PThe virus has resurfaced in Gaza for the first time in 25 years, thriving in the same conditions that are killing people. The first case was confirmed on Friday in a 10-month-old unvaccinated child in Deir al-Balah, the enclave’s health authorities said. The World Health Organization announced last month that the virus had been detected for the first time in the city’s sewage. Now in Gaza, the medical safety of thousands of children depends on the safe delivery of vaccines to the region.
“Just when it seems that the situation for Palestinians in Gaza cannot get any worse, the suffering is growing – and the world is watching,” UN Secretary-General António Guterres said in a press statement on Friday. “In recent weeks, the polio virus has been detected in sewage samples in Khan Younis and Deir al-Balah,” he said.
The resurgence of polio in Gaza was not entirely surprising, given the situation in the region since Hamas attacks on Israel last October that killed some 1,200 people. According to figures from the Hamas-run Gaza Health Ministry, which are considered reliable by the U.S. government and the UN, more than 40,000 people were killed in Gaza in the ensuing conflict—and, not surprisingly, vaccination rates for cVDPV2 (circulating vaccine-derived poliovirus type 2) have fallen at a staggering pace. “Any disease that can spread in this way will eventually spread,” says Dr. Majed Jaber, a Gaza doctor who spoke to TIME from Al-Mawasi, a town in Khan Younis. “A kind of Murphy’s Law.”
Art from ancient Egypt suggests that polio has been around for thousands of years. In 1840, a German scientist theorized that the disease might be contagious, but it took more than 100 years for a vaccine to be developed. In 1938, after President Franklin Delano Roosevelt, who was diagnosed with polio at age 39 and left partially paralyzed, announced the creation of the National Foundation for Infantile Paralysis—named after the then-name for polio—comedian Eddie Cantor mused, “…Almost anyone can send a dime or two. But ten dimes make a dollar, and if a million people send just one dime, you get $100,000.” Parents sent “truckloads” of dimes to the White House, leading to Roosevelt’s foundation being renamed the March of Dimes.
When Jonas Salk, born in 1912 to Russian Jewish immigrants, licensed the first version of the vaccine in 1955 – at that point the virus was killing or paralyzing over half a million people worldwide each year – it was intended to be available to everyone. Salk never profited from its formulation or production. When asked who owned the vaccine, Salk said, “Well, the people, I would say. There is no patent. Could you patent the sun?”
After the oral poliomyelitis vaccine (OPV) was developed in the late 1950s, mass vaccination campaigns were more feasible due to its ease of administration; this type of vaccine is now more commonly administered in areas outside the United States. Since the 1980s, the global polio infection rate has declined by 99%, a success attributed to the introduction of the Global Polio Eradication Initiative (GPEI). Over the past few decades, Palestinian vaccination efforts have been a success story, largely because parents could easily bring their children to the hospital to receive scheduled vaccinations. “The occupied Palestinian territories had a very high vaccination rate, and that is why we were quite successful in eradicating polio,” says Dr. Hamid Jafari, Director of the Department of Polio Control for the WHO Eastern Mediterranean Region. “According to regular vaccination schedules, children in Gaza were vaccinated very often.”
From 1995 to 1999, annual national vaccination days were held in the West Bank and Gaza Strip, during which the more common OPV vaccine was also administered. According to the UN, Gaza has been polio-free since 1999. According to Jafari, the vaccination rate before the war was as high as 99 percent.
The resurgence of polio in Gaza is believed to be caused by the same strain that struck Egypt in late 2023. The virus may have been circulating among Gaza victims since September last year. Although there is now a vaccine that can stop the virus, it can still spread rapidly through contact with feces – a problem now exacerbated by the combination of the displacement of masses of Palestinians and the fact that, according to the UN, all five of Gaza’s sewage treatment plants have been closed, allowing sewage to flow freely into the streets. “Remember that polio is spreading in already neglected areas – areas without access to the slightest help,” says Jaber.
Read more: The infants among the war dead
However, the fact that both inactivated polio vaccine (IPV) and OPV are readily available does not mean that vaccination efforts are necessarily easy – and the situation in Gaza is only exacerbating this difficulty.
Of Gaza’s 36 hospitals, only 16 are partially functioning today. Of the 107 primary health care facilities, less than half are still operating, Jafari says. The vaccines themselves must be stored at optimal temperatures to remain effective and are connected to refrigeration equipment that requires a stable power supply that Gaza lacks. The trucks transporting the vaccines and equipment also require fuel – a resource that Israel has blocked from entering Gaza. Even basic hygiene practices that prevent the spread of infectious diseases such as polio are difficult. In Gaza, “Israelis have severely restricted access to hygiene products such as soap, toilet paper, cleaning products and towels,” says Jaber, the doctor in Khan Younis. “They have turned them into luxury items that most cannot afford.”
The virus’s form also presents a risk in itself, as it can mask illness behind common symptoms. “(They) typically include symptoms of the stomach flu, like nausea, vomiting and diarrhea,” says Dr. Michael K. Wroten, who directs a clinic for polio survivors at Medstar National Rehabilitation Hospital in Washington, DC. Children in Gaza have been affected by the spread of other infectious diseases before. The proliferation of all types of disease makes it difficult to identify the root cause of such symptoms. “Polio is a nightmare to even think about,” agrees Jaber, who works in clinics in Gaza between shifts. “We doctors don’t have the facilities to treat a child with diarrhea. Now we have to worry about that.” (Plus, polio’s long-term effects, such as paralysis, are especially hard to deal with in places that lack infrastructure, meaning people with disabilities are inaccessible both physically and professionally. “These factors can impose significant emotional and financial burdens on those affected by polio, their families and communities,” says Wroten, “particularly in times of conflict when resources are already scarce.”)
A UN vaccination campaign is to send 708 teams to Gaza’s hospitals – most of which are barely operational. But the logistics are daunting. At least two rounds of vaccinations are planned to treat all children under 10 in Gaza. This comes after two more cases of acute flaccid paralysis, a symptom of polio, were confirmed in the area on Tuesday, in a 5-year-old and a 10-year-old. According to Jafari, the GPEI plans to roll out the novel oral polio vaccine type 2 (nOPV2), a modified version of the vaccine used in Gaza in the past that is more effective in emergency conditions.
“Without proper interventions like vaccination campaigns,” says Wroten, “we could have widespread polio outbreaks in a matter of months.”
But while the UN has called for a “polio pause” in the fighting to carry out its campaign, several people familiar with the situation argue that fighting the virus in Gaza requires a real ceasefire. “As far as carrying out these polio vaccination campaigns, there should be peace,” Jafari says. “…and if peace cannot be achieved, if a ceasefire cannot be implemented, at least periods of calm … should be very clearly established so that the program can communicate very clearly to these communities when it is safe to bring their children for vaccination.”
Read more: Britain’s new government is under pressure to turn the tide on the Gaza issue
“We all want to have hope,” says Dr. Susan Kullab, an infectious disease specialist who volunteered in Gaza in May for the Palestinian American Medical Association and the Jordanian American Physicians Association. She points out that health workers there do not have reliable internet access to communicate with each other. “But the reality is that without a ceasefire, that is very difficult. Even if (the vaccines) do arrive, how are they going to make sure that the children get them?”
Edward Ahmed Mitchell, deputy director of the Council on American-Islamic Relations, puts the argument even more clearly: “No vaccination campaign will be successful as long as the population is actively experiencing genocidal bombing.” The UN’s plan to ship vaccines will not work without cooperation from Israel and Hamas, he notes.
The resurgence of polio cases in Gaza after 25 years underscores the devastating impact of the war on public health. “A ceasefire is the only way to ensure public health security in Gaza and the region,” the WHO said in a statement on Friday. As history has shown, polio is a formidable enemy and the future of countless children in Gaza remains at risk.
