The polio virus was detected in wastewater samples in Gaza last week, an alarming yet unsurprising development given the dismantled state of the territory’s health systems after nine relentless months of war.
Across Gaza, more than 39,000 people have been killed, 89,000 wounded, and more than 10,000 are estimated to be missing. Most hospitals are no longer able to function. Already, diarrhoeal diseases, respiratory infections and hepatitis A, among others, are raging through Gaza. Nearly everyone in Gaza is facing acute food insecurity and catastrophic hunger. Thousands of children are malnourished, making them even more susceptible to disease.
About 2.3 million people live in the 365 sq km (141 sq mile) Gaza Strip, which has become even more concentrated amid limited access to clean and safe water, and deteriorating sanitary conditions.
Since early May, almost a million people have been relocated from Rafah to Khan Younis and Deir al-Balah, where the polio samples were detected.
While no cases of polio have been recorded yet, without immediate action, it is just a matter of time before it reaches the thousands of children who have been left unprotected. Children under five are at risk, and especially infants under two because many have not been vaccinated over the nine months of conflict.
The World Health Organization (WHO) is sending more than 1m polio vaccines to Gaza, which will be administered in the coming weeks to prevent children being struck down by the disease. However, without an immediate ceasefire and a vast acceleration of humanitarian aid, including a targeted vaccination campaign focused on young children, people will continue to die from preventable diseases and injuries that are treatable.
Repeatedly, we have seen polio thrive in places hit by conflict and instability. In 2017, in wartorn Syria, an outbreak of variant poliovirus – a mutated form of the wild virus that can spread in under-immunised populations – left 74 children paralysed. In Somalia today, a decade-long civil war has resulted in the longest unbroken chain of variant poliovirus transmission globally, circulating since 2017. In Afghanistan and Pakistan, the last two countries where children are paralysed by wild polio, humanitarian crises and insecurity have prevented the world from stomping out the virus for good.
Now, children trapped in Gaza face this same threat and are left with nowhere to turn. Prior to the conflict, vaccination coverage was at 99%. Now that rate has dropped to 86%, which is dangerous as this provides pockets of unvaccinated children, where the virus can circulate. The decimation of the health system, lack of security, destruction of infrastructure, mass displacement of people and shortage of medical supplies have prevented children from receiving many lifesaving vaccines.
Only 16 of Gaza’s 36 hospitals are functional – with reduced services – and less than half of the primary healthcare facilities are operational. Meanwhile, 70% of all sewage pumps in Gaza have been destroyed and not a single wastewater treatment plant is working. These conditions present the perfect breeding ground for disease to spread.
Amid this dire context, health workers are risking their lives to care for people, from operating without electricity to testing samples of wastewater for deadly diseases. The fact that polio was detected in Gaza before a large-scale paralytic polio outbreak is testament to these incredible efforts, given the disease surveillance system has been severely reduced because of the insecurity.
For more than three decades, the Global Polio Eradication Initiative – made up of Rotary International; the US Centers for Disease Control and Prevention; the WHO; Unicef; Gavi, the Vaccine Alliance; and the Bill & Melinda Gates Foundation – has supported health authorities around the world to build and maintain resilient disease-surveillance systems capable of detecting the virus, along with other emerging health threats, no matter the circumstances.
In Syria in 2017, these systems helped identify and stop the outbreak after a handful of house-to-house vaccination campaigns. Last year, surveillance activities in Ukraine revealed an outbreak of variant poliovirus. Two children were paralysed, before a rapid vaccination response stopped the virus.
In the face of profound peril and hardship, the international community has a responsibility to leave no one behind and prioritise health and wellbeing. This is not unprecedented – from El Salvador’s civil war in the 1980s to conflict in Sudan’s Darfur region in the early 2000s, ceasefires, called “days of tranquility”, have been negotiated to essentially put wars on pause and ensure life-saving vaccines reach communities trapped in inaccessible, conflict-affected areas.
Today, the detection of polio in Gaza is yet another sobering reminder of the dire conditions that people are facing. Continued conflict will not only add to the rising death toll in the territory, but it will hamper efforts to identify and respond to preventable health threats like polio.
While immediate efforts to reach every child with polio vaccines are now being put into motion, ultimately, a ceasefire and free-flowing aid are the only definite ways to protect people and prevent an explosive outbreak.
Tedros Adhanom Ghebreyesus is director general of the World Health Organization
This article includes mention of the support given to polio eradication by the Bill & Melinda Gates Foundation. Support for the Guardian’s global development journalism comes from the Bill & Melinda Gates Foundation via theguardian.org. Read more about how the Guardian ensures its editorial independence here
