Tareq S. Hajjaj
Mondoweiss / August 2, 2024
In July health officials in Gaza detected the polio virus in the water. Now, the threat of a polio outbreak has been declared an epidemic, and officials are demanding an immediate ceasefire and vaccination campaign “before it’s too late.”
Sewage water is flowing in most of the streets of the Gaza Strip. Mountains of garbage are piling up next to crowded refugee camps and shelters. In some areas of the strip, children can be found rummaging through the piles of trash in search of food or scraps that their family can use.
Due to Israel’s targeting and destruction of Gaza’s water and sewage networks, millions of Palestinians in the crowded Strip have nowhere to dispose of waste other than the street. And with the total collapse of municipal and sanitation services, there is no one to collect the waste. The sanitation workers who try to reach the dumps near the border to dispose of waste are targeted by the Israeli military.
The families who live in tents near the piles of garbage and waste have to worry about more than just the putrid smells of hot, rotting garbage. Many, particularly children, have become afflicted with various rashes and unexplained skin conditions.
For months the Gaza Ministry of Health and other international public health agencies have warned of the spread of diseases due to the lack of clean water and untreated sewage in the streets. In mid-July, in cooperation with the World Health Organization, the Gaza health ministry conducted an analysis of samples of sewage water in the Gaza Strip, and found the presence of poliomyelitis, or as it is more commonly known, the polio virus.
The highly infectious disease, which in severe cases can cause paralysis or death, was eradicated in Gaza more than 25 years ago. The detection of the virus in July caused the health ministry and the WHO to set off the alarm bells. The ministry declared a ‘polio epidemic’ in the Gaza Strip, and the WHO called for immediate intervention to prevent the spread of the disease.
Though the Gaza health ministry has not yet announced any cases of polio in the population, doctors and health officials in Gaza say action must be taken before it’s too late.
Dr. Jamal al-Homs, Director of the Kuwait Specialized Hospital in Rafah, says that there has been a significant and noticeable increase in various epidemic diseases that are now spreading rapidly throughout the Gaza Strip.
“Today, the polio virus has returned due to the lack of a proper sewage system, the lack of clean and potable water, and the lack of the possibility of general hygiene due to the accumulation of garbage and the inability of citizens to maintain general hygiene,” he told Mondoweiss.
Al-Homs stressed that if the polio disease spreads in Gaza, there will be no way to stop it under the current conditions.
Dr. Ahmad al-Farra, the head of the pediatric department at the Nasser Medical Complex in Khan Younis, told Mondoweiss that the majority of diseases that children contract are caused by the spread of viruses among displaced families in the refugee tent camps.
In theory, polio, which affects the spinal cord and brainstem causing paralysis and difficulty breathing, “would find a suitable and hospitable environment to spread in the crowded tent camps,” Al-Farra said.
“If one of the individuals is infected, the spread of the disease will be swift due to the severe crowding and sharing of public toilets among the displaced,” he said.
“The solutions lie in personal hygiene and the use of soap, alcohol, and sterilizers,” al-Farra said. “But the Israeli occupation prevents the entry of these materials, and the fuel that is needed to operate the sewage treatment facilities.”
“The samples [collected by the MOH] showed polio type 2, which must be prevented by intramuscular vaccination,” he continued.
And while limited polio vaccines are available for newborns in some parts of Gaza, al-Farra said that the necessary vaccines to treat polio type 2 aren’t available due to the lack of electricity, which prevents hospitals and health facilities from storing the vaccine at the correct temperature.
“The health situation in the Gaza Strip is catastrophic,” al-Farra said.
‘We all have diseases that we don’t know about’
Next to mountains of garbage in the southern Gaza Strip city of Khan Younis, Mustafa Abu Luli, 53, sits underneath a tarp with his family. The family of five were displaced from Rafah to Khan Younis, and have been living in a tent for months. Every single member of the family suffers from some kind of skin disease or rash.
“We all have diseases that we do not know about and cannot find treatment for,” Al-Luli told Mondoweiss, holding up his sons one by one, revealing their bare bellies and backs, covered with bumps and rashes. “Our women have also been infected with hepatitis before, and are still suffering from the effects of the disease.”
As he spoke, Abu Luli pointed to the piles of garbage amassed next to the family’s tent. “This is the source of the diseases we are suffering from. We all have serious diseases and cannot find treatment. We tried and failed. All these diseases are due to the lack of water and cleanliness. But there is nothing we can do. We have nothing,” he said.
Next to Abu Luli’s tent, children walk on the mountains of garbage and dig for scraps. Anything could be useful: something that can be used to light a fire so their family can cook food; or maybe some scraps of food if they are desperate. After they dig through the trash, many of the children come back into the camps.
According to residents, they are surrounded by flies and other bugs, as well as wild dogs that come into the camps in search of food or drink.
“All the causes of death are available to us in the Gaza Strip. The piles of garbage are a disease, the lack of water is a disease, the tent is a disease, everything here causes diseases,” Abu Luli lamented. “The heat and the sun are diseases, the mosquitoes and flies are a disease, the dogs that attack our tents at night are a disease. Not to mention the bombing and destruction.”
“We are terrified of the spread of polio, especially since we are close to the sewage where they discovered the disease. Our children go there when they pass from one place to another or from one street to another. They can’t avoid it, because the sewage is spread everywhere” Abu Luli said. “If this disease spreads, we will die without anyone looking at us. If it infects someone in my family, they will die because we will not find a cure.”
According to doctors and public health experts, a host of preventable diseases and infections are already running rampant in Gaza, and with a barely-functioning health system, most people, like Abu Luli’s family, can’t get basic treatment.
“We notice many serious skin diseases coming to us from the displaced families, and there is no treatment for them,” Dr. al-Homs told Mondoweiss.
“Due to the problematic health conditions and catastrophic living conditions in light of the lack of treatments and the closure of crossings, it is expected that these diseases and the number of those infected with them will increase and thus represent a significant threat to citizens,” he said.
“The World Health Organization has reported tens of thousands of cases of lice and scabies,” Dr. Yara M. Asi, a Palestinian public health expert and the co-director of the Palestine Program for Health and Human Rights, told Mondoweiss.
“Thousands of cases of rashes that have spread very easily among children that are clustered together. Over half of the population has reported respiratory infections. There are very high reports of acute diarrhea, which for children under five can be quite lethal. There are tens of thousands of cases of jaundice,” she continued.
“These are easily treatable conditions. The tragic tragic part of this is that, by themselves, none of these need to lead to a health emergency. And yet the conditions that Israel has created and enabled will cause significant unnecessary suffering, disability, and death for people,,” Asi said.
“Largely because there is no capacity for people to receive care from advanced traumatic injuries like amputations, let alone something as basic as lice.”
Immediate intervention needed to prevent disaster
Following the news that the poliovirus was detected in the sewage water in Gaza, Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, said that the organization would send more than a million doses of the polio vaccine to Gaza and distribute them over the coming weeks to prevent children from being infected.
Ghebreyesus stated in an opinion piece in the British newspaper The Guardian, “Although no polio has been recorded so far, without immediate action, it will only be a matter of time before thousands of children become infected and become unprotected.”
Ghebreyesus wrote that children under the age of five are most at risk of contracting this virus, especially infants under the age of two, due to the disruption of regular vaccination campaigns as a result of the conflict that has been ongoing for nine months.
“Polio is almost entirely preventable with vaccinations. That’s part of what’s so devastating about this,” Asi told Mondoweiss. “This is completely predictable, completely avoidable.”
According to Asi, prior to October 7th, Palestinian vaccination rates for polio across the occupied territories, including the Gaza Strip, was about 99%. Since October 7th, with the decimation of the healthcare system, and the birth of thousands of babies who have been unvaccinated, that number has plummeted to about 86%.
“This is incredibly low. We have thousands of children missing all sorts of routine vaccinations,” she said. And while no cases of polio have been reported yet in Gaza, Asi warned that doesn’t necessarily mean no cases exist.
“There has been a communication blackout in many parts of Gaza. Many families are completely displaced. They’re not exactly in contact with health authorities. Many hospitals and health clinics are shut down, destroyed, and nonfunctional. So it’s not impossible that there are cases that simply haven’t been reported yet,” she said.
“The ramifications of a potential, or at this point, probable polio outbreak in Gaza are multifaceted,” Asi continued. “You have thousands, tens of thousands of babies that have been born since October 7th. We’re already seeing a very high infant mortality rate because of lack of care.
These children, many of them are not getting vaccinated. If they contract certain types of polio, they will be paralyzed for life. They will require lifelong treatments that, if they stay in the Gaza Strip, there is little capacity to provide.”
Emphasizing the need for a mass vaccination campaign, and for Israel to allow shipments of aid and medicine into Gaza, Asi pointed to the fact that the Israeli military had begun a campaign to offer polio booster vaccines to its soldiers following the news that the virus was detected in Gaza.
“The IDF recognizes that this is a problem… they don’t want [their soldiers] to return to Israel and spread polio there,” Asi said. “…And they’re taking care to make sure that their aquifers are protected because a polio outbreak they know is devastating to a population.”
“Viruses, as we learned during COVID-19, do not respect borders. So if polio were to spread through people exiting, humanitarian workers or others leaving the territory, it could be carried into Egypt and spread into the rest of the region,” she said.
“It’s frankly very terrifying. And that’s why I think the World Health Organization has really sounded the alarm, because it is naive to assume that this will, A, not escalate within Gaza, and B, has no potential to escalate elsewhere.”
Highlighting the WHO’s calls for an immediate ceasefire, Asi said that a cessation of hostilities to allow the entry of vaccines and permit health officials to distribute them to the population is the first, and most basic step to address the public health disaster in Gaza.
“The problem is we are past the point where a ceasefire alone is going to end suffering for people,” she said. “We will see the ramifications of this for months, years, possibly generations. The spread of disease is not going to stop the day of a ceasefire. That’s going to take weeks, months, again, potentially years to get under control.”
Tareq S. Hajjaj is the Mondoweiss Gaza Correspondent, and a member of the Palestinian Writers Union
Hassan Suleih conducted interviews for this report from the Gaza Strip. Yumna Patel contributed to this report
