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This guideline is intended to provide a summary of background and health issues for newly arriving Palestinian refugees from Gaza.Ìý

Background

• Land and populationÌý- Gaza is 41 km long and 6-12km wide, with a total area of 365 km2, divided into five governates (north to south) North Gaza, Gaza, Deir Al Balah, Khan Younis and Rafah. Pre-conflict, Gaza had 8 refugee camps, and one of the world’s highest population densities, with an estimated population of 2.1 million people in 2024. The Ìýwas predominantly urban (85%) and young (15% <5 years, 40% <15 years, around 60,000 births/year). Gaza had some of the world’s highest unemployment (46%) and poverty (53%) rates ( and data).
• Language - Arabic.
• Religion - predominantly Sunni Muslim population (99%) with a small Palestinian Christian population (<1%).
• Administration - Hamas won elections in Gaza in January 2006, and assumed administration from June 2007. The United Nations Relief and Works Agency for Palestine Refugees in the Near East () was established in 1949, after the 1948 Palestine war and 1948 Arab-Israeli war.Ìý UNRWA maintains active for , and an additional 781K people eligible for UNRWA consideration.ÌýUNRWA registration is voluntary, and UNRWA records are not considered to be a civil register.Ìý
  • Definitions - are defined by the United Nations (UN)Ìýas people whose place of residence was Palestine during the period 1 June 1946 to 15 May 1948, and who lost both home and means of livelihood as a result of the 1948 conflict. Palestine refugees, and descendants of Palestine refugee males, including legally adopted children, are eligible to register for UNRWA services.ÌýMore thanÌýÌýprior to the conflict.
    
  • .
• Current conflictÌý- as of Feb 2026 (days 843-9) - at least 1.9M people (90% population) internally displaced, most multiple times (, Ìýand maps).
  • Deaths and injuriesÌý- () 71,769ÌýPalestinians have been killed since Oct 2023,including 21,283 children,Ìý171,483 people have been injured.
  • Gender based violence -ÌýUnited Nations Population Fund (UNFPA) reports ongoing GBV for women/girls in Gaza - seeÌý.Ìý
• Food insecurityÌý- By Dec 2023,Ìý. By Aug 2024,ÌýÌýhad been destroyed. By Sep 2025, the prevalence of malnutrition was 11.9% overall, and 27.9% in children <5y (based on MUAC measurement,Ìý). In Jan 2026, 63.2K children are receiving treatment for malnutrition.
  
• Healthcare - pre-conflict Gaza had a system of 72 primary care facilities, strong vaccination programs and maternal and neonatal health indicators (see for background), and 36 hospitals (24 in the north, 12 in the south). As of Feb 2026, there have been 931 attacks on healthcare facilities (), 18 hospitals and 101 PHC clinics are functioning, and only 12/662 (1.8%) health service points are fully functioning ().ÌýÌý
  • Ìýin Jun 2024,Ìý, . More than 600,000 children have been vaccinated in three rounds ().
  • Public health situation analysis -ÌýÌý(5 Nov 2023),ÌýÌý(7 Nov 2023),ÌýÌý(7 May 2025).
    
• InfrastructureÌý- An electricity blackout has been in place since Oct 2023 (). By Oct 2025, 1 million people were accessing less than the emergency minimum of 6 litres of drinking water per day ().ÌýÌý
• EducationÌý- pre-conflict Gaza had 737 schools, with 288 run by UNRWA.ÌýAll schools have been shut since Nov 2023, by Mar 2025, 88% schools had been destroyed/damaged (). By Aug 2025, 660,000 children had missed 2 years of school ().Ìý
  

Australian response

• Australia recognised the State of Palestine in Sep 2025 ()).ÌýSee Ìýand .Ìý
• By late 2023, Israel and Palestine. More than 17,000 Gazans holding dual nationality were permitted to evacuate (media ).Ìý
• Australia announced $72.5M in humanitarian assistance over - in 6 separate support packages. As of Oct 2025, Australia has provided $100M in humanitarian assistance for civilians affected by the conflict in Gaza ().
• Between Oct-Dec 2023, Australia granted 2649 visas to Israeli citizens, and 2274 visas to Palestinians in Gaza and West Bank with a connection to Australia (), also see ÌýNov 2023.Ìý By Feb 2024, just over 330 Palestinian refugees had arrived in Australia on visitor visas (media ). By Aug 2024, Australia had granted 8746 visas to Israeli citizens and 2922 visas to Palestinians (media ).
• Individuals typically travelled under tourist (visitor) visas,Ìýtourist visas do not have access to work rights, Medicare or Centrelink.
• The Victorian government has enabled free public healthcare for people fleeing the Israel Palestine conflict (see ).Ìý
• In Feb 2024, the Australian government announced a bridging visa E (BVE, subclass 050) pathway for people arriving on visitor visas from Gaza - this allows access to Medicare, work rights and study rights, but does not provide humanitarian settlement program (HSP) support. Students remain fee liable, and need case-by-case exemption (in Victoria for school age students, contact international Students section of DET).Ìý
• In Nov 2024, for Palestinians in Australia who are unable to return home. This pathway is a 2-step process - with a 449 Humanitarian Stay (Temporary) followed by a 786 Temporary (Humanitarian concern) visa.
  • The 449 visa provides rights to work, study, travel, and access to settlement supports and social services (but does not provide Medicare) and is a bridge to the 786 visa.Ìý
  • The 786 visaÌýis a 3-year visa that provides rights to work, study, Centrelink and Medicare, and access to HSP supports and social services. Individuals can request permission for international travel in compelling circumstances.Ìý
  • The process is that the Government offersÌýa pathway to transition to 449/786 to eligible individuals. Legal advice is available (). Also see on visa options for this cohort.ÌýÌý
    • People cannot apply, although individuals can register their interest for these visas with DHA (see ). There is no cost for these visas. Individuals must meet health, character and security criteria - they will need to undertake an immigration health examination (with BUPA) and may be required to have AFP checks. In Victoria, the cost of the health examination is funded through HSP providers.
    • Receiving an offer of a 449/786 affects eligibility for other visas (regardless of whether the offer is accepted). Under the Migration Regulations (1994), people offered a temporary humanitarian stay pathway cannot meet criteria for a protection visa (even if this application is already lodged).Ìý
    • Permanent pathways will be considered at the end of the 786 visa 3-year period.Ìý
  • Once the offer of 449 is accepted, DHA refers individuals to HSP (AMES in Victoria) for specialised and intensive services (SIS) case management (see for a summary of supports).Ìý

Health screening

Immediate health triage (for all ages) should assess for acute physical health issues (including malnutrition and injuries), acute mental health issues, disability, frailty/mobility issues in elders, pregnancy and medication type and supply.ÌýChildren/adults may have acute (and severe) malnutrition and re-feeding syndrome is a consideration in this population.Ìý

Like any mass migration event, and where people have been living in very crowded conditions, consider outbreak risk and vaccine preventable diseases (VPD), including hepatitis A, measles, varicella, typhoid, polio and other enteric infections. Media in Dec 2023Ìýreported outbreaks of varicella and cases of acute jaundice (likely hepatitis A), and there have been 480 cases of hepatits A since Nov 2025 (). reported 71,000 cases of diarrhoea in children <5 years in one week (Dec 2023; vs 2000/month pre-conflict). . Parasite infections are common in Gaza, ask about gastrointestinal symptoms, including abdominal pain and diarrhoea/dysentery. Iron deficiency anaemia and vitamin D deficiency are common, and there are high rates of antimicrobial resistance (antibiotics are/were sold over the counter).

Children and families are arriving from a direct conflict situation with acute trauma. They have been displaced, and evacuation orders and search for safety has meant people have been displaced multiple times. They will have witnessed bombs, destruction of cities and houses, injuries and deaths; they may have lost or been separated from family members, or experienced injuries themselves. Clinicians should ensure a supportive approach, following principals of Ìý(being mindful of symptoms/signs of psychological trauma, but not exploring trauma directly if people are not ready). Mental health support is available in Victoria, although there may be cultural stigma around engaging with mental health support. Ìý

Recommended health assessment Gazan arrivals

All new arrivals should have anÌýinitial health assessmentÌýandÌýcatch-up vaccination.ÌýThe same initial health screening investigations are recommended for children and adults from Gaza (based on prevalence data below and ):

• All: FBE/film, ferritin, vitamin B12, folate, vitamin D, vitamin A, zinc, HAV serology (IgM* and IgG), HBsAg*, cAb, sAb, Strongyloides serology, faecal OCP + PCR.
  
• Age/risk based: extended nutritional screening (clinical, low threshold - see guideline), add ALP in children, TB screening (clinical), HCV/HIV (clinical), STI screening (clinical/UHM), Schistosoma screening (periods of residence in Egypt), Pb levels,**Ìý to determine catch-up, offer pregnancy testing to women if relevant, consider H Pylori (if symptoms).
• Catch-up primary care: see HPV screen (women 25-74y), kidney disease (risk based, Alb:creat/eGFR), diabetes (40y+, BSL/HbA1C), lipids (45y+, frequency varies with risk), FOBT (45-74y), mammogram (women 50-74y, younger if increased risk)

^{* Ensure no recent (within 1m) HAV or HBV vaccine - may cause or HBsAg+, which is then a public health reporting pathway.Ìý}

^{**Families have advised us to consider lead screening with concerns for contaminated soil. Use of car batteries as a power source is an additional risk. Ìý Ìý}

Presumptive treatment

• Albendazole – unless pregnant (class D pregnancy drug) or <6 months age. Dosage is 400mg stat oral for age 12 months or older and weight 10kg+ (or 200mg stat oral for age 6 months and older and weight up to 10kg). 

  
• Recommend healthy food intake – vegetables, legumes, fruit, grains, meat and avoid high intake of energy dense foods/drinks in days after arrival if acute malnutrition is a consideration (consider re-feeding syndrome).
• Consider high dose vitamin C and zinc supplements (e.g. Vit C 500mg/Zinc 20mg - to a max 1mg/kg/day zinc), and a multivitamin. Unfortunately most commercial multivitamins only contain low doses of vitamins (well below recommended intakes) and are not useful clinically.
  
• Encourage self-management of low vitamin D for those with ongoing risk factors.
  

Catch-up immunisation

Prior to the conflict, Gaza had a strong immunisation program and high compliance with vaccinations (coverage >95% - see ). More than 13,700 children received (via UNICEF), and there has been mass polio vaccination between Sep 2024-Feb 2025 (). The includes: DTwP-Hib-HepB, OPV/IPV, rota, 10vPCV, MMR and influenza vaccine, in the following schedule:

Missing compared to Australian schedule: meningococcal ACWY, (meningococcal B - risk groups only), varicella, zoster, and HPV. Also note use of 10vPCV (vs 13vPCV in Australia). Also consider both covid (age dependent) and influenza vaccines.

• Where written records are not available, full catch-up vaccination is recommended - see Catch-up immunisation guidelinesÌýand .Ìý
• Entering information on to the Australian Immunisation Register (AIR) - use 'encounter overseas', schedule = 'other', add dates, and use generic vaccine type where needed (e.g. for pentavalent vaccines, may need to record as DTPa generic, Hib generic and HepB generic). Enter dose numbers accurately, and the record should submit.
  • AIR records can be created for people without Medicare. In order to do this, a vaccination must be entered (either from an overseas record or a vaccine given in Australia) - it is not possible to create a record for someone without Medicare and enter natural immunity alone (a quirk of AIR).Ìý
    
  • AIR will not allow entry of the same antigen on the same day, which means overseas schedules with simultaneous OPV and IPV cannot be entered accurately. Ìý
    
• NoteÌý- Abridged catch-up - RCH/MVEC protocols for catch-up vaccination after chemotherapy use infanrix-hexa and MMR-V up to age 18y, this reduces needles required, and we use this in practice. AIR will accept these vaccines for adolescents, **AIR data entry - useÌýother, and enter byÌýantigen, and then accept queries.Ìý
• Translated catch-up information:Ìý Ìý(),Ìý(), Ìý()
  

Other

• Acute malnutrition - ask about pre-morbid weight,Ìýseek specialist advice for acute weight loss of 10% or more;Ìýhealthy diet as above, consider presumptive treatment with 1 week thiamine (10-50mg daily), vitamin B12 (1000 mcg melts daily), stoss doses vitamin A (50,000 IU all ages) and vitamin D (150,000 age 12m+),Ìýand 1 month vitamin C/zinc supplements (e.g. Vit C 500mg/Zn 20mg combined - 1/2 tablet <5y and 1 tablet 5y+) and multivitamin ongoing.
  • Iron deficiencyÌý- seeÌýguidelineÌý(note iron treatment may need to be delayed in severe malnutrition)
  • Vitamin A deficiencyÌý- seeÌýguideline
  • Vitamin D deficiencyÌý- seeÌýguideline
  • Vitamin B12 deficiency - see guideline
  • Zinc deficiencyÌý- treat with 1mg/kg/day for 1 month - commercial supplements are usually 20-25mg/tablet (some combined with vitamin C which is often useful).
  • General nutrition guideline.
    
    
• Diarrhoea and parasites (also see Parasite guidelines, Strongyloides guidelines)
  • Treatment for diarrhoea caused byÌýE. histolyticaÌýis metronidazole (children 15mg/kg (max 600mg) and adults 600mg tds for 7 days - higher doses for severe disease/confirmed amoebic liver abscess - see ), noting that for elimination of luminal carriage - paromomycin is an SAS medication and takes weeks to obtain (also 7-day course).ÌýÌýin Victoria.
  • Treatment forÌýGiardia duodenalisÌý- in asymptomatic carriage in immune competent patients usually do not require treatment (). If needed, treatment is metronidazole (children 30mg/kg (max 2g) and adults 2g daily for 3 days OR children 10mg/kg (max 400mg) and adults 400mg tds for 5 days). Tinidazole was discontinued in Australia in 2020;Ìý nitazoxanide 3 days or albendazole 5 days are alternatives as per Sanford guide.
  • , , ,Ìý, and are in Victoria (+ others).
    
    
• Confirm birthdate - individuals may have fled without paperwork or identity documents
• Ensure medication supply and continuity where required - free medications may be available (see resources below).
• Disability/complex health issues - seek early assistance through specialist services for children or adults with disability and/or complex medical issues. See paediatric refugee health clinic details.
• Mental health/trauma - refer for mental health support or trauma counselling if required – Ìýor the multilingual phone hotline is available.
• Education enrolment – for children, seek advice from language schools and consider grade placement – in general, children should be placed so they are in the older cohort within a given year (e.g. a 6-year old child can be placed in foundation/prep which will have both 5-year-old and 6-year-old children starting school).
  • School enrolment - ContactÌýInternational Education Division at: international@education.vic.gov.au for enrolment with fees waived for 6 months. Ph: +61 3 7022 1000.
  • Specialist school enrolment - seek specialist advice, in practice this has been very difficult for all refugee-background children in recent years.Ìý
  • Kindergarten enrolment - contact LGA CALD outreach officer.
• Dental care - see oral health guideline which provides details for community dental clinics and also Dental Health Services Victoria and also .
• Antibiotic resistance - Consider bacterial screening if hospital admission is required.

Prevalence data for Gaza

The following summary provides background for the screening investigations recommendations above.

• NutritionÌý- By Mar 2024 the entire Gaza population was experiencing acute food insecurity (). Ìý(Jan 2024) reported 90% children <2 years were consuming two or fewer food groups, and diarrhoea outbreaks. FromÌý, the entire territory was classified in Emergency (IPC Phase 4), withÌý22% in Catastrophe (IPC Phase 5). Pre-conflict surveys show high prevalence of undernutrition, andÌý.Ìý
  • AnaemiaÌýhas been found in:ÌýÌý(2012),ÌýÌý(2017), andÌýÌý(2019).
  • TheÌýÌýin Gaza reported the following prevalence of nutritional deficiencies:
    • Pregnant womenÌý(2nd - 3rd trimesters, n=587) - anaemia 42.8%, iron deficiency 38.6%, zinc deficiency 84.7%, folate deficiency 10%, vitamin A deficiency 18.6%, vitamin B12 deficiency 51%, vitamin D deficiency (<50nmol/L) 100%, vitamin E deficiency 3.3%.
    • Children 6-59 monthsÌý(n=582) - mild anaemia 22.9%, moderate anaemia 7.8%, iron deficiency 19.0%, zinc deficiency 70.9%, folate deficiency 1.8%, vitamin A deficiency (<0.7 micromol/L) 35.3%, vitamin D deficiency 65.8%, vitamin E deficiency 32.5%. (B12 not reported in the same survey).
  • UNRWA primary care centres provide 6-monthlyÌýÌýfor children 6-59m.
    
    
• Non communicable diseases (NCD)Ìý- the baseline prevalence of NCD was high (seeÌý) - health system disruption will have worsened this situation. provides some detail on NCD and maternity care needs.
• Mental health and intimate partner violence (IPV)Ìý-Ìý high prevalence reportedÌýpre-conflictÌý(adults - 71% anxiety/depression/both, 7% PTSD; children 24% PTSD, high prevalence IPV) - seeÌý.
  
  
• TuberculosisÌý(TB) -ÌýÌý(<1/100,000 vs 7.3/100,000) - routine TB screening notÌýindicated.
• Hepatitis A (HAV) -Ìý risk with current situation and reporting of acute jaundice outbreaks (Jan 2024 >8000 cases - seeÌý, and Nov 2025 ). High baseline seroimmunity likely (), so cases are more likely in younger children (pre-schoolers) who may be asymptomatic - recommend routine screening.
• Hepatitis B virusÌý(HBV) - 2019 prevalenceÌýÌýand higher in haemodialysis centres ();ÌýAustralia -ÌýÌý-Ìýrecommend HBV screening.
• Hepatitis C virusÌý(HCV) - low prevalenceÌý,Ìýand higher in haemodialysis centres ();ÌýÌý- routine HCV screening notÌýindicated.
• HIVÌý- very low prevalence, with onlyÌý;ÌýAustralia - 0.1% in adults 15-49 years - routine HIV screening notÌýindicated.
  
  
• Ìý- many parasitic infections are reportable diseases in Gaza (92,494 parasite infections reported 2008-17) with a relatively high incidence of amoebiasis (348/100,000 per year), pinworm, Giardia (140/100,000 per year) and scabies, and documented endemic infection with Strongyloides, and Ascaris. Leishmaniasis and hydatid disease are also reported in the West Bank (also seeÌý), and toxoplasmosis is reported as an issue in pregnant women.
  • AÌýÌýof 1600 children 3-18 years in Northern Gaza (using stool sample) found 75% had parasite infections, including 45.8% withÌýA. lumbricoidesÌýand 5.6% withÌýStrongyloidesÌýinfection.
  • In aÌýÌýaged 1-69 years, 40.8% had intestinal parasites, 9.1% had more than one parasite (30.5% protozoal parasites, 3.5% helminths).
  • Recommend Strongyloides serology + faecal OCP/stool PCR (which detectsÌýE. histolytica) + albendazole dose. Consider Schistosoma testing, especially for those who have resided in Egypt.

Resources

• Department of Home Affairs
  • Ìýand to request consideration.
• Department of Health adviceÌýÌý(Dec 2023)
• Department of Premier and CabinetÌýSupport for newly arrived Palestinians May 2024 (Arabic version)
• Health
  • Ìý(Victorian DH)
    
  • – 0800-2200 (no Medicare required)Ìý
    
  • Ìý(also see )
  • Ìý(also has pharmacy waiver program)
  • 
    
  • Ìýby , more than 440 healthcare professionals had offered to provide pro-bono healthcare, with a list of local GPs, with Google maps information and information packs for new arrivals
• Pathology -ÌýÌý– free pathology for new arrival refugees
• Medications -Ìýfree medications may be available at Pharmacy4Less,ÌýÌý
  
• OptometryÌý- ACO Carlton will take direct referrals - send to ndeen@aco.org.au. Free eye checks and glasses are available at
• RadiologyÌý- free imaging has been available at , in Dallas (requires 'Gazan refugee' to be noted on request slip), or through hospitals, other services may offer assistance
• Dental -ÌýseeÌýoral health guidelineÌý(includes details for community dental and DHSV) and
• Education -ÌýInternational Education Division at: international@education.vic.gov.au for enrolment with fees waived for 6 months. Ph: 7022 1000
  
• Trauma counselling
  • - referrals
• Other
  • -ÌýIsrael-Gaza legal hotline – 9413 0107Ìý
  • . Casework may be available if people are intending to apply for asylum. Food, material aid and housing support are available, other funding/support may be available.
  • Ìýand - organisations providing support and coordination

_{Immigrant health resources. Author Georgia Paxton, Saniya Kazi 19 Jan 2024. Most recent update Feb 2026. Contact georgia.paxton@rch.org.au}

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