Cease-fire: the only way to prevent a polio epidemic among Gazan and Israeli babies

A woman with a baby and a boy next a to a dark streak of sewage flowing into the streets of the southern Gaza town of Khan Younis, July 2024

Ora Paltiel, Ronit Calderon-Margalit, A. Mark Clarfield, Eldad J. Dan, Nadav Davidovitch, Hagit Hochner, Orly Manor and Dorit Nitzan write in Haaretz on 21 July 2024:

The polio virus, which is highly infectious, has been detected in sewage samples from Gaza, posing a new and yet anticipated threat to both Israelis and Gazans.

Conditions in Gaza, triggered by the horrific Hamas attacks against Israel on October 7, were ripe for the spread of vaccine-preventable infectious diseases. These include displacement, inadequate access to safe water, sanitation and hygiene, malfunctioning of the sewage system, crowded shelters, food insecurity and a collapse of the health care infrastructure, including vaccination services. The longstanding captivity of 120 hostages captured in Israel and still being held in Gaza, as well as the prolonged deployment of Israeli soldiers in Gaza, also places both groups at risk alongside Gazans.

Those at greatest risk are Gazan babies and Israeli infants, who have not completed their required vaccinations due to health service disruptions or their young age. They are not guilty of any crime, other than the dangerous circumstances they were born into.

The identification of the polio virus in Gaza reminds us that pathogens and toxic exposures know no borders. Polio can be spread for weeks by infected individuals who have no symptoms. The devastating consequences of this disease, including paralysis, long-term disability and death are well known.

Even countries where polio was officially eradicated have had outbreaks under conditions of war and conflict. Sadly, many public health officials, including some of us, have warned about this scenario for months.

The response to this threat needs to be multi-pronged, coordinated and comprehensive. It requires the cooperation of international organizations. In Israel, the current response will require the vaccination of all soldiers currently or recently in Gaza (a decision was just made to do so), hostages who have returned and those we hope will return soon, and those caring for them. In Israel, it will require attention to infants who have not yet been adequately vaccinated. In Gaza, international agencies will need to reach infants, humanitarian and health workers and immunocompromised adults.

Present conditions in Gaza make this a daunting task; the conditions of an ongoing war make it almost impossible. We, therefore, need a ceasefire – not only in order to free our hostages, but also to mount an extensive vaccination campaign for soldiers, those in contact with them and the civilian population of Gaza.

A ceasefire will enable efforts to improve the water, sanitation and hygienic conditions and to enhance food security, rebuild adequate shelter and rehabilitate Gaza’s health system. Hamas will need to cease all hostile activities, release all hostages and allow humanitarian agencies to do their work to promote access and accessibility to vaccines.

Palestinian children sort through trash at a landfill in Nuseirat refugee camp, Gaza Strip, June 2024

Experience from previous global conflicts[1] in Syria, Iraq, Yemen, Somalia and the Democratic Republic of Congo, teach us that we must act very quickly, and comprehensively to prevent further spread. Successes have occurred in areas where pre-conflict levels of vaccination were high (in Syria for example) but are highly dependent on the level of trust in those providing vaccines as well as on access to health care facilities where vaccines are dispensed.

Failures have been documented in areas where conflict is ongoing and where there is mistrust of health workers and poor accessibility to services. The State of Israel knows how to deal with this threat and has mounted campaigns in the past to ensure mass vaccination of people at risk, babies and immunocompromised adults. Historically, Israel also contributed to building the vaccination program and health facilities in Gaza, whose children had high levels of vaccination prior to the current war.

We know what needs to be done. It must be done for the sake of all residents of the region. This is not about politics. This is about health and life.

Ora Paltiel is Professor of Epidemiology and the Jerrold M. Michael Chair in Public Health at Hadassah-Hebrew University; Ronit Calderon-Margalit is Professor of Epidemiology and current director of the Braun School of Public Health and Community Medicine, Hadassah-Hebrew University; Mark Clarfield is Emeritus Professor, Faculty of Health Sciences, Ben-Gurion University of the Negev; Eldad J. Dann is Clinical Professor of Hematology, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa; Nadav Davidovitch is the Director of the Public Health School of Public Health, Ben-Gurion University of the Negev; Hagit Hochner is Associate Professor of Epidemiology at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine; Orly Manor is Professor of Biostatistics, Braun School of Public Health and Community Medicine, Hebrew University-Hadassah; Dorit Nitzan is Professor and Director of the Masters Program in Emergency Medicine – Preparedness and Response to Emergencies and Disasters, School of Public Health, Ben-Gurion University of the Negev

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