OPINION: Why You Should Be Worried about Polio in Gaza

Damage in Gaza provides ideal conditions for polio to spread (Wikimedia Commons).

Palestinian health officials confirmed the first case of polio in their territory in more than 25 years in August. Initial concern from international experts including the World Health Organization and the United Nations started in June after wastewater testing indicated the presence of the virus, according to the Guardian.

Gaza, like many warzones, is an ideal transmission site for the poliovirus. Residential areas and evacuation sites with limited access to clean water, streets filled with untreated sewage, and a lack of sanitation equipment allow the virus to rapidly spread through contaminated food and water, according to Science.

One in 200 poliovirus infections leads to paralysis, according to the Pan-American Health Organization (PAHO). A 10-month-old Palestinian baby paralyzed in one leg, as reported by the Associated Press, indicates that levels of community transmission are high in Gaza.

Additionally, with nearly two million Gazans displaced, as reported by the United Nations Population Fund, polio can continue to spread into neighboring countries.

This country-to-country transmission is the probable mechanism for polio’s arrival in Gaza. According to the New York Times, this strain most likely emerged in Nigeria, before spreading to Chad where it was detected by genetic analysis in 2019. The virus was in Sudan by 2020, before surfacing in unvaccinated populations in Egypt.

"Humanitarian situations put populations at risk for infectious diseases, especially children. The recent polio outbreak in Gaza shows the interconnection between human health and the environment. Without access to strong health systems that provide appropriate vaccines and care, and safe drinking-water, sanitation, and hygiene, nearly eradicated diseases like polio will continue to put those most vulnerable at-risk,” said Dr. Deise Galan, Adjunct Professor in Georgetown University’s Department of Global Health.

The re-emergence of polio in Gaza is not merely a coincidence of nature. Rather, it is the product of a system that deprioritizes disease mitigation when it is no longer perceived as an international concern.

Polio was eradicated from most of the world after the success of an injected vaccine campaign. Wild-type poliovirus remains endemic in two countries, Afghanistan and Pakistan. The type currently spreading in Gaza arises from a weakened form of the poliovirus that is shed after inoculation with a live virus, as reported by the New York Times. While this shed was expected, the combination of poor sanitation and a significant lack of vaccination in developing countries was not, allowing the virus to spread.

An international campaign to contain the transmission of this strain failed, in part due to administrative failures and the COVID-19 pandemic, per the New York Times. Poliovirus can only thrive among unvaccinated populations.

In the United States, widespread vaccination campaigns permitted WHO to declare the virus eradicated in the 1990s, allowing the disease to fade from public consciousness. However, in Gaza, the breakdown of the healthcare system during the war has resulted in at least a ten-percentage-point drop in routine polio vaccination rates, per WHO. As reported by NPR, since the war began, Gaza’s children have been unable to access vaccines and have no choice but to use untreated water where diseases can easily spread.

Gaza today faces a perfect storm for polio transmission. But polio is not the only disease that infects during a conflict. Syrian refugees fleeing a state with a severely damaged medical system spread tuberculosis, and tuberculosis-drug resistance, into neighboring countries, as studied by Ismail et al. (2018). In the Democratic Republic of the Congo, conflict helped produce the second-largest ebola outbreak in history, as it affected vaccination effectiveness and even reversed declining trajectories of the epidemic, according to Wells et al. (2019).

Diseases thrive when the world focuses on weapons and not bandages, when violence interrupts humanitarian medical aid where it is needed the most, and especially when these diseases are not believed to have an impact on the countries with the resources to fight them.

In Gaza, public health officials pushed for a humanitarian pause for more than a week after the first case was confirmed. International pressure, including from United States Secretary of State Antony Blinken, ensured a critical three-day break for vaccinations, per CNN.

The heroic efforts of doctors, nurses, and administrators who entered Gaza, one of the deadliest places to be a health worker, reports CNN, cannot be overlooked. Their organized response resulted in the vaccination of more than half a million children, per UN News, with the Director-General of the World Health Organization Dr. Tedros Adhanom Ghebreyesus calling the campaign a “massive success amidst a tragic reality of life.”

Yet their work is far from over. Polio vaccines require a second dose to be effective. This dose must re-enter a blockaded region, be preserved at a cool temperature, and be readministered to the same children, all in a territory where no hospital remains fully functional, according to the United Nations Relief and Works Agency.

Moreover, there is no guarantee of an additional pause in fighting. Even then, the health situation will not change unless improved sanitation and clean water become accessible.

The Washington Post asked in September if the outbreak of polio in Gaza was a threat to the United States. The author concluded that the risk was limited to people in communities with low vaccination rates.

While it is true that vaccines remain effective against the disease, and while it is true that the United States has a high rate of vaccination, the author’s perception is flawed.

This use of a threat/non-threat binary is what allowed polio to slip through the cracks long after it should have been eradicated. It is this distorted paradigm that permits dengue and rabies and tuberculosis to spread in the global South while developed countries forget about the diseases they once hoped to destroy.

The perception that a disease is not a threat because it does not pose a direct physical danger is deadly. Not only does it divert resources away from where funds are most needed, it also shifts priorities and overlooks the lives of millions of defenseless people.

Perhaps it is because polio is most likely to strike children that it is able to create forgotten casualties of war. These children, with the quietest voices in our society, are those most likely to suffer from a disease that humans know how to fix. If we fail to advocate for them because we decide this plague is not a threat to us, their struggles will persist, ignored, as this disease continues to infect.

So, you—yes, you—should be worried about polio in Gaza. Not because it will kill you, not because it will spread into your home, not because it will paralyze your children, but because it will do all of those things to someone else. Someone without the voice and the resources you command. Someone without the privilege to ignore its harm.

You should worry about polio in Gaza. You should worry about all the diseases we could have stopped. And you should worry that you weren’t worried before.

Josephine Balistreri is the Opinion Editor at The Caravel. The views expressed in this article belong solely to the author.