Tthe poliovirus was detected in wastewater samples last week in Gaza, a worrying yet unsurprising development given the dilapidated state of the territory’s health systems after nine relentless months of war.
Across Gaza, more than 39,000 people were killed, 89,000 woundedand more than 10,000 is estimated to be missing. Most hospitals can no longer function. Already, diarrheal diseases, respiratory infections and hepatitis A, among others, rage through Gaza. Almost everyone in Gaza is with 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 mi) Gaza Strip, which has become even more concentrated amid limited access to clean and safe water, and deteriorating sanitary conditions.
Since early May, nearly a million people have been moved from Rafah to Khan Younis and Deir al-Balah, where the polio samples were detected.
Although no cases of polio have yet been recorded, without immediate action, it is only a matter of time before it reaches the thousands of children who have been left unprotected. Children under-fives are at risk, and especially babies under two because many have not been vaccinated over the nine months of conflict.
The world Health The organization (WHO) is sending more than 1 million polio vaccines to Gaza, which will be administered in the coming weeks to prevent children from being affected by the disease. However, without an immediate ceasefire and a major acceleration of humanitarian aid, including a targeted vaccination campaign focused on young children, people will continue to die from preventable diseases and treatable injuries.
We have repeatedly seen polio flourishing in places stricken by conflict and instability. In 2017, in war-torn Syria, an outbreak of variant poliovirus – a mutated form of the wild virus that can spread in underimmunized populations – left 74 children paralyzed. In Somalia today, a decade-long civil war has led to the longest uninterrupted chain of variant poliovirus transmission worldwide, circulating since 2017. In Afghanistan and Pakistan, the last two countries where children are paralyzed by wild polio, humanitarian crises and uncertainty have prevented the world from stamping out the virus for good.
Now, children trapped in Gaza face the same threat and are left with nowhere to turn. Before the conflict, vaccination coverage was at 99%. Now that rate has dropped to 86%, which is dangerous as it provides pockets of unvaccinated children where the virus can circulate. The destruction of the health system, lack of security, destruction of infrastructure, mass displacement of people and a shortage of medical supplies have prevented children from receiving many life-saving vaccines.
Only 16 of Gaza’s 36 hospitals are functional – with reduced services – and less than half of the primary health care facilities are operational. Meantime, 70% of all sewage pumps in Gaza have been destroyed and not a single waste water treatment plant is working. These conditions provide the perfect breeding ground for the spread of disease.
Amidst this dire context, health workers risk their lives to care for people, from working without electricity to testing samples of waste water for deadly diseases. The fact that polio was detected in Gaza before a large-scale crippling polio outbreak is testament to these incredible efforts, as the disease surveillance system has been severely reduced due to the uncertainty.
For more than three decades the Global Polio Eradication Initiative – consists of Rotary International; the US Centers for Disease Control and Prevention; The WHO; Unicef; Gavi, the Vaccine Alliance; and the Bill & Melinda Gates Foundation – have 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, regardless of the circumstances.
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In Syria in 2017, these systems helped identify and stop the outbreak after a handful of door-to-door vaccination campaigns. Last year, surveillance activities in Ukraine revealed an outbreak of variant poliovirus. Two children were paralyzed, before a rapid vaccination response stopped the virus.
In the face of great danger and hardship, the international community has a responsibility to leave no one behind and to prioritize health and well-being. It’s not unheard of – from El Salvador’s civil war in the 1980s to conflict in Sudan’s Darfur region in the early 2000s, ceasefires, called “days of calm”, have been negotiated to essentially put wars on pause and ensure that life-saving vaccines reach communities trapped in inaccessible, conflict-affected areas.
Today, the detection of polio in Gaza is another sobering reminder of the dire conditions people face. Continued conflict will not only add to the rising death toll in the area, but it will hamper efforts to identify and respond to preventable health threats such as polio.
While immediate efforts to reach every child with polio vaccines are now underway, a ceasefire and free-flowing aid are ultimately the only definitive ways to protect people and prevent an explosive outbreak.
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Tedros Adhanom Ghebreyesus is director-general of the World Health Organization
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This article mentions the support given by the Bill & Melinda Gates Foundation to polio eradication. 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
