Water infrastructure attacks should be treated as health attacks, experts say

Attacks on water systems should be understood as attacks on health systems, according to experts writing in The BMJ. Their argument is straightforward: conflict rarely begins because of water scarcity alone, but warfare increasingly damages the infrastructure people depend on for drinking water, sanitation, disease prevention and recovery.

The authors, including Rohit Ramchandani of the United Nations University Institute for Water, Environment and Health, say this damage can create a cycle in which fragile water services worsen public-health conditions and deepen the instability surrounding a conflict. They argue that water-system attacks should be counted, contested and prepared for as health threats.

Scarcity is not a sufficient explanation for conflict

The article cautions against treating water scarcity as a stand-alone explanation for war. Water can compound existing tensions, the authors write, but it is seldom the only cause. Their examples illustrate why.

Syria’s 2007–09 drought is often described as a trigger for the 2011 uprising. Yet the authors note that agriculture rebounded strongly in 2010, while prewar migration was largely internal, temporary and adaptive. In the Lake Chad region, the lake shrank by as much as 90% between the 1960s and 2000, but violence escalated after 2010 as water levels were stabilizing.

The more consequential question, they argue, is how the costs of water stress are distributed. When freshwater systems fail and the least powerful communities bear the burden of adjustment, grievances can intensify. That analysis places governance, inequality and the deliberate destruction of infrastructure alongside environmental conditions.

Damage to water services rapidly becomes a health emergency

Water infrastructure is closely tied to health because its failure affects far more than access to drinking water. Damage can undermine treatment systems, sanitation, hygiene and the ability of clinics and communities to prevent disease. The authors’ examples show how quickly these consequences can surface.

In Sudan in May 2025, damage to a power plant cut electricity to Khartoum’s water-treatment stations. The disruption was followed by almost 500 cholera cases in a single day, according to the article. In Gaza, roughly 57% of water infrastructure had been damaged or destroyed by the end of January 2024. The World Health Organization reported 136,400 cases of diarrhea in the three months after the conflict escalated.

These figures do not mean that every disease case can be assigned to one damaged facility. They do show why the authors want water infrastructure to be treated as part of a health system during conflict, rather than as a secondary utility problem to address only after fighting subsides.

A growing record of violent incidents

The article points to the Pacific Institute’s record of 420 water-related violent events in 2024, a 78% increase from 2022. Sixty-one percent involved direct attacks on water infrastructure.

Ukraine illustrates the scale of disruption that can follow an invasion: within months of Russia’s full-scale invasion, millions of people struggled to obtain daily drinking water. The authors also cite reported incidents in the Persian Gulf during the year, including a US strike on an Iranian desalination plant that cut water to 30 villages on Qeshm Island, an Iranian drone attack damaging a plant in Bahrain, and alleged targeting of two reservoirs in Sirik that supplied 20,000 homes.

The examples point to a common vulnerability. Water systems rely on physical assets such as treatment plants, reservoirs, desalination facilities and electricity supplies. A strike on one part of that network can disable services far beyond the immediate site of damage.

Preparing for water attacks as health attacks

The experts’ proposal is not that water stress itself should be treated as an automatic predictor of war. Instead, they call for a clearer accounting of the public-health effects when water services are deliberately attacked or degraded in conflict.

That approach could reshape how humanitarian and health institutions assess risk. Protecting treatment capacity, backup electricity and access to safe water is not merely an infrastructure concern; it is part of limiting outbreaks and protecting civilians. Counting attacks consistently can also make the consequences more visible to decision-makers and to those responsible for documenting violations.

The article’s core warning is that recovery becomes harder when water infrastructure is allowed to collapse. A population without reliable water is more exposed to disease, while weakened health services have less ability to respond. Breaking that cycle requires treating water systems as essential health infrastructure before, during and after conflict.

Key points

• The Pacific Institute recorded 420 water-related violent events in 2024, with 61% involving direct infrastructure attacks.
• The authors argue water scarcity alone rarely explains conflict; unequal exposure to its costs can deepen grievances.
• Disruption of treatment and power systems can rapidly contribute to disease outbreaks.
• The BMJ article calls for attacks on water systems to be documented and prepared for as attacks on health.

This article is based on reporting by Medical Xpress. Read the original article.