LONDON: More than 1 million children in the Gaza Strip are at risk of contracting poliovirus type 2, a highly infectious disease that can lead to paralysis and even death, as displacement and the destruction of sanitation infrastructure leave people vulnerable to disease.
The World Health Organization has announced plans to send 1.2 million polio vaccines to Gaza after the virus was detected in wastewater samples taken last month from displacement camps in the northern governorates of Khan Younis and Deir Al-Balah.
Although no clinical cases of polio have been diagnosed so far, WHO regional director Hanan Balkhy has warned that the virus could “spread further, including across borders,” unless agencies act quickly to vaccinate the population.
However, any mass polio vaccination campaign in Gaza, targeting 600,000 children under the age of 8, would face a number of challenges, chief among them the absence of a ceasefire that would allow doctors to safely reach displaced communities.
“We need a ceasefire, even a temporary one, to successfully carry out these campaigns,” Balkhy said at a news conference on Wednesday.
Children under the age of 5, especially infants, are most at risk of contracting polio, as many were unable to participate in regular vaccination campaigns that took place in Gaza before the conflict began on 7 October.
The virus, which is spread through contact with the feces, saliva, or nasal mucus of an infected person, attacks nerves in the spinal cord and brain stem, causing partial or complete paralysis within hours.
It can also immobilize the chest muscles, causing difficulty breathing and even leading to death.
Polio was eradicated from Europe in 2003 thanks to an effective vaccination campaign. There have been no confirmed cases of paralysis due to polio in the UK since 1984.
Cases of wild poliovirus 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 was eradicated in 2020. As of 2022, type 1 remained endemic in only two countries: Pakistan and Afghanistan.
In Gaza, overcrowding, lack of clean water and hygiene materials, a deteriorating health system and the destruction of sanitation facilities have contributed to the resurgence of the type 2 virus, according to Hamid Jafari, WHO director for polio eradication, who spoke at a press conference on Wednesday.
The United Nations estimates that at least 70 percent of Gaza's water and sanitation facilities, including wastewater treatment plants and sewage pumping stations, have been damaged or destroyed since the conflict began.
In late July, Gaza's health authority declared the enclave a “polio epidemic risk zone,” attributing the virus's resurgence to Israel's bombing campaign and the resulting damage it had caused to the health system.
The Israeli army has begun shelling the Gaza Strip in retaliation for the October 7 Hamas attack on southern Israel. Although the Israeli army insists it is not targeting civilian infrastructure, schools, hospitals and services have suffered severe damage.
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 healthcare system in tatters. Only 16 of Gaza’s 36 healthcare facilities remain partially functional.
INNUMBERS
1.2 million Polio vaccines that WHO plans to send to Gaza to prevent the outbreak.
600,000 Children under the age of 8 will be the recipients of the vaccination campaign.
70% Percentage of Gaza's sanitation facilities damaged or destroyed.
1.9 million Palestinians in Gaza have been displaced several times since the conflict began.
According to the U.S.-based NGO Physicians for Human Rights, three of these facilities are located in the north, seven in Gaza City, three in Deir Al-Balah, three in Khan Younis, and none in the southern city of Rafah.
Javid Abdelmoneim, head of a medical team for Doctors Without Borders who was working at Nasser hospital in southern Gaza last month, told the organization that “every day in July has been one shock after another.”
Recounting one particularly traumatic incident, he said: “I walked behind a curtain and there was a little girl alone, dying alone. And this is the result of a collapsing health system. An 8-year-old girl, dying alone on a trolley in the emergency room.
“In a functioning health system, she would have been saved.”
Despite calls from the WHO and other humanitarian agencies for the warring parties in Gaza to allow “absolute freedom of movement” so that doctors can launch a vaccination campaign, the possibility of a ceasefire appears no longer within reach.
The Israeli military on Wednesday issued new evacuation orders for several areas of the northern Gaza Strip, including Beit Hanoun, Manshiyya and Sheikh Zayed.
Avichay Adraee, a spokesman for the Israeli military, posted the evacuation orders on the social media platform X. He ordered residents of Beit Hanoun to “immediately move” to Deir Al-Balah and Zawayda.
“The Beit Hanoun area is still considered a dangerous combat zone,” he added.
Despite assurances that these areas would be considered safe zones where civilians could take refuge, both Deir Al-Balah and Zawayda have been subjected to regular Israeli attacks in recent months.
The UN reported that while nowhere in Gaza is safe, 86 percent of the besieged Palestinian enclave is under an Israeli evacuation order. Some 1.9 million of Gaza's 2.1 million residents have been displaced at various times since October 7.
“Nowhere is safe. Everywhere is a potential death zone,” said UN Secretary-General Antonio Guterres at the opening of the UNRWA Donors Conference on 12 July.
The continued movement of families in Gaza has made it difficult for humanitarian agencies, already short of funds and struggling to reach affected populations, to locate and identify unvaccinated children.
Jafari, a WHO polio specialist, warned that the virus could be circulating in Gaza as early as September, as the enclave offers “ideal conditions” for its transmission.
Prior to 7 October, polio vaccination coverage in the occupied Palestinian territory was estimated at 89%, according to WHO.
Even if the expected 1.2 million vaccines are successfully delivered to Gaza, it will be a “huge logistical challenge” to ensure their successful distribution, WHO official Andrea King told the BBC.
Vaccines must be stored within a limited temperature range from the time they are produced until they are administered. Getting these refrigerated vaccines into Gaza and keeping them at the required temperature would be a difficult feat even in the best of times.
On Wednesday, WHO Director-General Tedros Adhanom Ghebreyesus said a ceasefire or at least a few days of calm were essential to protect children in Gaza.
As of 7 July, WHO recorded an increase in infectious diseases, including 1 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.
This is said to be mainly due to the lack of drinking water and the destruction of a vital water facility in Rafah, in the southern Gaza Strip.
