isolated <i>Enterobacteriaceae</i> in water and wastewater samples was found to be resistant to amikacin, ceftazidime, ceftriaxone, and imipenem. All <i>Enterobacteriaceae</i> isolates from swab samples were found to be resistant to piperacillin-tazobactam, amikacin, ceftazidime, and ceftriaxone; 13.8% of <i>S. aureus</i> in water samples was methicillin resistant. The prevalence of ESBL genes among <i>Enterobacteriaceae</i> isolates was 25% OXA, 19.4% SHV, 2.8% KPC, 66.7% TEM, 41.7% blaCTXM, and 5.6% blaCTXM-3. For carbapenem-resistant gene (MDM), the prevalence among <i>Enterobacteriaceae</i> was 11.1%, and among <i>Pseudomonas</i> was 12.5%. The antibiotic susceptibility profile was also presented for <i>Pseudomonas</i>, <i>Enterococcus</i>, and <i>S. aureus</i>. CONCLUSIONS The results underline the level of contamination with AMR bacteria in WASH samples and highlight the need to consider the safety of WASH service at health care facilities as an essential aspect in the fight against the spread of AMR and to interrupt nosocomial transmission.