It Could Happen Here - Infectious Disease Risk in Palestine

Episode Date: January 4, 2024

James and Shereen are joined by Saskia Popescu and Kaveh Hoda to discuss the huge risk of an infectious disease outbreak in Palestine.See omnystudio.com/listener for privacy information.

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We have joining us today Saskia Popescu, who's an infectious disease epidemiologist and assistant professor at the University of Maryland. Welcome, Saskia. Thank you for joining us. Thanks so much for having me. Yeah, of course. Yeah, you're welcome. It's not just you. We've also got Kaveh. Kaveh's back. I'm back. I'm back, baby. I'm back. This is actually my first time. This is Shireen. Also, I'm here.

This is my first time meeting Kaveh, so this is a real treat for me. Hi, Shireen. I've done you wrong, Shireen. I'm sorry I didn't introduce you. That's okay. It's probably in the description or something that I'm here. No one's surprised. Yeah, you'll make a valuable contribution. People will know you're here. But yeah, it's all of us.

We're talking today because I think the origin story of this particular episode is that a few weeks ago, there was a very funny thing on the internet about people in the idf getting diarrhea yeah which is funny objectively that's what the d and idf stands for actually yeah that's what all the kids are saying uh but i'm sorry i'm sorry no it's funny don't you ever apologize yeah you do not apologize for that no any opportunity just to shit on them you're good yeah yeah this is expect many it's half an hour at least of this don't be driving because you might laugh too much and crash uh but no it's very funny it's the name of our group chat it's the israeli diarrhea forces but aside from that and like this raises a more important question, right?

Which is that people in Gaza don't have access to very many medical supplies to begin with. Weird things are embargoed, like tornicase, which we've spoken about in this podcast before. They also have, obviously, a very resource-constrained environment

to begin with. And then a number of their hospitals have been bombed since then, which obviously further reduces their access to medical care. Also, they have less access to things like running water now because they're being bombed to an incredible degree. And so Saskia has joined us today to explain the risk of the spread of infectious disease, maybe give us an update on what's already happening and the risks of what could happen so i guess maybe we should start off with

really basic stuff and explain what infectious diseases are and like how they're different from non-communicable diseases i guess people aren't familiar would one of you like to do that yeah i'm happy to so infectious diseases you know we have when we talk about diseases in general as you mentioned there are chronic diseases things, we have when we talk about diseases in general, as you mentioned, there are chronic diseases, things like diabetes, cancer, when we talk about infectious diseases, meaning they're communicable. For the most part, that means that they are spread through various sources, human to human, like influenza, there's things like anthrax that you can E. coli, campylobacter, that you can get from soil from from food and the zoonotic diseases that they are also spread through animals so things like ebola mers which is middle east respiratory syndrome coronavirus so infectious diseases are viruses bacteria fungi parasites and they really love to take advantage of high stress environments for spread. And unfortunately, this is one of them. So this is a very, what we see with infectious diseases a lot is that conflict and environments

where people are stressed, resources are stressed, and the environment is under continuous bombardment. There's densely populated spaces, no access to health, clean food and water, etc. I mean, I could probably go on for five minutes about what makes an infectious disease spread is going to amplify it. So these are diseases that take advantage of these environments. I'll add that the situation is just a perfect setup for infectious disease to run rampant. There's over 1.9 million people that have been displaced. Of that, 1.4 million are living in overcrowded shelters at this point. And in the best scenario from what I've seen, there's one toilet for every 220 people. Now, if you ever lived in a house of five people and there's one case of diarrhea, you'll realize how terrible that is.

Now, you amplify that to 220 at the minimum. And that's the best case scenario. I've heard as high as one per 700 people in some places. And then, you know, people have to go in the streets. They have to go where there's water supplies and you're going to be infecting those areas. There's one shower for every like 4,500 people, again, best case scenario. So it's a huge number of people getting concentrated into smaller and smaller areas

and without the infrastructure there to handle that in any way. And when that happens, I mean, we are going to see, I am really worried about seeing in the end of this

more deaths from infectious disease than from the bombardments. Yeah. Well, that's's like a it almost feels like a double because another weapon that they're that that they're that they've used because they're not letting them have a chance to recuperate or have a sanitary place to do surgeries or anything because if they're doing surgery with unsanitary conditions they can get infected like the wounds can get infected, and that's a whole other thing. Or even just, like, having waste in the street, like, making it, like, having it fester.

It just, it's, it's really, I think people forget that it's not just, like, a building was destroyed or people were killed. It's, there's lasting effects that linger for probably generations. It's just, I don't know, it really is infuriating. I think the crazy part is the World Health Organization, so the WHO, recently released some data as to what is being reported to them in terms of disease. And they said so far, now keep in mind, these are just reported numbers. And that means it's just the tip of the iceberg in most cases. 100,000 cases of diarrhea. And those are in young children. So half of those are in young children under the age of five, which means it can be deadly. And this number is just 25% higher than what we have seen reported pre-conflict. And in terms of respiratory infections,

the things like COVID, influenza, pneumonia, 150,000 cases. And that's just the numbers that we know about. But we're also seeing cases and outbreaks of things like meningitis, skin rashes, babies, lice, chickenpox, which is highly infectious. And we worry in those cases about when people are in these close quarters and their bodies are already strained. Because one thing we do know is that when your body is physiologically under stress, meaning no sleep, malnutrition, not access to clean water to wash your hands, you're dehydrated, etc., you're at an increased risk for disease and severe disease. So that means that people are at higher risk to get it and then to spread it in these environments. And that's what's really scary because it becomes a hotspot for transmission.

And you mentioned that this feels like a secondary effect in many ways. It's almost like a secondary conflict, if you will, and one that will leave lasting implications. Because what we do know is that disease and conflict go hand in hand. And when I think about it a lot, it's, and we've seen this, unfortunately, throughout time is that conflict can bring disease, and it can amplify disease. When I say bring disease, we know that people in these spaces, soldiers can bring in diseases that are being spread around. But we've also seen sexually transmitted diseases in the past being spread through sexual assault, and sexual violence. And that's one thing I definitely worry about. And unfortunately, we know that's happening. And it's not something

we're going to see reported for a while, but things like that can and do occur. And it's a very scary situation. If I can tack on a little bit to the diarrhea subject here, because I am a GI and liver doc. I mean, in a typical month in Gaza, there is about 2000 cases of diarrhea in kids under five. And in the last month, there was over 40,000 cases. And for kids that aren't getting water, they're not getting the recommended amount of like daily water. Like it's like seven to eight liters in refugee situations is what's recommended. These people are getting like one to two liters per whole families. So they're not staying hydrated.

And these are kids that are most vulnerable. That's the part that is really hard for me. And I've actually seen people sort of downplay it, like just like, well, it's diarrhea, you know, that's what you get. But in these situations, it's going to be very serious for these kids. And the other thing we're seeing is cases of jaundice.

They're noting that people are becoming, which to me suggests that there's hepatitis A and hepatitis E, which is, you know, you get through fecal-oral contamination. And hepatitis E in particular is what concerns me because there is pregnant women, and when pregnant women get hepatitis E, it's worse for them. That's a really bad situation. eat, it's worse for them. That's a really bad situation. And when that happens, I mean, these are women who are already not getting support. They're already undernourished. They're not able to produce breast milk. They're going to be sick. They're not going to be able to feed their kids. I mean, I can't imagine, honestly. I mean, I know it's funny. We can say these things. We can talk about the numbers, but it is like to actually wrap my brain around it breaks my brain i cannot like imagine the numbers of people that that are sick and are in these hospitals not just being treated but like the nasser hospital which is one of the two hospitals in in gaza you know they there are like a 350 bed hospital there are already over

like a thousand patients and not to mention the many thousands over 70 000 people just staying there you know for for refuge it's absolutely a nightmare i can't i can't wrap my brain around it yeah like often i know when i speak to colleagues who are there or other journalists they'll go to hospitals a in the hope that they'll be safe which hasn't proven to be true sadly which is pretty messed up but b you know they have maybe generators right so they can charge and and and tell the world what's happening or try to seems like some of the world isn't listening but yeah it their hospitals are incredibly overcrowded. I wonder if we could go back to diarrhea. There's not a fun topic to talk about.

Score. It's my time to shine. It's life's work. So I think it was diarrhea that I read kills more people than conflict annually. Oh, yeah. Worldwide? Sure, yeah.

I mean, Saskia probably has better numbers on it than i do actually but worldwide yeah it's uh probably the number one um number one killer so like let's just break that because i most of like by the very nature of this being a podcast right most of our people listening uh in in the in the kind of the in the neoliberal core or the global north whatever you want to call it, right? Like they have a smartphone and they've downloaded this and it might be difficult to understand how you die from diarrhea,

which is like an inconvenience in a lot of places. So can you just explain that for people so they can understand and how the conditions that we're seeing in Gaza would compound that saskia do you want me to go first oh all you i'll talk about how it spreads so i mean the there's a couple of issues that can happen there's a lot but i mean dehydration is going to be a major one and loss of electrolytes and these people can get so badly dehydrated that their circulatory

system isn't working properly, or they can lose the amount of electrolytes that they need and they're not replacing. And that can cause cardiovascular issues as well. So it's a terrible way to die. I mean, you know, cholera and these terrible like diarrheal epidemics that, you know, we, we think of, of mostly in the past, they're terrible. They're terrible ways to go. And especially if you don't have the,

I mean, it's treatable. Usually it's treatable. You know, you get fluid rehydration, you get electrolyte management. It's, it's pretty manageable in the right situation.

But if you don't have that, it's, it's gonna, it's gonna be a devastating right situation. But if you don't have that, it's going to be a devastating thing to the body over time. And for young kids, sooner rather than later. Yeah. So maybe we should explain how it spreads. Yeah. I mean, the scary part,

so there's multiple pathogens that can cause diarrheal illness. And for the most part, we see bacteria and viruses. If you've had norovirus, which is the cruise ship bug that is highly transmissible, meaning it just goes through households and environments very, very quickly during outbreaks, you can't just use hand sanitizer and a simple disinfectant, you need bleach. And if we're thinking about the best case scenario, and I've seen, you know, diarrheal illnesses go through schools, hospitals, you name it, we still struggle to contain those. Now put yourself in an environment with this level of stress. And, you know, of the 36 hospitals in Gaza, 26 have been damaged, 21 are not functional at all, 13 are partially functioning functioning and two are barely functioning.

So we know that access to care is a challenge. Resources, I can't even imagine. So that means the capacity to treat patients with antibiotics, with fluids, everything, and now contain it, which is the disinfection, you know, all the infection prevention, essentially. And I don't even want to think about contact tracing and public health interventions, because it doesn't exist. It's an entirely collapsed system. You know, this is a humanitarian crisis. So when you know, when you have people in close quarters, and there's a lot of high touch items, because a lot of diarrheal illness is spread through touch, it's, you know, contaminated hands and objects. And then, you know, you touch your mouth, you eat with your hands, etc. That's how these things are spread. So between the bathroom, not having access,

you know, not having access to restrooms, you know, we mentioned the toilet situation, there's also one shower for every 4500 people. So we know that people are not able to clean themselves effectively. And this is a ripe condition for diarrheal illness to spread and they it spreads very quickly very efficiently and it is exceedingly hard to get rid of and it worries me because a lot of these diseases it's not just like you get it one time and you have immunity to it it can keep going around and if you have a situation like that where you cannot clean effectively you can't treat effectively then we're just going to see it continuously compound. And that's absolutely terrifying. Because, you know, we were talking about pregnant women earlier, there's 50,000 pregnant women right now in Gaza, and they are

malnourished. That's just the tip of the iceberg. And we see that so many children there are malnourished. And these are very dangerous infections for vulnerable people and on the best of days we struggle to contain diarrheal illness so my big concern is this and respiratory viruses to be honest with you because when you have this many people in close quarters and ignore the fact that they are extremely you know physically strained and stressed right now which is when your immune system struggles it's going to spread and it's going to be exceedingly hard to contain it. So this is an environment where we're going to see diarrheal illness spread and it's going to unfortunately kill a lot more people than we will even realize. It's going to take years to

understand the implications of this. If we even consider that access to clean water and food, we've been talking a lot about malnourishment which is huge but i'm also concerned with the quality of food that they're getting to is in the water all of it everything about the situation is going to spread disease it's you know i i know that sounds quite dramatic but it's entirely true no i mean i'm glad you're emphasizing that because i i don't think people realize the gravity of of like a second wave of death like that happens like not even not with weapons. But no, I'm glad you emphasize that. Let's let's take our first break.

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Apple Podcasts, or wherever you get your podcasts. And it reminds me, too, of when we saw UN peacekeepers in haiti and they introduced cholera and you know and that's it's an unfortunate reality when you are bringing in groups of people to and this you know for in haiti they were trying to help the situation um in this case it's not surprising i mean there's there's a really good book called Contagions and Chaos that actually talks about how infectious diseases can amplify conflict or create it. And ultimately, I think we're just going to see this as a rolling health issue until there's a ceasefire and until there's really substantial work in there to resource and

to take care of people. I mean, it's scary uh kaveh you mentioned that you had a question for saskia i do you know you've written and you talked a lot about the intersections of science and policy particularly in terms of covid19 we've seen that global threats elsewhere can affect americans and i'm wondering is there a way to try and appeal to Westerners who aren't that interested yet in why they should care about infectious diseases that are rising or becoming rampant in other places? Is there an argument you can make to these people who may not care that much about the Palestinian people per se? care that much about the palestinian people per se oh i there's there's the the political answer i should give you and then there's the real answer which is you know political answer saying that you know people do care and you know we're just having to have in the console your mind but the real

answer is look we just came out of three and a half years of a pandemic and at this point if people don't give a shit they're not going to and I know that's crude for me to say, but it's, I've been working in this, and we've seen it from Ebola to MERS to MPOCs. And in now coming out of COVID, I think we can safely say that, you know, it's not a matter of if but when, but people really like the saying that is infectious disease knows no borders. And to a certain extent, that is true. Infectious diseases, they don't know that. But it ignores the fact that is infectious disease knows no borders. And to a certain extent, that is true. Infectious diseases, they don't know that. But it ignores the fact that some countries are more equipped to handle them. And that borders are a porous concept. So in this case, I think from an American perspective,

where it is a very complicated relationship Americans have, and I'm not getting into that when it comes to Israel. The reality is that it shouldn't matter if it's a conflict. If you see an outbreak somewhere, you should be worried for those people, and it shouldn't matter if it's going to impact you. But now that we have lived through a pandemic, a historical event, I would like to think people would see this and realize any one of these diseases can come to the states. It can strain global resources.

And I'm hopeful that with the amount of attention that's coming to this and that the work that the WHO and the UN have been drawing attention to it, that will change. But I get a little nervous every time we talk about infectious diseases and conflict areas, because I find that Americans, and it's not just us, but people in high income countries disassociate because that is a conflict related issue. But it's not. Conflict can mean many different things. And it's essentially saying this is this is an issue that's going to bubble out of control. And if we were in a situation where there was no clean food and water, we had no access to health services and medicine, fuel was an issue in power, no communication. And I just read that three Palestinian internet providers went down,

so they have no way to contact the outside world, safe housing, safe passes, etc. Any one of those impacted us, we would be experiencing it. And I will leave that question with one comment to say, we are a very well resourced country, the US invests so many resources into health, global health security, bio preparedness, all of the above. And we were one of the worst performers when it came to COVID response. And I say that having worked in healthcare during that and doing epidemiology. And I think this should be a continuous wake-up call that we're one disease away from an international crisis. And when we see this, it should really speak to the fact that it is global health. It's not national health, not local health. It is global health.

That's my TED Talk. The good TED Talk. I guess if I could piggyback on that like there is not a single war that i have covered uh either remotely or in person where i have not then seen those people arrive our border where i live uh like i was in syrian kurdistan in october i am seeing people leaving turkey more more tur Kurdistan, but also Syrian Kurdistan, or people who went to Syria and went back to Turkey at our southern border right now. I am seeing people from conflicts all over the world at our southern border right now.

And every single conflict, because we tend to stick our nose into every single conflict, ends up here, right? Because we tell people we support them and then we abandon them and they come here thinking that we were going to support them i'll also add that every time there is infectious disease outbreak going forward it will be used in the same way that covid was to prevent asylum uh so the title 42 that was used to like quote unquote catch and release migrants at the southern border allowed border patrol to to eject people without processing their asylum claim that's a public health law it's not a migration law biden's already indicated that he would love to do the same thing again and like you don't even need an excuse with this infectious disease stuff right the law is already there and

it was already in place for several years and so it's kind of stood the test of the courts and this will impact even if you don't give a shit about people in palestine and maybe you should examine what's up with your morality if you do like this will impact you because people will come here and it will impact you because people who should come here won't be able to and that will mean that people who have done nothing wrong who trusted us when we lied to them you know people americans seem to care about Afghans more than other people. Like I've spoken to hundreds of Afghan women at our border and like they were stuck under Title 42 in very dangerous situations in places like Mexico. So even if you only care about those people, you should still care about this, I guess. Can I add something to i think

please you know to to avoid fueling isolationism because i think that happens all the time when we talk about these global health issues every resource that has to be put to helping this health crisis that is bubbling out of a humanitarian crisis is a resource that's not back where it's supposed to be addressing global health issues. Meaning, so for example, when we saw the Ebola outbreak in West Africa in 2014, after there were, you know, we started to actually realize the implications to malaria control, tuberculosis, HIV. So when we have to throw a bunch of emergency resources at a crisis, those are coming out of somewhere else. And I worry too, that people don't realize that we're, you know, as the WHO, the UN, everywhere, MSF is having to help this situation because there's no access to care. And

again, it is a health crisis. That means we're going to start to see other things pop up elsewhere. And that really worries me because we are already very strained when it comes to global health resources. We just, again, came out of a pandemic. So everyone's tired. Everyone's burnt out. We've got health systems and a lot of, and we're seeing it in the US where a lot of funding for the CDC is being pulled and NIH. So now that we're out of kind of coming back into this panic neglect cycle, I worry that a lot of the resources that we're having to pull to address this crisis are going to then ultimately leave a lot of other places at risk for infectious diseases for long term health implications. So it is a lot bigger than one area or people, you know, having to flee to the US. It's all of these things. And too often,

we approach this with a very short-sightedness. And we have, we don't, you know, we have finite resources when it comes to global health response. And when we have to use them, because, you know, we're not, you know, approaching this effectively or appropriately then we're gonna see larger implications yeah even like uh we can just keep building off each other's stuff and just not hear from the other two even uh recently i was trying to buy some humanitarian daily rations for the border which are people aren't familiar they're like mres for refugees yeah and made sure he need one on a live show once yeah it's very salty yeah very salty that's good for the electrolytes but um they're like as the state department is buying the back of surplus retailers at the minute which like means that there's obviously like a critical lack of supply of these things same with

unhcr shelters and like that means that someone else doesn't get to eat right because we've just massively increased the burden of people who desperately need to eat and like it's not like these things were chilling before like they're they're you know hunger is still a massive problem in the world despite us having so much food here and so like the same yeah the same is true of medical supplies like you said right that means that somebody else doesn't get them that money doesn't go to something else very important that it could be going to. Can I ask about something I just learned about the past couple of days?

So on December 25th, the Jerusalem Post reported that an IDF soldier died of a fungal infection. And apparently he was hospitalized and eventually he he died and at least 10 other soldiers have been diagnosed with infections of some sort i think what kind of made me annoyed is that there is a headline from the times of israel that said as a soldier with fungal infection dies fears grow of gaza diseases spreading into israel and apparently they're examining whether the infections originated from the hamas tunnels and all this stuff i think while i it's right it's a plague tunnel i that's it really it really bothered me because i i looked

at all these articles i mean most of them are obviously um sourced, but it still was the same rhetoric of there is diseases in Gaza and our soldiers are getting them. And honestly, the takeaway in all of these was we have to worry about Israeli public health and the Israeli citizens. It wasn't about anything about the Gazans or anything like that and i was just i guess i wanted to ask is there any truth at all to the idea that there can be certain infections localized to that degree even though it's like a very small country in general and i guess it's it's it's really i feel like it's a fear-mongering tactic using health as a weapon but i don't know i'd love to hear your thoughts even the fungus has gone woke i can't believe it they've weaponized fungus um saskia i'll let you address it but i would say this i mean i i think the fear

i just did an episode um of my podcast uh on funguses and talking about the last of us and seeing like the truth if there's really a concern especially with global climate change and it is it i mean the the thought of a fungus affecting humans in that way who are not in some way under their body under stress or immunosuppressed it's it's not that likely and i definitely agree from what i'm hearing that like this is just another way to be like look at these dirty people we should bomb them to the really get rid of the fungus yeah everything related to palestinians is oh they're all it's all the plague like they're scary they're barbaric and also they're gonna make you sick it's it's really infuriating they're just going at every angle i just i found the quote that made me mad can i read it okay i'm gonna read it basically it says uh the war between israel and hamas has led to the

destruction of large swaths of gaza and internal displacement of the vast majority of its population resulting in what is called humanitarian crisis for the palestinians it is called that because it is that uh body body blood these conditions have led to the outbreaks of various diseases which can potentially threaten the well-being of hundreds of thousands of idf troops fighting in gaza they can also ultimately spell trouble for public health in israel i just can't believe that's the takeaway i'll let saskia do you want to uh address the the spread of fungal infection in a situation like this? Yeah. I mean, look, again, this is a situation where disease is going to be spread and that includes IDF

soldiers. They are at risk because guess what? They all have to go back to their bunks and sleep at night in close quarters. Do we see diseases spread easily in militaries? Of course. I mean, it would be insane not to think that. But trying to, you know, source it in Palestinians and Gaza is slightly ridiculous because there's no epidemiological evidence of that. But it's also kind of weird to me that they're saying a fungal infection. That's a very specific thing. Fungal infections aren't fast infections.

For the most part, you know, when we do see them, I think from a regional perspective, if you live in the Southwest, like I do, valley fever is a fungal infection. It's in the dirt, though. It's a spore in the dirt. And it's not spread between people. So that's the key part. It is you inhale it and you get it. And it takes months in a lot of cases. But, you know, can you can you see fungal infections? Yeah, that could be contaminated water, you know, inhalation, through showers, things like that. I mean, there's ways for that to happen. But we really just for the most part, see those infections spread from an individual source, not an individual person. They tend to really not be, they're environmentally

spread, you know, and I'm not a fungal expert. I can just speak to the ones that I've seen. And really, we don't see them spread between people. And so I think that it's a weird choice to say, and I worry a little bit that they're just, again, to your point, trying to say like, oh, look, our soldiers are getting sick, you know, the sacrifice they're making is so much. And here's the thing, conflict is where we're going to see disease spread no matter what. And if you're so worried about soldiers getting fungal infections from Gaza, then maybe keep the people in Gaza safe. And then they're, you know, either way you paint this, if you're trying to blame it on them they keep them safe and they won't be able to spread disease very simple yeah they did they did cite contaminated soil okay that's a contamination thing like environmental

yeah this one epidemiologist said that these soldiers have come back with serious antimicrobial resistant infections that they've picked up through contact with contaminated soil among other factors like one i feel like it's like a very uh direct statement there's a lot there's a lot to unpack there yeah yeah again though if it's in the soil it's an environmental exposure right that is like that's not anyone's fault from an antimicrobial perspective that i i'm having a hard time believing that valley fever, as I mentioned, is really hard to treat. So sometimes it's not responsive to some of the medications you give, but you know, you're going to get antimicrobial infections more so from people

and contaminated objects, because that means that it has to have been exposed to antibiotics and become resistant to the infections. But there's,'s i that feels like very messy uh you know reporting on their part or communications because not a lot of that makes sense to me and either way if they're saying it's from the environment congratulations you've just proven you're not getting it from people yeah thank you for getting into that i just the the hamas tunnels uh the hamas terror tunnel sorry in their words they're terror tunnels they're going to investigate whether um infections have originated from there it just it's also uh just that doesn't make any sense so i'm glad to have two doctors here agree and that's all i

wanted i mean i will say this coccidia mycosis is valley fever and we like you know she just mentioned it's we see it here in california it's the reason why we used to say if you're driving down central valley california down the i-5 you should roll up your window and and not breathe in the air because there's a possibility of getting it from that so they say that well they i don't think they do so much anymore i need to do there's a whole number of reasons why you don't want to be breathing in yeah there's a lot of cow farms out there too it gets a little bit nasty out there in the i5 but but i mean it's what is an endemic thing it's like if they don't want to be exposed to it stay out of that area yeah yeah but you're not going to get it from other people that's the kicker it's not spread from people yeah it is very common to attribute infectious

diseases that come from conflict to your enemy like if you look at like the 1918 pandemic flu right and all the different things that people called that flu and the people to whom they attributed it like you you can see that we've been doing that for more than 100 years it's uh it's part of the process of dehumanizing people who you're trying to kill. It happened with COVID, too. Yeah, yeah. I mean, yeah. That was a whole different situation.

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and we're kicking off our second season digging into how tech's elite has turned Silicon Valley into a playground for billionaires. From the chaotic world of generative AI to the destruction of Google search, better offline is your unvarnished and at times unhinged look at the underbelly of tech from an industry veteran with nothing to lose. This season I'm going to be joined by everyone from Nobel winning economists to leading journalists in the field and I'll be digging into why the products you love keep getting worse and naming and shaming those responsible. Don't get me wrong, though. I love technology. I just hate the people in charge and want them to get back to building things that actually do things to help real people. I swear to God things can change if we're loud enough.

So join me every week to understand what's happening in the tech industry and what could be done to make things better. Listen to Better Offline on the iHeartRadio app, Apple Podcasts, wherever else you get your podcasts. Check out betteroffline.com. So I wonder, Saskia, like we, obviously this is a terrible situation and it's one that's like super easy to feel very disempowered with because uh you know as as much as you march around and do things it doesn't seem to be stopping is there is there anything that like people can do advocate for uh like take action on that could make this slightly less bad i mean a ceasefire i encourage

people to donate to unicef and obviously you know msf a lot of the wonderful organizations doing work there and probably my my biggest one right now especially since we're around the holidays and people are spending a lot of time with family and likely getting into some heavy conversations around the dinner tables make sure you're well informed and you're not spreading misinformation and disinformation online, because that's been a huge aspect of this. We saw with the humanitarian crisis in Ukraine, Russia took direct action to spread misinformation and disinformation. And we're struggling with that in the United States right now with this. And we're struggling with that in the United States right now with this. So I encourage people to stay informed of this, to really utilize good resources and not pull things from social media. If you're going to share something, you know, do so from an accurate source. I really, you know, the WHO, UN have been really good at doing continuous updates and sharing that information, human rights watch and all of the above.

And on top of, again, donating and really being an advocate for a ceasefire to me is the biggest thing. And also reminding people, hey, this is currently a localized crisis, but infectious diseases and humanitarian crises rarely stay that way. I would also plug the Palestinian Medical Relief Society, the PMRS. They're the on-the-ground people. They've been there since 1979. They were founded by Palestinian doctors. It's mostly Palestinian-run, and they're doing, I think, really good work down there as best they can. And they're where actually the WHO gets most of their information, or a lot of it at least.

It's coming from their updates from the PMRS people on the ground. So that's another local source to look at if people are interested in getting involved. Perfect. Thank you. Shereen? I'm not going to wrap it up yet. I was just thinking how unfortunate it is that people don't care enough. So you have to be like, it's not only going to stay localized. Like, it's not just that.

You know what I mean? I hate that we have to go there because especially after going through a pandemic yourself, if that is still not enough for you to have any kind of empathy. That's, that's just insane to me. That's, the one consistent thing I've seen is a lot of people say, Oh, this conflict is, is, you know,

very, there's a lot of history and I don't really want to get involved. And yeah. And, and, you know, to us, I do understand that there is a long complicated history that not a lot of

people are well informed of, but inform yourself and that doesn't mean you can't have empathy you can you know denounce amass and also denounce anti-semitism yeah these things are not exclusive and it's it's impressive to me that we're still after you know it's not even been three months and we've lost 20 000 people that we know of in this um We're seeing journalists killed left and right as well. It's impressive to me that people are still saying, oh, I don't really want to comment on that. It's very messy. It is and it's not though. In the medical world,

I've seen doctors complain more about the word provider and how it's used than the fact that 300 medical professionals have been killed some of them while doing their duty in the hospital like that's a part that kind of surprised me from a medical perspective um and i you know i i think i mentioned it to you before i'm grateful for coming on your show because i think a lot of the there's an overlap between doctors who listen to our show and they listen to yours and they're very vocal and they're online and they are the ones who are really giving me hope in these situations because there's a lot of people in medicine. This is a medical issue. I mean, I'm not even talking about any of the history. That's nothing.

That's not what I'm. That's not what is important to me right now. It's about this health care crisis that is worsening and progressively worsening and i it is it is a bit of a bummer that i'm not seeing a little bit more interest in addressing it yeah i would hope also that most people like inside or outside the medical community could maybe agree that like the correct number of hospitals to bomb is zero hospitals and that but that yeah there isn't a reason why you bomb hospitals you just shouldn't mean anthony blinken said like a year or what about ukraine and russia russia bombed hospitals and schools there's no way

that's normal and like there's a video where it's like cross-sectioning into like right now how he's like we're always going to support israel so it's like no it's not normal bombing hospitals and schools is never normal or okay it's crazy that israel went from being like we would never bomb a hospital to bombing dozens of them and nothing happening yeah but and like yeah i guess just for like like completion again it's not okay when turkey bombs hospitals in northeast syria either like i was there when they bombed one they bombed another one since it's not okay when the hunter in myanmar bombs hospitals i know this one hospital left standing in the whole of korea any state right now and like this is happening there too when we're not like not caring about those people because this

is a topic of the day or whatever like it's also not okay to use white phosphorus on on our civilians no like across the board we're yeah like in general it's horrific and i just i think it's it's you know and there was there were a couple of reports and i think that there's still data coming out about it that um bodies had organs stolen from them yeah which is just horrific jesus and yeah and there's a really practice that israel has done for a while though israel's uh they said they stopped it and then they're continuing to do it but it's like they're notorious for bringing to returning bodies that have been like autopsied or having all their organs removed and i want to just point out that for muslim burials the body is like it's very important that the body is whole and the same for jewish burials but it's just uh

really disgusting just point blank and then also really disrespectful but yeah sorry i interrupted no no i mean it's and again you know i think there's still a lot of information coming out about that and how many that occurred etc because i like i mentioned before i think information right now is really challenging accurate information of course is exceedingly difficult so i i'm always very careful you know what what we say and but to me, you know, the Washington Post just released a really good article and in-depth analysis of the attacks on the Al-Shifa hospital, because that's the biggest hospital in Gaza. And for a while, you know, IDF was saying, well, this is where Hamas

has been operating, they have tunnel networks, and there was a good breakdown of why this is inaccurate. And at the end of the day, no, there's no acceptable reason to bomb a hospital and drawing attention to the fact that this was occurring and misinformation is being shared is huge. So I'm hopeful that, you know, and very grateful to be on this podcast and talk with you all because the more information we can communicate about this situation, but also about the fact that there are much larger consequences of this from just even an infectious disease perspective is so critical, because I don't think people realize that. And again, they disassociate when they hear it's a conflict, it's a result of conflict. It's it is so much larger than that it will, you know, we will see

it in the States, we will see the ramifications of this. And if nothing else, again, coming out of COVID, I'd like to think that we realize that we are a part of a much larger interconnected world and infectious diseases are simply a plane flight away. Yeah. Yeah. Very true. Thank you both so much for your brains and your knowledge and for coming on the show. It's thanks for having us. Yeah. Thank you so much for your brains and your knowledge and for coming on the show.

Thanks for having us. Yeah. Thank you so much for having us. Of course. And before we go, I'd like to ask you guys if you have anything you'd like to plug, like where people can find you. You've mentioned a couple of good resources, but other information resources, that kind of thing that you'd like to share? So in terms of the resources, I am following a couple members of the PMRS.

They have a Twitter feed, but it's not very active. But the WHO gets a lot of the same information and they do a good job of updating. In terms of where you could learn more, I just did an episode on the healthcare crisis in Gaza on my podcast, the house of pod, which James has been on and Shreen, I'm trying to get you to come on.

So I'm down. We're going to keep working on you and Saskia too. I mean, you're all invited. I'm recording this. I'm just going to release it on my podcast as well. And yeah, so listen to us there. I'll going to release it on my podcast as well and uh yeah so listen to us there i'll be doing more episodes on this uh topic as well in the in the coming months

cool perfect let's ask you how about marrying all of those resources i really um been looking to of course i'm a public health parent so who you just have human rights watch for my big go-tos as you know again as all the sources we've already mentioned. And I really, I want to give a shout out to a colleague of mine, Jessica Altay-Rivera, who is really, really wonderful in this space and has been doing a lot of science communication on her Instagram. I tend to be a little bit more on the cesspool that is formerly Twitter. But, you know, I think there's some really wonderful people out there, this entire group included, that are

actively working to share information, but also how people can get engaged and involved. So, shout out to her and just all the hard work that a lot of key journalists are doing in this space, because, again, if you have no communication out, it's really hard to get accurate information.

Well, thanks guys for listening. why are you laughing james can i wrap this out or is this too monotone you're crushing it shireen send it no that's the show again thanks again for both of you being so outspoken i think especially reminding everyone that it's actually not complicated because it's also like a medical issue. It's not exactly, when you just look at the numbers, look at body count, look at families, that's I think what our main focus should be. And I appreciate you both because I know it's tricky out there to be outspoken. So thank you. Thank you, guys. Thanks so much. It Could Happen Here is a production of Cool Zone Media.

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Listen to Better Offline on the iHeartRadio app, Apple Podcasts, wherever else you get your podcasts from. On Thanksgiving Day, 1999, five-year-old Cuban boy Elian Gonzalez was found off the coast of Florida. And the question was, should the boy go back to his father in Cuba? Mr. Gonzalez wanted to go home

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