(Photo by Defense Visual Information Distribution Service via NARA and DVIDS Public Domain Archive/PDM 1.0 DEED)
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Renad Attallah is a 10-year-old chef in Gaza with over 770,000 followers on Instagram and 460,000 followers on TikTok. Her September 3, 2024 Instagram post reads: “Vaccination done.” The post includes photos of Renad at an outdoor vaccination site and a video of her and another child receiving drops of the oral polio vaccine. Renad is one of over 187,000 children vaccinated during the first phase of a coordinated polio vaccination rollout across Gaza.
In July 2024, the Gaza Health Ministry discovered a strain of polio called poliovirus type 2 in the sewage. The declaration of a polio epidemic has caused global concerns, considering the current rarity of the disease. Before now, a largely successful global polio eradication programme reduced the incidence of wild poliovirus to just two countries worldwide.
According to the Global Polio Eradication Initiative (GPEI), the number of people contracting polio globally is now at 1%, compared to 1988. However, polio is highly contagious and could spiral out of control if not contained. The Gaza Health Ministry has warned that thousands of people are now at risk of contracting polio in Gaza and its surrounding areas.
History of the Polio Vaccine
For most of the 20th century, scientists viewed polio as a major global threat because it is highly contagious and incurable. Although some patients experience only mild symptoms, polio can cause paralysis and respiratory problems if the virus attacks the nervous system. Before the development of a vaccine, an average of 500,000 people per year lost their lives or were left paralyzed as a result of contracting poliovirus.
The 1950s saw the development of both an oral and injected vaccine for polio. Medical teams have been using the oral polio vaccine in Gaza because it prevents community transmission during variant type 2 polio outbreaks. Since the 1950s, the number of reported polio cases has notably declined thanks to the polio vaccines and coordinated global efforts. However, international organizations like the GPEI warn against complacency regarding polio.
The Re-Emergence of Polio in Gaza
A baby named Abdul Rahman became the first confirmed child to contract polio in Gaza in over 25 years. His condition paralyzed his legs. His mother told Al Jazeera, “The dirty water and lack of nutritious food made Abdul Rahman sick. I think contaminated water, the kind they distribute to us, is the main reason for the spread of polio.”
Like Abdul’s mother, experts have blamed the reemergence of polio in Gaza on Israeli forces’ destruction of vital infrastructure, including drinking water facilities, sewage systems and wastewater management. Due to the mass displacements of Palestinians in Gaza, thousands are living in very cramped conditions. Without proper infrastructure, wastewater and sewage have begun to build up in these crowded areas. As there is limited access to hygiene facilities, water or waste droplets contaminated with poliovirus can be easily ingested through the mouth, allowing the virus to enter the body.
Many children in Gaza have also missed their routine vaccinations due to widespread displacements and the collapse of healthcare facilities. These harsh conditions have similarly led to outbreaks of hepatitis and meningitis, all contagious diseases contracted from fecal-oral transmission.
The context of the polio epidemic in Gaza is comparable to the re-emergence of polio in Syria in 2013. According to Dr Hamid Jafari of the World Health Organization (WHO), Syrian children missed their polio vaccinations because of the “breakdown of health services” due to the armed conflict between government and rebel forces. Thirty-six children contracted polio in Syria between 2013 and 2014. Until that point, there had been no polio diagnoses in Syria for 14 years.
Vaccine Rollout in Gaza
When the Gaza Health Ministry announced the detection of poliovirus type 2 in July 2024, the Israeli Defense Forces (IDF) began vaccinating soldiers operating in Gaza almost immediately. According to UNICEF, “[vaccination] is the only way to prevent polio infection.” Yet, it took until late August for the Israeli government to agree to so-called ‘humanitarian pauses’ that would allow for the rollout of a vaccination programme for children under ten years old.
The Palestinian Health Ministry, WHO, UNICEF and UNWRA have been working to vaccinate 640,000 children in Gaza. Health teams completed the third and final phase of the first round of vaccinations on the 11th of September. The WHO aims to complete a second round of vaccinations within a month of the first.
However, medical staff have described challenges due to the poor state of medical infrastructure and roads in Gaza caused by bombing. Israel also attempted to stall and prevent medical teams from entering certain parts of Gaza. In a recently published statement, the United Nations described an incident in which members of their medical personnel were questioned and held at gunpoint by IDF members for seven and a half hours.
Despite these hurdles, health teams reached 82% of their set target. Following the first phase of the vaccination rollout, the WHO acknowledged the bravery and dedication of the many families who came to the vaccination sites despite the dangers.
Vaccine Skepticism
Although United Nations spokesperson Stéphane Dujarric unequivocally confirmed the safety and effectiveness of the oral polio vaccine, some are skeptical about the vaccine rollout. Arwa Damon from the International Network for Aid, Relief and Assistance is uncertain that the rollout will succeed. He states Israel is using the polio vaccination drive as a “smokescreen” to distract from their violations of humanitarian law.
Some Palestinians have even taken to social media to express concerns about the safety of the polio vaccine. Bisan Owda is a journalist documenting life in Gaza and has 4.7 million followers on Instagram. She is among those encouraging families to carefully consider the decision to vaccinate their children against polio. In a video posted on September 1st, she said, “The Israeli occupation killed a whole generation. 17 thousand kids! How can I trust their trials to allow the vaccines to enter [the] Gaza Strip?” Suspicions stem from Israel’s admittance of vaccines into Gaza despite withholding food, drinking water and other vital medical supplies.
In recent years, there has been a decrease in the number of vaccinations given to children throughout the Middle East and North Africa. UNICEF has reported that the issue is particularly pressing in areas of conflict such as Palestine, Yemen, Syria and Sudan. In Palestine, there is also a lack of confidence in the international community and international organizations, which drives vaccine skepticism. During the COVID-19 pandemic, many Palestinians in Gaza chose not to be vaccinated because they did not trust the vaccine or believe that the virus was real. Others simply did not see the point in being vaccinated while under threat from bombing.
A social media activist told Al Jazeera in 2021, “People have generally relaxed precautionary measures such as wearing masks. They say, ‘We didn’t die in the war, so how are we going to die from a virus?’” Humanitarian organizations have expressed serious concern about vaccine skepticism, considering widespread vaccinations are the only reliable way to prevent community transmission.
The Children of Gaza
Many are finding it hard to be optimistic about the polio vaccinations. As a mother in Gaza describes, “I gave my children the polio vaccine to protect them from disease, but I can’t protect them from strikes and death.” Similarly, Karam Yassin, aged 10, states that the polio vaccine is “only useful against polio” but that he really wants to have a normal life where he can access education, nutrition and play with his friends.
Health experts have warned that deadly and contagious diseases will continue to spread rapidly unless Israel halts its genocidal campaign in Gaza. Nicola Perugini from the University of Edinburgh states that Israel is responsible for the rampant spread of diseases in Gaza. He defines the actions of the IDF as “attrition genocide,” meaning that they have caused preventable deaths by damaging vital infrastructure.
In the meantime, Renad continues to capture the hearts of her 760,000 Instagram followers with her cooking videos and radiant positivity. Yet, her smile disguises the harsh reality of her and many other Gazan children’s currently dire conditions. In a video posted on August 18th, she said, “In any second, a displacement could happen or shelling, so that stops me from making videos.”
WHO, GPEI and UNICEF may have applauded the relative success of the vaccination programme so far. However, many people in Gaza do not feel they have any reason to celebrate. Polio is just one of the risks to lives in Gaza. The vaccination programme may prevent the virus from spreading internationally but does not stop bombs and displacements. It does not rebuild schools or regrow lost limbs. Until there is a permanent ceasefire, Gaza’s children will continue to live in this nightmare. As Tedros Adhanom Ghebreyesus tweeted on 1st September, “Ultimately, the best vaccine for these children is peace.”
Edited by Qiu Guan
