TThe polio virus was detected in sewage samples in Gaza last week, an alarming but hardly surprising development given the state of disarray of the territory’s health systems after nine months of bitter war.
Across the Gaza Strip, more than 39,000 people have been killed, 89,000 injured and more than 10,000 are reportedly missing. Most hospitals are no longer able to function. Diarrheal diseases, respiratory infections and hepatitis A, among others, are already rampant in Gaza. Almost everyone in Gaza faces acute food insecurity and catastrophic hunger. Thousands of children are malnourished, making them even more vulnerable to disease.
About 2.3 million people live on 365 km² (141 sq mi) The Gaza Strip has become even more concentrated due to limited access to clean, safe water and deteriorating sanitation conditions.
Since the beginning of May, nearly a million people have been transferred from Rafah to Khan Younis and Deir al-Balah, where the polio samples were detected.
Although no cases of polio have been recorded to date, without immediate action it is only a matter of time before the disease reaches the thousands of children who have been left unprotected. Children under five are at risk, especially infants under two, as many have not been vaccinated during the nine months of conflict.
The World Health Organization (WHO) is sending more than a million doses of polio vaccine to Gaza, which will be administered in the coming weeks to prevent children from becoming infected with the disease. However, without an immediate ceasefire and a massive acceleration of humanitarian assistance, including a targeted vaccination campaign for young children, people will continue to die from preventable diseases and treatable injuries.
Time and again, we have seen polio thrive in places affected 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 under-immunized populations – paralyzed 74 children. Today, in Somalia, a decade-long civil war has resulted in the world’s longest unbroken chain of variant poliovirus transmission, circulating since 2017. In Afghanistan and Pakistan, the last two countries where children are paralyzed by wild polio, humanitarian crises and insecurity have prevented the world from eradicating the virus for good.
Today, children stranded in Gaza face the same threat and have no recourse. Before the conflict, vaccination coverage was 99%. Today, that rate has dropped to 86%, which is dangerous because it creates pockets of unvaccinated children, where the virus can circulate. The decimation of the health system, insecurity, destruction of infrastructure, mass displacement, and shortages 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 primary health care facilities are operational. At the same time, 70 percent of Gaza’s sewage pumps have been destroyed and no sewage treatment plants are functioning. These conditions provide fertile ground for the spread of disease.
In this dire context, health workers are risking their lives to treat the sick, from working without electricity to testing sewage samples for deadly diseases. The fact that polio was detected in Gaza before a large-scale paralytic polio outbreak is a testament to these incredible efforts, given that the disease surveillance system has been severely curtailed due to insecurity.
For more than three decades, the Global Polio Eradication Initiative—comprised of Rotary International, the U.S. Centers for Disease Control and Prevention, WHO, UNICEF, Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation—has helped health authorities around the world build and maintain resilient disease surveillance systems that can detect the virus and other emerging health threats, no matter the circumstances.
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In Syria in 2017, these systems helped identify and stop the outbreak after a few door-to-door vaccination campaigns. Last year, surveillance in Ukraine revealed an outbreak of variant poliovirus. Two children were paralyzed before a rapid vaccine response stopped the virus.
In the face of enormous danger and challenge, the international community has a responsibility to leave no one behind and to prioritize health and well-being. This is not unprecedented: from the civil war in El Salvador in the 1980s to the conflict in Sudan’s Darfur region in the early 2000s, ceasefires, known as “days of tranquility,” have been brokered to pause wars and ensure that lifesaving vaccines reach communities trapped in inaccessible, conflict-affected areas.
Today, the detection of polio cases in Gaza is yet another reminder of the dire living conditions of the population. Continued conflict will not only worsen the death toll in the territory, but will also hamper efforts to identify and respond to preventable health threats like polio.
Although immediate efforts are underway to vaccinate every child against polio, a ceasefire and continued humanitarian assistance are the only effective ways to protect populations 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 acknowledges the Bill & Melinda Gates Foundation’s support for polio eradication. The Guardian’s global development journalism receives support from the Bill & Melinda Gates Foundation through theguardian.org. For more information on how the Guardian ensures its editorial independence, click here