שמואל א, פרק ה׳, פסוק ט׳

Moving the Ark of the Covenant from one city to another did not bring relief to the Philistines. Instead, the very act of relocating the Ark to Gath only intensified the anger of God, resulting in a significantly harsher punishment [מלבי״ם, מצודת דוד, ביאור שטיינזלץ].

This escalation in divine retribution unfolded in three distinct ways. First, a profound sense of turmoil overtook the city. This manifested either as a paralyzing terror and dread that gripped the inhabitants [מלבי״ם], or as a series of different plagues that swept through the population [ביאור שטיינזלץ]. Second, the scope of the devastation was unprecedented. The affliction expanded to strike every single resident of the city without exception, affecting everyone from the youngest to the oldest [מלבי״ם, רלב״ג].

The third and most severe escalation involved the nature of the disease itself. The affliction took the form of hemorrhoids, but these developed as hidden, internal tumors deep within their intestines. Because they were internal, these growths were far more painful, dangerous, and difficult to cure than external wounds [רש״י, רד״ק, מצודת דוד, רלב״ג, מלבי״ם]. Another perspective suggests that rather than remaining hidden, the disease caused these painful growths to violently burst forth from the bodies of the afflicted residents [ביאור שטיינזלץ].