UN agencies and local health officials in the Gaza Strip are launching an ambitious campaign to vaccinate 640,000 children against polio.
The rollout is contingent on a series of local lulls in fighting between Israeli forces and Hamas fighters, with the first lull expected to begin on Sunday.
To be effective, at least 90% of children under the age of 10 must be vaccinated within a short period of time, according to the World Health Organization (WHO).
This follows the discovery of the first confirmed case of polio in Gaza in 25 years, with a UN expert saying more children are likely to be infected and a wider regional outbreak could occur if the virus is not tackled.
A video taken a few months ago shows baby Abdulrahman Abu Judyan crawling early. But now that he is one year old, his mother Niveen — who lives in a crowded tent camp in central Gaza — worries he will never walk.
“It was very shocking,” Niveen told the BBC, recalling her son’s recent polio diagnosis, which has left him partially paralyzed in one leg. “I didn’t expect this. Now he might not be able to crawl or walk and the child has been left without proper medical care.”
On October 7, the day of a shocking Hamas-led attack on southern Israel that killed 1,200 people, newborn Abdulrahman was scheduled to be routinely vaccinated, but it never happened.
During the ensuing war, the Abu Judyan family, originally from the far north of Gaza, moved five times: first to Gaza City, then to various locations in the centre, to Rafah in the far south and back to Deir al-Balah.
About 90% of Gaza’s residents have been displaced and the health care system is under great strain. Most children have stopped receiving their regular vaccinations, leaving them vulnerable to infection, like Abdulrahman.
“I feel very guilty that he didn’t get the vaccination. But I couldn’t give it to him because of our circumstances,” Niveen says, cradling her baby in a car seat. She fervently hopes her son can be taken outside Gaza for treatment. “He wants to live and walk like other children,” she says.
The mother struggles to find clean drinking water for her nine children. Raw sewage flows through the street near the makeshift tent where they live.
The conditions are ideal for the spread of diseases, especially polio, which is highly contagious.
Since the discovery of the virus in wastewater samples taken in June, UN agencies have been busy setting up an emergency vaccination program.
About 1.3 million doses of the vaccine were recently brought in through the Kerem Shalom checkpoint by UNICEF, the UN children’s agency. It had to keep them in cold storage in its warehouse at the right temperature to maintain their potency. Another shipment of 400,000 doses will be delivered to Gaza soon.
On Thursday, the WHO said it had reached an agreement with Israel for limited pauses in fighting to allow the polio vaccination program to take place, starting in central Gaza but then expanding to the south and north. Each “humanitarian pause” will last from 6 a.m. to 3 p.m. local time, spread over three days, with the option of adding an extra day if needed.
Jonathan Crickx of Unicef says it is crucial that these temporary ceasefires hold.
“You cannot conduct and implement a polio vaccination campaign in an active combat zone. It is simply impossible,” he says.
“Families need to feel safe bringing their children to get vaccinated, but health care workers also need to be able to reach communities safely.”
“This is a huge undertaking,” Mr Crickx added. “Especially in a place like Gaza, where we know, for example, that roads are damaged, that access is problematic and that security incidents occur on a daily basis.”
More than 2,000 workers — mostly locals — are involved in the vaccination effort. Palestinian health officials say there will be more than 400 fixed vaccination sites — including health centers, hospitals, clinics and field hospitals — and about 230 so-called outreach sites, community meeting places, where vaccines will be distributed.
Each child should receive two drops of oral polio vaccine in two rounds, the second four weeks after the first. It is essential that the program is implemented quickly to prevent mutation of the virus and to break transmission.
The polio strain that caused this latest outbreak is itself a mutated virus from an oral polio vaccine. This is because the vaccine contains a weakened live virus that is very rarely shed by those who receive it and can then evolve into a new form that can cause new epidemics.
As doctors in Gaza are extra alert for possible polio infections in children, tests are being carried out in a WHO-approved laboratory in Jordan.
“There could be more cases of paralyzing polio until this outbreak is stopped and this virus will paralyze more children,” Dr. Hamid Jafari, WHO director of polio eradication for the Eastern Mediterranean, told me from Amman.
He says the stakes are high for the entire region. “The risk is of course not just for Gaza, given the high transmission rate in Gaza, there is a risk that this could spill over into Israel, into the West Bank and surrounding countries.”
For now, however, the focus remains on Gaza, where children make up almost half of the 2.3 million inhabitants.
The past year has robbed many of their loved ones, their homes and their health. With no end in sight to the war, the hope is that at least one new source of suffering can be eliminated.
