LONDON: More than a million children in the Gaza Strip are at risk of contracting poliovirus type 2, a highly contagious disease that can cause paralysis and even death, as populations are left vulnerable to disease due to displacement and the destruction of sanitation infrastructure.
The World Health Organization has announced it will send 1.2 million polio vaccines to Gaza after the virus was discovered last month in sewage samples from refugee camps in the northern governorates of Khan Younis and Deir Al-Balah.
Although no clinical case of polio has been diagnosed yet, Hanan Balkhy, WHO regional director, warned that the virus could “continue to spread, including across borders” if authorities do not act quickly and vaccinate the population.
However, any mass polio vaccination campaign in Gaza, targeting 600,000 children under the age of eight, would face numerous challenges. Chief among these challenges is the lack of a ceasefire that would allow doctors to safely reach the displaced communities.
“We need a ceasefire, even if it is only a temporary one, to be able to carry out these campaigns successfully,” Balkhy said at a press conference on Wednesday.
Children under five, and especially infants, are most at risk of polio because many of them missed the regular vaccination campaigns that took place in Gaza before the conflict began on October 7.
The virus is transmitted through contact with the feces, saliva or nasal mucus of an infected person and attacks nerves in the spinal cord and brain stem, causing partial or complete paralysis within a few hours.
It can also lead to paralysis of the chest muscles, causing breathing difficulties and even death.
Thanks to an effective vaccination campaign, polio was eradicated in Europe in 2003. There has been no confirmed case of paralysis due to polio in the UK since 1984.
Wild poliovirus cases have declined by more than 99 percent since 1988, from an estimated 350,000 cases in more than 125 endemic countries to six reported cases in 2021.
Of the three strains of wild poliovirus, type 2 was eradicated in 1999 and type 3 in 2020. In 2022, the endemic type 1 was found in only two countries – Pakistan and Afghanistan.
In Gaza, overcrowding, a lack of clean water and hygiene products, a deteriorating health system and the destruction of sanitation facilities have all contributed to the resurgence of polio type 2, Hamid Jafari, WHO polio eradication director, said at a press conference on Wednesday.
According to UN estimates, at least 70 percent of water and sanitation facilities in the Gaza Strip, including sewage treatment plants and sewage pumping stations, have been damaged or destroyed since the conflict began.
At the end of July, the Gaza Strip's health authority declared the enclave a “polio epidemic area,” attributing the resurgence of the virus to Israeli bombings and the damage they caused to the health system.
The Israeli military began bombing the Gaza Strip in retaliation for the Hamas-led attack on southern Israel on October 7. Although the Israeli military insists it does not attack civilian infrastructure, schools, hospitals and utilities have been badly damaged.
The more than 490 attacks on medical facilities and personnel documented by the UN in the first six months of the conflict alone have left Gaza's health system in ruins. Only 16 of Gaza's 36 health facilities are still partially functioning.
INPAY
1.2 million To prevent an outbreak, the WHO plans to send polio vaccines to Gaza.
600,000 Children under 8 years of age should be specifically included in the vaccination campaign.
70% Percentage of damaged or destroyed sanitation facilities in the Gaza Strip.
1.9 million Since the beginning of the conflict, Palestinians in the Gaza Strip have been displaced several times.
Three of these facilities are in the north, seven in Gaza City, three in Deir Al-Balah, three in Khan Younis and none in the southern city of Rafah, according to the US-based non-governmental organization Physicians for Human Rights.
Javid Abdelmoneim, head of a MSF medical team who worked at Nasser Hospital in southern Gaza last month, told the organization: “Every day in July was one shock after another.”
He recounted a particularly traumatic incident: “I went behind a curtain and there was a little girl dying alone. And that is the result of a collapsed health care system. A little 8-year-old girl dying alone on a stretcher in the emergency room.”
“In a functioning health system she would have been saved.”
Despite calls by the WHO and other aid organizations to the warring parties in the Gaza Strip to grant them “absolute freedom of movement” so that medical workers could carry out a vaccination campaign, the possibility of a ceasefire does not seem to be any closer.
On Wednesday, the Israeli military issued new evacuation orders for several parts of the northern Gaza Strip, including Beit Hanoun, Manshiyya and Sheikh Zayed.
Avichay Adraee, the spokesman for the Israeli army, published the evacuation orders on the social media platform X. He called on the residents of Beit Hanoun to move to Deir Al-Balah and Zawayda “immediately”.
“The Beit Hanoun area is still considered a dangerous combat zone,” he added.
Despite assurances that these areas would be treated as safe zones where civilians could find shelter, both Deir Al-Balah and Zawayda have been subjected to regular Israeli attacks in recent months.
The UN reported that while there is no security anywhere in Gaza, 86 percent of the besieged Palestinian enclave is under Israeli evacuation orders. About 1.9 million of Gaza's 2.1 million residents have been displaced multiple times since October 7.
“Nowhere is safe. There are potential death zones everywhere,” said UN Secretary-General Antonio Guterres at the opening of the UNRWA donor conference on July 12.
The constant mobility of families in the Gaza Strip makes it difficult for aid organizations to search for and identify unvaccinated children. They are already under financial pressure and struggle to reach the affected population.
WHO polio specialist Jafari warned that the virus may have been circulating in Gaza since September because the enclave offers “ideal conditions” for its transmission.
According to the WHO, polio vaccination coverage in the occupied Palestinian territories was estimated at 89 percent before October 7.
Even if the planned 1.2 million vaccines can be brought to Gaza, it will be a “huge logistical challenge” to ensure their successful use, WHO official Andrea King told the BBC.
The vaccines must be stored within a limited temperature range from the time they are manufactured until they are administered. Bringing these refrigerated vaccines to Gaza and keeping them at the required temperature would be a difficult undertaking even under the best conditions.
WHO Director-General Tedros Adhanom Ghebreyesus said on Wednesday that a ceasefire or at least a few days of calm were essential to protect children in the Gaza Strip.
As of July 7, WHO recorded a sharp increase in the number of infectious diseases, including one million cases of acute respiratory infections, 577,000 cases of acute watery diarrhea, 107,000 cases of acute jaundice syndrome, and 12,000 cases of bloody diarrhea.
The report says this is mainly due to the lack of clean drinking water and the destruction of a vital water supply facility in Rafah in the south of the Gaza Strip.
