Biomass use and its health effects among a sample of the Palestinian community during the war 2023–2025

Energy insecurity during armed conflict forces households to adopt high-risk combustion practices, yet the health implications of crisis-driven biomass fuel use remain underexamined in humanitarian settings. This study provides novel evidence on biomass exposure and its health effects among Palestinians during the 2023–2025 Gaza war. A cross-sectional descriptive study was conducted between August 25 and September 5, 2025, involving 130 household leaders across the Gaza Strip. Data were collected using a structured, self-administered questionnaire comprising three sections: socio-demographic factors, biomass fuel use and its determinants, and common symptoms or morbidities experienced in the past month. Biomass reliance was widespread: coal (30%), wood (22.3%), waste olive pomace (16.2%), and a combination of wood, cardboard, and plastic (17.7%). Most households used biomass more than once daily (73.1%), burned ≥ 2 kg per session (87.7%), and operated for ≥ 2 h/day (49.2%). Symptoms were highly prevalent, including sputum cough (93.8%), nasal congestion (90.8%), dizziness (87.7%), headache (86.2%), dyspnea (57.7%), and pneumonia (63.1%). Logistic regression showed that waste olive pomace increased the odds of chest wheezing and pneumonia (OR = 4.5 each). Burning mixed wood–cardboard–plastic fuels was associated with dyspnea (OR = 6.80; 95% CI 1.83, 25.30) and wheezing (OR = 3.9; 95% CI 1.11, 13.80). Exposure ≥ 2 h/day elevated risk of wheezing 24-fold (OR = 24.00; 95% CI 2.90, 200.50) and a 5.5 times higher risk of burn (OR = 5.50; 95% CI 1.40, 21.80). Burning fuel outdoors or in both indoor–outdoor spaces significantly predicted dyspnea (OR = 4.40; 95% CI 1.80, 10.80), chest wheezing (OR = 19.3; 95% CI 6.20, 60.30), and pneumonia (OR = 3.45; 95% CI 1.36, 8.70). Burning fuel in both places (Inside & Outside) was associated with a higher experience of chest wheezing (OR = 20.20, 95% CI 6.40, 63.70), pneumonia (OR = 3.80; 95% CI 1.45, 9.60), and injury (OR = 16.80; 95% CI 2.10, 138). Biomass fuel use during the Gaza war created extreme and preventable health risks. Expanding access to clean fuels and safer cooking technologies is urgently required to reduce household air pollution and protect vulnerable populations in conflict settings.