By Ikram Mezghani

Imagine waking up with a sudden fever that leaves your muscles aching, and as the days pass, moving your limbs becomes impossible.

For much of the early 20th century in the United States, that was a reality for many patients who contracted polio. Poliovirus is a highly contagious but often silent disease for most carriers, though it posed a unique threat to children under five years old. The virus is transmitted through the fecal-oral route, typically through contaminated food and water. Inside the body, the virus replicates in the throat and intestines, where it can invade the bloodstream and, in some cases, reach the nervous system.

While most infected patients present with mild flu-like symptoms, 1 in 200 infections can lead to often-irreversible paralysis resulting from viral attacks to the nervous system. Poliovirus can cause lifelong disability, and in the most severe cases – when it targets the respiratory system – it can be fatal. What makes poliovirus particularly dangerous is its ability to spread rapidly, especially in areas with inadequate sanitation and where people are in close proximity. President Franklin D. Roosevelt, who was partially paralyzed due to polio, recognized the urgent need to fight this devastating disease, leading him to establish the National Foundation for Infantile Paralysis, known today as the March of Dimes. This organization became a key player in funding Dr. Jonas Salk’s research that led to the development of the first polio vaccine in the early 1950s. Committed to equitable access for all, Salk ensured that the vaccine’s formulation and production processes were shared without personal profit for himself. This echoed the beliefs of the insulin discoverers, who similarly prioritized saving lives over financial gain. With this major and affordable breakthrough, the polio vaccine could be widely distributed to children across the country, and eventually, the world, saving countless lives.

Today, although polio is incurable once contracted, it is entirely preventable in never-infected individuals through vaccination. The development of the polio vaccine is one of the most successful public health achievements in history. The oral polio vaccine and inactivated polio vaccine have been instrumental in nearly eradicating the disease worldwide. In fact, since the 1980s, the global incidence of polio has decreased by over 99%, with only a few countries still reporting cases. Vaccination efforts protect individuals while helping to build “herd immunity,” a term describing how at-risk individuals’ likelihood of disease exposure decreases when they are “insulated” by a community of fully vaccinated people. Herd immunity helps prevent viruses from circulating in the wider community. Despite these advances, devastating global crises – like the genocide in Gaza – can, and do, result in a resurgence of the disease.

Blockage and Genocide: Gaza’s struggle against disease and destruction

The ongoing genocide in Gaza has left hospitals and clinics on the brink of collapse, and with such disaster comes disease: poliovirus has recently been detected in Gaza’s wastewater.  

With 20 out of 36 hospitals no longer operational and the remaining 16 far from fully functional, Gazan healthcare resources are stretched thin and primarily focused on trauma injuries. As such, infectious disease patients face long delays, sometimes weeks, and receive little to no care due to a severe shortage of medical staff and medical supplies. Much of this critical shortage of healthcare resources is due to healthcare infrastructure, workers, and humanitarian personnel being targeted by Israeli military forces (Fig.1). Although the Israeli military has claimed such attacks are necessary for achieving their objectives, these types of attacks, including on healthcare centers, have resulted in an estimated 186,000 civilian deaths, including the killing of over 885 healthcare workers, as well as over 100,000 civilian injuries. The Geneva Convention and the United Nations (UN) have long established that military targeting of civilian healthcare infrastructure is a clear violation of international law.

These actions, combined with Israel’s blockade of food, water, fuel, and aid, has caused a catastrophic dearth of basic necessities in Gaza.  Due to the supply blockage and the infliction of starvation as a tactic of war, fuel and electricity are scarce, making it difficult to keep food supplies safe and healthy for human consumption. Meanwhile, sewage runs through the streets among accumulating piles of rubble and garbage as solid waste management has come to a halt. These conditions have resulted in increased, wide-ranging spread of various infectious diseases amongst Gaza’s distressed population – and among these disease risks is polio. While it seems that Gaza may avoid a full-scale polio outbreak for now, the outlook for its 2.2 million residents is grim.

The virus currently circulating in Gaza is vaccine-derived type 2 poliovirus. While oral polio vaccines (OPVs) have been critical in global polio eradication efforts, the weakened virus in these vaccines can mutate in under-immunized populations, becoming virulent once again. Areas with ongoing transmission continue to rely on OPVs to achieve high levels of community immunity within a short time, but places like Gaza face increased risk of mutation. In August 2024, a 10-month-old child in Gaza was paralyzed after being diagnosed with polio, marking the region’s first case in over two decades.  This has triggered international concern as high population density and poor healthcare access – precisely what is being seen in Gaza – increase transmission risks. Children are at heightened risk for severe polio; half of Gaza’s population consists of children, further intensifying the urgency for vaccination efforts.

In response to this crisis, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have mobilized a mass vaccination campaign, aiming to vaccinate the children and at least 90% of the population with the new oral polio vaccine type 2 (Fig. 2). This vaccine is engineered to be more genetically stable, reducing the risk of dangerous mutations that cause virulent disease. However, the ongoing bombardment and siege of Northern Gaza have severely impacted efforts to reach large swaths of young Palestinians for vaccination. Safety concerns, limited access, and continuous airstrikes complicate the situation, despite the UNICEF and WHO requesting a humanitarian ceasefire to safely conduct vaccination campaigns.

Polio is just one of many health challenges facing Gaza’s population. With water and sewage systems largely destroyed, other infectious diseases such as cholera, hepatitis A, and meningitis are also prevalent. Various reports have indicated rising cases of acute respiratory and diarrheal infections, which further complicate the effectiveness of polio vaccinations – the vaccinations are less effective in patients with already-weakened immune systems. Inadequate hygiene and insufficient medical supplies exacerbate these health issues, placing further strain on Gaza’s health services.

The polio outbreak in Gaza emphasizes the public health consequences of a prolonged humanitarian crisis. The Israeli regime’s impunity, along with the deafening silence from the international community – including, notably, from U.S. leaders – has exacerbated this health crisis and perpetuated a lack of accountability for those involved in prolonging these circumstances. The head of the United Nations’ Agency for Palestinian refugees (UNRWA) Philippe Lazzarini states, poignantly: “Polio does not distinguish between Palestinian and Israeli children”. Without coordinated action and long-lasting peace efforts, the spread of vaccine-preventable diseases like polio poses a serious threat not only to Palestinian children in Gaza, but to neighboring regions and eventually the globe.

Despite the devastating crisis and genocide unfolding in Gaza, humanitarian organizations are working tirelessly to alleviate the suffering of the Palestinian people, especially through initiatives led by dedicated medical healthcare workers on the ground. The WHO, UNICEF, and the Palestinian Child Relief Fund have been running polio vaccine campaigns despite intense bombardment, restricted access to the region, and what the United Nations Security Council has observed to be direct targeting of humanitarian personnel. By learning more about these efforts and contributing to such causes, you can also play a role in supporting emergency relief to vulnerable populations, especially children, who are impacted by this crisis.  

*Disclaimer: This article was written with the assistance of ChatGPT.

Photo Credit for Article Image: © 2024 Jehad Alshrafi/AP Photo