Polio vaccination in war-torn Gaza facing logistical nightmare

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Calls are intensifying for a “vaccine ceasefire” to tackle the logistical challenges of a critical campaign to immunise 640,000 children in Gaza, following its first polio case in 25 years.

The World Health Organisation, Unicef, Gaza's local health authorities and other groups are planning to vaccinate children under 10 in the last week of August. However, executing that plan effectively presents a logistical nightmare, as Israeli attacks continue to displace thousands of civilians, targeting roads, critical infrastructure and wastewater systems, all of which complicates efforts to control the spread of the highly infectious disease.

The UN vaccination campaign will include setting up a “cold chain” or a system to ensure that the 1.2 million vaccines are stored at a controlled temperature from the time that they are manufactured to the moment they are administered. Since the breakdown of the medical system in Gaza, and the absence of a single fully functioning hospital, doctors will have to go from “tent to tent” to administer vaccines in a place where nine out of 10 people have been displaced by war.

Unicef's spokesman Jonathan Crickx told The National from Jerusalem that overcrowding in tents, where there is no infrastructure, nor proper toilets, sewage or waste water treatment systems, as well as the hot weather, further exacerbates existing problems and makes it crucial to be able to operate without the threat of violence.

“That’s the only way to put back together a proper functioning health system, functioning water distribution system, or any of the things that are needed to prevent the spread of the disease – and that’s why for months now, humanitarian actors have asked for a humanitarian ceasefire to be put in place in Gaza,” he explained.

Last week, UN Secretary General António Guterres called for the warring parties in Gaza to guarantee humanitarian pauses in the fighting so a polio vaccine campaign can be conducted. But reaching a deal between warring parties has become more difficult despite Hamas's approval of a US proposal in May due to additions later made by Israeli Prime Minister Benjamin Netanyahu.

Still, the UN campaign aims to ensure that at least 95 per cent of Gaza's children are vaccinated, from the current 89 per cent. Part of that operation will involve removing limits by Israeli authorities on what is being allowed into Gaza, the US-based International Rescue Committee (IRC) said in a statement on Thursday.

“Restrictions must be removed by Israel on the entry of materials such as water chlorination supplies, fuel to run water systems and equipment such as water pumps, solar panels and generator systems to help rebuild Gaza’s water infrastructure, and provide clean water,” Dr Jude Senkugu, the group's Emergency Health Co-ordinator for the occupied Palestinian territory, affirmed.

Pre-war success story

Dr Zaher Sahloul, chief of the humanitarian charitable non-governmental organisation MedGlobal, told The National his group faced challenges when bringing in medical supplies, despite receiving clearance from Israeli authorities.

“There were medical supplies, dressing tubes for patients, catheters, suture kits, ventilators, hospital beds and oxygen cylinders,” he said. “We sent them the list of supplies and they approved their entry through the Rafah border. But when the items arrived from the US to Egypt to be dispatched to Rafah, we were told we couldn't bring them in because of the oxygen cylinders. Not only did they return those items, they returned the entire shipment including things that are not of dual use.”

The entry of medical equipment has become even more restricted, he added, with doctors coming from abroad only able to bring in one bag of supplies, compared with the previous 25 or so.

The situation in Gaza was not always so abysmal. The coastal territory used to be a “success story” for the eradication of polio and had a 99 per cent vaccination rate, according to the US-based MedGlobal chief, whose group is participating in the WHO-led vaccination scheme in Gaza and has 16 primary health clinics in the Strip.

Medical advances and widespread vaccination campaigns worldwide have rendered new cases of polio rare, with only a few hundred reported every year. It had been declared eradicated in the occupied Palestinian territories for at least 25 years until its detection in Gaza's sewage samples and later in a 10-month-old child.

Dr Sahloul's experience in Syria at the start of the 2011 war demonstrated that a single polio case quickly escalated to 36, necessitating a vaccination campaign targeting “millions” of children. “Now, in Gaza, one case is too many,” he warned.

There are at least two other suspected cases of infections in Gaza, with symptoms including acute flaccid paralysis, a condition that results in complete immobility.

“This is the hallmark of polio and if these cases are confirmed, that means there are other children who may be harbouring the virus and don't have symptoms. This is because only one out of 200 children who contract the virus will have symptoms,” Dr Sahloul said.

Paralysis related to polio is “irreversible and incurable, leading to lifelong disability and sometimes death”, he said.