Public Awareness and Self-Medication with Antibiotics During the 2023 Gaza Conflict

Overview

This cross-sectional survey examined antibiotic self-medication (SMA) and public awareness among 422 adults who lived in Gaza during the 2023 conflict. Conducted in 2025, it asked participants about antibiotic use before and during the war. Reported SMA was higher during the war, alongside substantial barriers to formal healthcare.

Background

SMA involves using antibiotics without a prescription or medical supervision. Inappropriate use can contribute to adverse effects, treatment failure, and antimicrobial resistance (AMR). The study examined reported practices and knowledge amid disruptions to healthcare access in Gaza; it did not measure whether resistance increased.

Objective

To estimate reported SMA before and during the war and assess participants’ antibiotic-related knowledge, attitudes, practices, and perceptions of AMR.

Approach

Researchers surveyed adults from May through October 2025 using an Arabic questionnaire completed on paper or online. Participants were recruited by convenience within predefined geographic and residential-setting groups at primary healthcare centers, community pharmacies, and displacement shelters.

Data Highlights

• Reported SMA rose from 60.4% before the war to 80.6% during it (P < 0.001).

• During the war, participants cited difficulty accessing healthcare (75.4%), overcrowded facilities (74.6%), and treatment costs (69.0%) as reasons for SMA.

• Reported pharmacy purchases without a prescription rose from 23.7% to 80.6%, while black-market acquisition rose from 2.1% to 41.0%.

• The overall knowledge, attitudes, and practices score averaged 67.46%. Only 41.2% correctly identified that antibiotics are ineffective against influenza.

Key Findings

• Reported SMA was common among surveyed participants despite moderate overall antibiotic-related awareness.

• Barriers to formal care were prominent reasons participants gave for SMA during the war.

• Participants reported adverse effects after self-medication, including stomach pain and diarrhea. The study did not measure treatment failure or AMR outcomes.

Interpretation

The findings show a gap between awareness and reported antibiotic-use practices in this sample. They are consistent with the authors’ concern that restricted access to care may encourage SMA, but the cross-sectional survey cannot establish that the war or healthcare disruptions caused the reported increase.

Clinical Implications

The authors call for public education, antibiotic stewardship, improved healthcare access, and stronger oversight of antibiotic distribution. The study did not test whether these measures reduce SMA.

Limitations

Convenience recruitment and the high proportion of university-educated participants limit generalizability. Antibiotic use was self-reported, and participants recalled pre-war practices approximately two years later. The findings should not be treated as population-wide prevalence estimates for Gaza or as evidence of causation.

Conclusion

Among surveyed Gaza residents, reported SMA was substantially higher during the war than before it. The results identify healthcare access barriers and inappropriate antibiotic-use practices that the authors argue warrant attention.

Related Resources & Content

The following publication details appear in the supplied paper or its reference list:

• Altalla SA, Abu Mustafa AM, Elmanama AA. “Antibiotic self-medication and public awareness during the 2023 Gaza war: a cross-sectional investigation.” International Journal of Infectious Diseases. 2026;172:109090.

• Kumar R, Tanous O, Mills D, et al. “Antimicrobial resistance in a protracted war setting: a review of the literature from Palestine.” mSystems. 2025;10:e01679-24.

• Moussally K, Abu-Sittah G, Gomez FG, Abou Fayad A, Farra A. “Antimicrobial resistance in the ongoing Gaza war: a silent threat.” The Lancet. 2023;402:1972–1973.

• Naseef H, Joza’ D, Awawdeh A, et al. “Evaluation of self-medication with antibiotics in primary care clinics in Palestine.” Patient Preference and Adherence. 2022;16:2877–2892.

• Cabral C, Zhang T, Oliver I, Little P, Yardley L, Lambert H. “Influences on use of antibiotics without prescription by the public in low-and middle-income countries: a systematic review and synthesis of qualitative evidence.” JAC-Antimicrobial Resistance. 2024;6:dlae165.