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Disease Burden And Economic Impact Attributable To The Gaza Conflict For Children With Congenital Heart Disease: A Population-based Modelling Study
Rebekah R. Boyd, MD1, Ayman Ali, MD1, Lerin Eason, BS1, Rodrigo Soto, MD2, Joseph W. Turek, MD PhD MBA1, Henry E. Rice, MD1.
1Duke University, Durham, NC, USA, 2Gift of Life International, New York, NY, USA.
Objective: Children in Gaza with congenital heart disease (CHD) have historically depended on external referral pathways for treatment. Since October 2023, these pathways have been suspended. We estimated the burden and impact of disrupted pediatric cardiac care during the Gaza conflict.
Methods: We conducted a population-based modelling study using Global Burden of Disease (GBD) 2023 data for Palestine. Excess burden was estimated across two components: amplification of existing CHD burden among children already living with CHD (Component A); and untreated burden among infants born with CHD during the conflict (Component B). Economic impact was assessed using the human capital approach. Robustness was assessed using deterministic and probabilistic sensitivity analyses.
Results: Pre-conflict baseline CHD burden in Gaza was 8,925 disability-adjusted life years (DALYs) per year (95% uncertainty interval (UI) 6,907-10,867) and 97.5 deaths per year. Over the 2.5-year conflict period, Component A yielded 21,963 excess DALYs and Component B yielded 217 excess deaths and 158 years lived with disability. Total excess DALYs were 37,949 (range 14,237-80,902; Monte Carlo mean 40,566, 95% UI 25,147-60,157). The central economic cost was US$268.1 million (Monte Carlo mean $214.3 million, 95% UI $110.6-$356.1 million) (Figure 1).
Conclusions: The Gaza conflict has generated a substantial and robust burden of CHD-attributable disability and premature mortality across all sensitivity analyses. Findings support urgent expansion of humanitarian medical evacuation for children with CHD.
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