The Gaza Strip has reported its first case of polio in 25 years, posing significant challenges for health workers and aid agencies trying to launch a mass vaccination effort in the conflict-ridden territory.
Israel's relentless airstrikes, ongoing for more than 10 months against Gaza's rulers, combined with severe restrictions on aid and sweltering summer heat, threaten the success of this crucial immunization campaign.
Despite these hurdles, equipment to support the extensive vaccination drive, which U.N. agencies anticipate will begin on Aug. 31, has already reached the region.
The Palestinian Health Ministry in the occupied West Bank said last week that tests in Jordan confirmed polio in an unvaccinated 10-month-old baby from central Gaza.
According to the United Nations, Gaza had not registered a case for 25 years, although type 2 poliovirus was detected in samples collected from the territory's wastewater in June.
Poliovirus is highly infectious and most often spread through sewage and contaminated water – an increasingly common problem in Gaza as the Israel-Hamas conflict drags on.
The disease mainly affects children under the age of 5. It can cause deformities, and paralysis, and is potentially fatal.
U.N. bodies, including the World Health Organization (WHO) and UNICEF, say they have detailed plans to vaccinate 640,000 children across Gaza.
But Israel's devastating military campaign, triggered by Hamas' Oct. 7 incursion on the country's south, poses a major challenge to prevention.
"It's extremely difficult to undertake a vaccination campaign of this scale and volume under a sky full of airstrikes," said Juliette Touma, director of communications for the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).
Once eradicated
Under the U.N. plan, 2,700 health workers in 708 teams would take part, with the WHO overseeing the effort, said Richard Peeperkorn, the agency's representative in the Palestinian territories.
UNICEF would ensure the cold supply chain as vaccines are brought into and distributed across Gaza, spokesperson Jonathan Crickx said.
Cold chain components, including refrigerators, arrived Wednesday at Israel's main international airport.
Some 1.6 million doses of the oral vaccine will follow and are expected to enter Gaza on Sunday via the Kerem Shalom crossing, Crickx said.
The U.N. agencies plan to administer two doses each to about 95% of children under 10 in Gaza, according to Crickx. Surplus doses will cover expected losses to heat or other causes.
While Israel has repeatedly dismissed claims it is blocking aid into Gaza, relief workers have long complained of the many obstacles they face in getting supplies into the territory, which has suffered severe shortages of everything from fuel and medical equipment to food.
Once in Gaza, fighting, widespread devastation and crumbling infrastructure further complicate delivery and access.
Touma, who worked on polio response during wars in Iraq and Syria, said, "The return of polio to a place where it's been eradicated says quite a lot."
Israel's military campaign since Oct. 7 has killed at least 40,223 people in Gaza, according to the Hamas-run territory's Health Ministry.
The Hamas incursion that sparked the war resulted in the deaths of 1,199 people in Israel.
Safe environment
Gaza's health care system has been decimated, with "only 16 out of 36 hospitals ... still functioning, and only partially," Crickx said.
Of those, only 11 facilities can maintain the cold chain, he added.
The vaccines will first be kept at a U.N. storage space in central Gaza and then distributed to public and private health facilities as well as UNRWA shelters "hopefully by refrigerated trucks if we can find some, otherwise by cold boxes" filled with ice packs, Crickx said.
Many Gazans now live in makeshift camps or UNRWA schools, making them hard to reach, said Moussa Abed, director of primary health care at the Gaza Health Ministry.
Nearly all of the territory's 2.4 million people have been displaced at least once during the war.
U.N. Secretary-General Antonio Guterres has called for two seven-day breaks in the war to administer doses.
Abed said that "without a safe environment for the vaccination campaign, we will not be able to reach 95% of the children under the age of 10, which is the goal of this campaign."
Contacted by Agence Frace-Presse (AFP), an Israeli Defense Ministry body overseeing civilian affairs in the Palestinian territories, the Coordination of Government Activities in the Territories (COGAT), did not directly mention the planned U.N. campaign but said that, "On the issue of polio, a joint effort will be made together with the international community."
A COGAT spokesperson promised "full cooperation."