Clinical Scorecard: Public Awareness and Self-Medication with Antibiotics During the 2023 Gaza Conflict: A Cross-Sectional Study

At a Glance

Key Highlights

• Among 422 surveyed participants, reported antibiotic self-medication rose from 60.4% before the war to 80.6% during it.

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

• Reported pharmacy purchases without a prescription rose from 23.7% to 80.6%; 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.

• The survey’s results describe its participants; convenience recruitment does not support population-wide prevalence estimates for Gaza.

Guideline-Based Recommendations

The supplied paper is a survey, not a clinical guideline. The sections below describe its findings and the authors’ proposed responses.

Diagnosis

• The study did not evaluate a diagnostic test. Participants’ self-diagnosis and use of antibiotics without medical advice formed part of the behavior being investigated.

Management

• The authors call for improved access to healthcare, public education, antibiotic stewardship, and stronger oversight of antibiotic distribution.

Monitoring & Follow-up

• The survey compared participants’ recalled antibiotic use before the war with their reported use during it. It did not follow patients over time or measure antimicrobial resistance patterns.

Risks

• Participants reported adverse effects after self-medication, including stomach pain and diarrhea. The paper discusses treatment failure and antimicrobial resistance as risks of inappropriate antibiotic use, but this survey did not measure those outcomes.

Patient & Prescribing Data

The survey included 422 adults; 92.4% reported displacement during the conflict, and 84.1% had a university degree. In the questionnaire, participants reported antibiotic use and sources, including nonprescription pharmacy purchases, leftover medication, and informal markets.

Clinical Best Practices

The authors propose combining education about appropriate antibiotic use with better access to formal care and stronger antibiotic stewardship and distribution oversight. Their survey found that awareness did not always align with reported practices. It did not test whether the proposed measures reduce self-medication.

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.

• World Health Organization. “Capturing the evidence on access to essential antibiotics in refugee and migrant populations.” World Health Organization. 2022.