The World Health Organization and its partners are gearing up for an ambitious mass vaccination campaign in the Gaza Strip after an 11-month-old boy contracted the Palestinian enclave’s first case of polio in 25 years.
“All his limbs are now paralyzed,” the boy’s mother, Nevin Abu al-Jidyan, said in a telephone interview this week from her tent in Deir al-Balah in central Gaza. “The left side is more rigid. He is even unable to bend over. I cannot even help him sit.”
The campaign is scheduled to begin Sunday and will roll out in phases, with both Israel and Hamas agreeing to brief “humanitarian pauses” to allow the vaccinations to take place. Health-care workers in southern Gaza on Saturday inoculated a small number of infants as a symbolic start to the immunizations, which the local health ministry said will include children up to the age of 10.
Polio’s reemergence in Gaza poses a looming threat to the war-torn territory and adjacent regions, health and humanitarian experts said. The highly infectious and deadly disease affects the nervous system and is a significant challenge to contain because the majority of people infected either have no symptoms or mild flu-like symptoms, potentially spreading the virus unknowingly.
There is no treatment for polio, but vaccination prevents the disease. Polio primarily affects children under 5, although anyone who is unvaccinated can contract the virus. One of every 200 infections results in permanent paralysis. Of those cases, up to 10 percent die when breathing muscles become immobilized, according to the WHO.
The WHO has been warning about the spread of poliovirus after it was detected in July in six sewage samples in Gaza’s southern and central regions, where the majority of the population has been displaced by the Israeli military into squalid living conditions. The virus spreads by entering the mouth after contact with an infected person’s feces or droplets from sneezes or coughs — and through contaminated food or water.
Polio’s return to Gaza is the result of a confluence of factors created by the months-long war, which has destroyed its water, sanitation and health infrastructure. Health authorities have warned for months that worsening conditions were breeding grounds for diseases. Sewage and solid waste spill into the streets and contaminate drinking water. Displaced residents live in overcrowded camps with little ability to bathe or even wash hands, residents say.
“If you were to concoct, in a lab, a perfect scenario for the spread of polio, it would look a lot like Gaza today,” said Jeremy Konyndyk, a former senior Biden administration official and current president of Refugees International, a humanitarian organization.
WHO officials said the circulating strain is closely linked to a strain in Egypt’s northern Sinai region and could have been imported into Gaza and spreading silently since last September.
Health officials and aid workers had been seeking a multiday humanitarian pause to ensure health-care workers and aid organizations can move freely to conduct the first of two rounds of the mass vaccination campaign starting this weekend.
The WHO announced Thursday that there will be limited “humanitarian pauses” in Gaza to allow for a vaccination campaign lasting three to four days in each zone. The first phase will start Sunday in central Gaza, followed by the south and the north, according to Rik Peeperkorn, who heads WHO operations in the occupied territories of Gaza and the West Bank. The pauses will last eight or nine hours each day. The children are supposed to receive their second doses four weeks later.
Due to dislocation, lack of security, and damage to roads and infrastructure, the three days might not be enough to reach the 90 percent coverage needed to stop transmission in Gaza and prevent international spread, Peeperkorn said, speaking from Gaza during a virtual briefing at the United Nations. He said COGAT, the Israeli agency responsible for administering civilian policies within the occupied territories, has agreed to expand the pause in fighting by one day in each zone, “or even more, when necessary.”
Experts have said vaccinating all or almost all the children simultaneously is critical to stopping transmission — but acknowledge that doing so is not feasible during wartime when there’s skepticism as to whether the humanitarian pauses will be maintained. A rollout staggered over time or geography will miss children given the population displacement, allowing further transmission and increasing risk of the virus mutating. Aid workers will mark the fingernails of children who have been vaccinated to document their status.
“I’m not going to say this is the ideal way forward, but this is a workable way forward,” Peeperkorn said. “Not doing anything would be really bad. We have to stop this transmission in Gaza, and we have to avoid the transmission outside Gaza.”
UNICEF has already brought in 1.2 million doses of oral polio vaccine to a warehouse in Deir al-Balah. Another 400,000 doses are expected to arrive in the coming days, UNICEF spokesman Jonathan Crickx said.
“It’s absolutely critical that this vaccination campaign is executed in a few days — between five to seven days is what we are asking for — and that more than 90 percent of the 640,000 children below the age of 10” receive their first dose in that period, Crickx said.
Before the war, 99 percent of Gaza’s 2.2 million residents were vaccinated against polio, according to the WHO. The rate has since dropped to 86 percent, a dangerous level that allows the virus to circulate in pockets of unvaccinated children.
The baby boy who now has polio had been developing normally until about two months ago, when he began vomiting and having a high fever, his mother said. He spent two weeks at al-Aqsa Martyrs Hospital, one of the last functioning hospitals in the enclave. Antibiotics and intravenous nutrients did not improve his condition. The hospital, suspecting polio, sent a stool specimen to Jordan for testing.
Two weeks later, on Aug. 16, Jidyan learned her youngest child, who turns 1 on Sunday, was Gaza’s first polio case in a quarter-century.
“It was a huge shock,” she said. “I was very sad that my child had contracted this disease.” She knew of polio’s dangers, but she said she did not expect her family to succumb so quickly.
Gaza health officials arrived at her tent and vaccinated her other eight children two days later.
“But what good will this measure do?” Jidyan said. “We live in a place where hygiene levels are completely nonexistent. The water is polluted. Sewage runs between the tents. The place is filled with insects and epidemics. … We live in hell.”
She added: “We learned that the Israeli army provided vaccinations to its soldiers, but they left us to die.”
Last month, Israel began offering polio boosters to soldiers deployed to Gaza.
COGAT said on X this week that the vaccination campaign in Gaza will be conducted by WHO and UNICEF in coordination with the Israel Defense Forces as part of “the routine humanitarian pauses that will allow the population to reach the medical centers where the vaccinations will be administered. We are committed to ensuring a successful vaccination campaign for the civilian population.”
WHO officials say there is high risk for further spread in Gaza, surrounding countries and internationally. Israel has high vaccination rates generally, except in certain vulnerable populations, such as the ultra-Orthodox communities, said Jeffrey Goldhagen, president of the International Society for Social Pediatrics and Child Health. Israeli health officials have reported detection of polio virus in wastewater and cases of polio in unvaccinated children in recent years.
In addition to the confirmed polio case, two suspected cases of acute flaccid paralysis, a common symptom of polio, have been reported in a 10-year-old and 5-year-old in Gaza, according to WHO.
The type of polio in Gaza is known as vaccine-derived poliovirus. It may emerge under crisis conditions when live weakened virus in the oral polio vaccine is shed in feces and circulates long enough in under- or unimmunized populations to allow it to mutate back to a more dangerous form that causes illness and paralysis.
Even with a humanitarian pause, the vaccination effort will be enormously complex. Children in Gaza must be brought to vaccination centers in schools, shelters and health facilities instead of the house-to-house campaigns that take place in most of the world.
Such a large-scale and complicated operation would require safety and access for families as well as an estimated 2,180 health and community outreach workers, U.N. officials said. The workers will also need fuel, cash and the restoration of telecommunications networks.
Security must ensure that gangs and groups that have been disrupting food distribution and smuggling cigarettes will allow vaccination to move forward uninterrupted, said Paul Spiegel, a physician and director of the Johns Hopkins Center for Humanitarian Health who worked as a health adviser on the Gaza crisis to UNWRA, the main U.N. aid agency there.
Another challenge may be parents’ unwillingness to bring their children to a vaccination site out of safety concerns, said John Kahler, a retired pediatrician and co-founder of MedGlobal, an international medical organization that is helping with the vaccination campaign.
After 10 months of unrelenting trauma, Kahler said, the thinking may be: “Do you want to get your kid a polio vaccine, or do you want to stay hidden in the tent?”
Harb reported from London.