Polio Threatens Gaza as Vaccination Rates Collapse and Aid Groups Call for a Fighting Pause

A 10-month-old child in Gaza has tested positive for polio, according to the Ministry of Health in Ramallah, which said late Friday that laboratory tests in Jordan confirmed the case. It was not immediately clear whether this was one of the three suspected cases the World Health Organization and UNICEF had announced earlier that day, whose stool samples were also being tested in Jordan. The disease had not been seen in Gaza for 25 years.

The alarm began in July, when the WHO announced that sewage samples from six locations in Khan Younis and Deir al-Balah, in the south and center of the territory, had tested positive for a vaccine-derived variant of the virus. The weakened virus used in vaccines can mutate into a stronger form and cause outbreaks where immunization is poor. Outbreaks of this kind have occurred in Ukraine and Yemen, though conditions there are not nearly as bad as in Gaza. Polio is endemic only in Afghanistan and Pakistan.

Immunization has slipped sharply. Before the war, 99% of Gaza's population was vaccinated against polio; the WHO now puts the figure at 86% and wants it back above 95%. Mercy Corps estimates about 50,000 babies born since the war began have not been immunized. Polio spreads mainly through contact with contaminated feces, water or food, and can cause difficulty breathing and irreversible paralysis, usually in the legs. It strikes young children especially hard and is sometimes fatal.

Conditions in the camps favor its spread. Hundreds of thousands of displaced Palestinians are crowded into tents without clean water or proper disposal of sewage and garbage. Water and sanitation systems have been destroyed, leaving open pits of human waste. Families have little clean water or even soap, and sometimes use wastewater to drink or to wash clothes and dishes. A July report by the Netherlands-based nonprofit PAX, using satellite imagery, counted at least 225 informal waste sites and landfills around Gaza, many near where families shelter.

The response is a mass campaign planned for the end of August and into September, aiming to give two rounds of vaccine to 640,000 children under 10. The UN wants to bring in 1.6 million oral doses, a more advanced formulation less prone to mutating into an outbreak. Current stocks are thin: more than 440,000 doses arrived in December, and just over 86,000 remain, said Hamid Jafari, the WHO's director of polio eradication for the Eastern Mediterranean Region. The WHO and UNICEF say the campaign will reach every municipality with help from 2,700 workers.

Getting the vaccine in is only the first step. UN workers struggle to retrieve supplies because of Israeli military assaults, fighting with Hamas and growing lawlessness that has led to looted convoys. Vaccines need refrigeration, and electricity is scarce. A senior Israeli official with COGAT, speaking anonymously, said only 15 to 20 refrigerated trucks serve all of Gaza, and they must also carry food and other medical supplies. Only about a third of Gaza's 36 hospitals and 40% of its primary care facilities are working, according to the UN.

For families, reaching a clinic is its own obstacle. "There's no transport system. The roads have been destroyed and you have quadcopters shooting at people," said Sameer Sah of Medical Aid for Palestinians, referring to Israeli drones; Israel says its strikes target Hamas militants. Francis Hughes, CARE International's Gaza Response Director, said aid groups are preparing for the worst-case scenario of an outbreak within weeks or a month, and warned that overwhelmed doctors may miss warning signs.

The WHO and UNICEF say a pause of at least seven days is needed. COGAT said it is preparing to support a comprehensive campaign, and Hamas said Friday it would back a seven-day truce for the vaccinations. Cease-fire talks resume in Cairo next week, and whether they yield a pause will largely decide whether the campaign can start on time.