- ‘We’re at a point now where it’s almost inevitable that there would be an outbreak,’ warns Francis Hughes, Gaza response head for CARE International 

- ‘We’re expecting a polio outbreak in the next number of days or weeks,’ Hughes, who is currently in Gaza, tells Anadolu 

- WHO considers there to be ‘high risk’ of polio spreading within Gaza and internationally, says spokesperson Tarik Jasarevic   

ISTANBUL

Warnings of an imminent polio outbreak in Gaza are growing as Israel shows no signs of either ending its deadly assault on the devastated Palestinian enclave or lifting a crippling blockade on essential supplies. 

Gaza’s Health Ministry declared the Palestinian territory a “polio epidemic zone” on July 30 after samples of the virus were detected in wastewater, triggering fears of a resurgence of a disease eradicated from the region over 25 years ago.

With millions of displaced Palestinians living in appalling conditions with no healthcare facilities or even basic medical supplies, experts see an outbreak of the viral disease as “inevitable.”

“We’re expecting a polio outbreak in the next number of days or weeks,” Francis Hughes, Gaza Response Director for global humanitarian agency CARE International, told Anadolu.

Polio is a particular threat to children under age 5 and especially infants less than 2 years old. The virus attacks the nervous system, leading to spinal and respiratory paralysis, and can prove fatal.

The World Health Organization (WHO) said last month that the vaccine-derived poliovirus type 2 (VDPV2) was found at six locations in sewage samples collected on June 23 from Gaza’s Khan Younis and Deir al-Balah areas.

According to the UN health agency, wild poliovirus was eliminated from the occupied Palestinian territories a quarter of a century ago.

With the detection of the virus, WHO spokesperson Tarik Jasarevic said the agency “considers there to be a high risk of spread of this strain within Gaza, and internationally, particularly given the impact the current situation continues to have on public health services.”

No clinical cases have been confirmed in Gaza so far but that is primarily due to a lack of surveillance and testing facilities.

“Acute flaccid paralysis (AFP) surveillance has not been functioning adequately, and surveillance has been suspended since Oct. 7 last year,” said Jasarevic.

As for immunization, he said vaccination rates in occupied Palestinian territories were “optimal” before the war, with routine coverage at 95% and above in 2022.

In 2023, polio vaccination coverage, primarily conducted through routine immunization, was estimated at 89%, according to latest WHO-UNICEF routine immunization estimates.

“In the past nine months, routine vaccination has been disrupted and tens of thousands of children under 5 years old are at risk of contracting polio and other vaccine preventable diseases,” said the spokesperson.  

Destroyed infrastructure

Hughes, who is currently in Gaza, said aid workers “could be missing the signs” of the disease.

“Our doctors and nurses have not been trained on how to identify the signs and symptoms of polio,” he said.

“There’s a strong possibility they have come to our clinic, but we haven’t necessarily identified them yet.”

Hughes said the situation in Gaza is one of the worst humanitarian disasters he has seen, with the deplorable health and hygiene conditions exacerbating the threat of polio and other infectious diseases.

He said most of Gaza’s infrastructure has been completely destroyed in Israel’s ongoing offensive, which has now killed nearly 40,000 Palestinians and wounded almost 92,000.

This includes water and sewage treatment plants, as well as basic water supply infrastructure such as pipes, he said, while access to water trucks is also gone as Israel is not letting in any fuel.

People throughout Gaza are forced to drink contaminated water and seawater, and “we have no way to test it either,” he said.

“When you drive through Gaza … there’s sewage everywhere,” said Hughes, warning that the situation will only get worse in the winter months when rains start.  

‘Extremely challenging circumstances’

Hughes pointed out that even if Israel is somehow made to let in vaccines and other critical supplies, there would still be massive hurdles to overcome.

“Once they (vaccines) get into Gaza, we need to roll out a vaccination campaign, but to do that in current situation is almost impossible,” he said.

Before any sort of vaccination campaign, there has to be “a lot of training for doctors and nurses” and everything is severely complicated as access to hospitals is very difficult, especially in the north of Gaza, he said.

“We’re at a point now where it’s almost inevitable that there would be an outbreak,” warned Hughes.

He said even aid workers “have been asked to quarantine for two weeks before they come into Gaza, if they come from a polio country.”

“This is putting more pressure on aid workers as we work all over the world and are coming to Gaza from different corners of the globe,” he said.

The WHO said a “socio-epidemiological investigation” in the field and a “risk assessment” are ongoing.

The agency will work with the local health ministry, including on vaccination campaigns and strengthening routine immunization and surveillance “as much as possible under the current extremely challenging circumstances,” said Jasarevic.

More than 90% coverage needs to be achieved to ensure cessation of an outbreak and mitigate the risk of re-emergence, according to the WHO.

“The decimation of the health system, lack of security, access obstruction, constant population displacement, shortages of medical supplies, poor quality of water and weakened sanitation … creates the perfect environment for diseases like polio to spread,” the spokesperson said.

“A cease-fire is essential to allow an effective response.”