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In August, health officials recorded the first case of polio in Gaza in more than 25 years, in an unvaccinated 10-month-old baby whose lower left leg became paralyzed by the virus. Sadness and frustration washed over me when I first heard the news. It is outrageous that polio — which is highly contagious and can cause paralysis, respiratory failure, cardiovascular collapse and even death — has been permitted to reappear in Gaza after being nearly eradicated across the globe.
In response, the World Health Organization and other groups began a huge campaign to vaccinate more than 640,000 children in Gaza. As a humanitarian worker with Medical Aid for Palestinians, I’m part of that effort. I’ve worked tirelessly with our team and the W.H.O. to monitor the quality of the vaccination process. It is a daunting task to inoculate hundreds of thousands of children in an area under constant attack, especially because two doses are needed some weeks apart. And yet against all odds, we’ve been able to administer the first doses of the polio vaccine to 559,161 children. I have been heartened by the number of parents striving to protect their children from polio in such dangerous circumstances, and I am proud to be working on this huge public health effort.
Nevertheless, the continued threats to these children’s lives is distressing. Israel’s military agreed to a series of “humanitarian pauses” in select locations for the vaccination campaign. But what is the logic of allowing the vaccination of children for polio today, when tomorrow they will be threatened by cholera or another disease? Or struck by bombs or other weapons? Or subject to starvation? Celebrating the success of the vaccination campaign rings hollow when other dangers facing children in Gaza remain. Because of Israel’s military offensive, we are witnessing conditions that could allow infectious diseases to run rampant throughout Gaza and break out into the rest of the region.
Some two-thirds of all of Gaza’s buildings may have been damaged or destroyed by the Israeli military, and its siege has largely cut off access to food, water and electricity. About 1.9 million people have been displaced from their homes, myself included, and more than 10,000 children have been killed. Hospitals have been hit in what U.N. investigators call “deliberate attacks,” and only 17 out of 36 are even partially functioning.
This has led to a steep erosion of sanitation and humanitarian standards. A vast majority of Gaza’s 2.2 million people have been forced to evacuate into an overcrowded area that takes up only 11 percent of Gaza. This designated “humanitarian zone,” still frequently hit by Israeli military airstrikes, is far from humane. Water lines that supply the area have been cut, sewage floods the streets, and people have no choice but to live in tents because of constant evacuations and bombings. Many have been forced to use seawater contaminated with untreated sewage to wash themselves and their clothes. There is almost no soap or washing liquid available to buy.
As a result of these conditions, Gaza is facing a tidal wave of infectious disease that is already emerging. On a daily basis, our team’s medical points in southern Gaza now see around 180 children with skin rash diseases, such as impetigo and chickenpox. We treat what we can, but we don’t always have enough medication. Since last October, the United Nations has reported more than 40,000 cases of hepatitis A, compared with only 85 in the same period before. Cholera is not yet here yet, but many doctors fear it is only a matter of time.
Timely treatment can be the difference between life and death. And right now, lifesaving care is out of reach. Our colleague Natheer Khalafallah, an intensive care unit doctor at Nasser Hospital, died in late August from severe liver failure after contracting hepatitis A from polluted drinking water. Dr. Khalafallah was referred for medical evacuation from Gaza in order to get treated. But since Israel’s closing of the Rafah crossing on May 7, medical evacuations remain generally suspended. Today, an estimated 12,000 patients have been unable to leave Gaza to receive urgently needed medical care.
Even in the hospitals that are still functioning, shortages of all kinds of materials make these places a potential hotbed for diseases. I have seen surgeons performing complex surgeries wearing only sterile gloves, without gowns or drapes. Some have had to operate in the dark. Many have worked without antiseptic. I have seen people die from the lack of supplies and medication, or because they were too weak from malnutrition to recover from their wounds.
The effects of malnutrition are especially pernicious, particularly when it comes to infectious disease. Vaccines may not confer their full protection if someone is undernourished. The hundreds of thousands of children we are vaccinating against polio may still be at risk of infection simply because they are living with constant hunger.
The Israeli military’s daily bombardment of Gaza not only continues to push faltering health care services to their limits; it also threatens survivors of illness with injury and death. Where we work, children will be vaccinated in the morning and then arrive in the hospital in the evening as casualties from airstrikes. On Sept. 5, one hour after the vaccination drive finished for the day, my colleagues at Nasser Hospital received a mass influx of patients, including a child whose hand had been blown off in an Israeli military attack. On that same day, displaced people sheltering in tents, including children, were hit in an airstrike next to Al Aqsa Hospital.
An infectious disease catastrophe threatens to unfold across the region — whatever gets a foothold in Gaza will not stay in Gaza. Stopping it will require international action to push for an agreement to an immediate and permanent cease-fire. It is vital that the Israeli military end restrictions on the delivery of food, clean water and other aid that can preserve existing institutions and health care centers. Rebuilding the health care system throughout Gaza will require reopening border crossings and ending the blockade. While bringing in international doctors and establishing makeshift clinics may offer a temporary solution, an enduring health care system that responds to Palestinians’ needs quickly and effectively must be managed and led locally, based on existing infrastructure.
Children in Gaza need so much more than just a polio vaccination. They need all their rights to health and dignity to be met: the right to safety from military attacks, the right to play, the right to move, the right to education, the right to get medical care and the right to food and shelter.
Mohammed Aghaalkurdi leads the medical program in Gaza for Medical Aid for Palestinians.
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