Sewage has been flowing into the streets of Gaza for months after IDF attacks destroyed much of the infrastructure. | AP
After 25 years without polio, the blockade of Gaza has led directly to a confirmed case of polio, which could mark the beginning of a polio outbreak.
British biologist Peter Medawar described a virus as “bad news wrapped in protein.” The polio virus is a perfect example.
When a poliovirus-infected cell dies, it bursts open and can release up to 10,000 individual virus particles. Each of these contains the poliovirus genome in a protective shell that protects the delicate virus genome from destruction and allows it to survive for months in most environments.
This allows the virus to cause damage again when it encounters another cell. For example, if the feces of a person infected with polio contaminates drinking water, the virus particles will also float in the water. Once a particle is ingested by another person, it can activate itself and inject the virus genome into their cells, starting the cycle again.
The poliovirus needs humans to survive. As far as we know, it cannot infect any other organism. Most infected people show no symptoms, but in some cases it causes severe paralysis and death as a side effect of its spread through the body.
In the 1950s, more than half a million people worldwide were paralyzed or killed by the polio virus every year, most of them children. But with the introduction of vaccinations, the picture changed.
The polio vaccine was a dramatic success story, nearly eradicating the disease. If everyone in the world was vaccinated against polio, the surviving virus particles would slowly decay until polio was gone forever.
However, in a few places in the world, the virus particles can still multiply, causing flare-ups and a chain reaction among unvaccinated people.
The polio vaccine uses a weakened form of the virus. Unfortunately, in some cases, the weakened form of the virus used for vaccination can mutate and become active again.
Such occurrences are extremely rare, but with millions of people and trillions upon trillions of virus particles, small probabilities lead to measurable numbers of cases.
This vaccine-derived virus can then spread through the human population like a natural virus. Vaccine-derived strains are now the main cause of most polio cases worldwide.
In 2023, just over 500 cases of paralysis were reported worldwide. As long as vaccination rates are high, vaccine-derived strains pose no threat, but once they decline, the strains become dangerous to unvaccinated children.
Thanks to vaccinations and hygiene measures, Palestine has been polio-free for over 25 years. In 2022, the vaccination rate was estimated at 99%. But on June 23 this year, vaccine-derived poliovirus was found in wastewater samples in Gaza – an indication that the virus may be spreading in the population.
The first case was confirmed by the Palestinian Ministry of Health on August 16 in an unvaccinated 10-month-old child; a week later, the World Health Organization (WHO) announced that the child was now paralyzed. Polio has returned to Gaza.
This is a completely predictable result of an illegal Israeli attack on civilian infrastructure. When the detection of the poliovirus was first reported, WHO Director-General Tedros Adhanom Ghebreyesus said the situation in Gaza was “perfect” for the spread of diseases such as polio.
We wrote back in October 2023 that Israel’s denial of water to Gaza following Hamas’s October 7 attacks was just the latest step in a decades-long water crisis caused by the actions of the Israeli government.
Since then, the situation has continued to deteriorate. In May, the BBC’s analysis of satellite images concluded that over 50 percent of water supplies had been damaged or destroyed. In July, an Oxfam report found that access to water had fallen by 94 percent.
The report said all sewage treatment plants had been destroyed, as well as 70 percent of sewage pumps and the two main water quality testing laboratories in Gaza. In Gaza City, all desalination plants and 88 percent of wells were either damaged or destroyed.
A former special adviser to the International Criminal Court, Leila Sadat, told the BBC that it was believed that such a level of destruction could not have been accidental: “The pattern indicates either reckless treatment of civilian objects or deliberate destruction; they were not all mistakes.”
In such conditions, there is little difference between drinking water and raw sewage. On Monday this week, BBC Arabic used satellite analysis to identify a sewage leak on Gaza’s coast that stretches over more than two square kilometers.
If more children in the Gaza Strip contract polio – and this is very likely – the virus will spread through the contaminated water that the unvaccinated and thirsty children will then be forced to drink.
The fiction of the “humanitarian zones” is that they are safe areas. An official from the UN Relief and Works Agency for Palestinian Refugees, UNRWA, said that the “humanitarian zone” in Gaza now only covers 11% of the Gaza Strip: “These are sand dunes, overcrowded areas where people (…) live between garbage and sewage lakes.”
The Israeli Defense Forces take the polio threat seriously – including for their own soldiers. In a press release on July 21, they said they were vaccinating their active soldiers against polio.
But the situation for civilians in Gaza is very different. Although some have been vaccinated since the siege began, according to Human Rights Watch, the Israeli government continues to block ongoing vaccination efforts.
So far this month, the government has rejected a third of the planned humanitarian aid operations, without even taking into account the near-impossibility of safely delivering and distributing the vaccines once they arrive in Gaza.
More than 1.2 million doses arrived in Gaza on Monday to vaccinate more than 640,000 children. But to give just one example of how difficult it is to vaccinate children amid the destruction, UNICEF estimates that at least 17,000 of them are currently unaccompanied or separated from their parents.
Polio is a natural disease, but its re-emergence in Gaza is a direct result of human activity. A 2018 systematic review found that risk factors for the spread of the infectious disease include: “overcrowding, forced displacement, poor housing, poor water, sanitation and hygiene, lack of health facilities and lack of adequate surveillance.”
All of these problems exist in Gaza today, and without a ceasefire and an end to the occupation, they can only get worse. Measures to combat a possible polio outbreak are only one aspect of the crisis.
An immediate ceasefire has been urgently needed since October last year. But as things stand, an urgent vaccination campaign is being carried out on the ground while Israeli forces continue to drop bombs from the air.
Morning Star
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