UN agencies and NGOs in Gaza had been warning for months: it was only a matter of time. The disastrous sanitary conditions, the crowds in tents, the mass displacements and the shortage of food and water would end up translating – sooner rather than later – into diseases, especially those that flourish due to overcrowding or the presence of faecal remains in the water. Last week, health authorities announced the first case of polio in Gaza in 25 years, in Deir Al Balah, a town where tens of thousands of displaced people have ended up. It is a 10-month-old baby who was not vaccinated. Not coincidentally, his age coincides with the duration of the invasion of Gaza, which has lowered the vaccination rate from 99% to 89% and during which at least 50,000 babies have been born who – between bombs and forced evacuations – will hardly have received the dose.
Polio is transmitted primarily through the consumption of water containing faeces. The virus had already been detected in July in sewage samples from six locations in Khan Yunis and Deir El Balah. To verify whether the suspected cases were real, the samples had to be taken to Jordan for analysis.
Last week, the World Health Organization (WHO) and the UN children’s agency, UNICEF, said in a joint statement that they have secured the supply of 1.6 million doses of the type 2 oral vaccine to supply more than 640,000 children under 10 years of age, but the campaign will only be effective if it reaches at least 96%, which “will be impossible” without a “humanitarian pause.”
The vaccines would arrive at the end of August via Ben Gurion Airport near Tel Aviv and should be delivered to Gaza without breaking the cold chain. There must also be enough cash (so that people can pay for travel), fuel and operational telecommunications networks to inform the population about the campaign.
The fate of the 640,000 Gazans under the age of 10 condemned to remain in the hell of Gaza therefore depends largely on those who are negotiating a ceasefire these days, even though they live in completely different worlds thousands of kilometres away.
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The dialogue goes through a impasseThe US-based diplomat Antony Blinken failed to allow Israeli Prime Minister Benjamin Netanyahu to modify what had been agreed, present the new draft as a “compromise proposal” and pressure Hamas to accept it. The goal, however, remains to hold the meeting scheduled for Thursday in Cairo this weekend. President Joe Biden (with Democratic presidential candidate Kamala Harris in line) spoke late on Wednesday with Netanyahu to convey to him the “urgency of closing” a ceasefire agreement.
For the White House, this “urgency” comes above all from the proximity of a close presidential election against Donald Trump and the risk of regional war if the dialogue fails. But for humanitarian organisations, it has more to do with avoiding an outbreak of polio, which mainly affects children under five, can cause paralysis or deformities and was almost completely eradicated from mass vaccination in the world four decades ago.
Humanitarian pause
As the immediate needs do not fit well with the timing of political negotiations, the discourse is now focused on achieving a one-week humanitarian pause for vaccination. This was requested last week by the UN Secretary General, António Guterres, and is supported by the Ministry of Health of the Hamas government in Gaza. Israel has not responded formally and COGAT (the Ministry of Defense agency that manages civil affairs in Gaza and the West Bank) merely points out that it has coordinated the entry of more than 300,000 vials and that 90% of Gazans have been vaccinated.
Blinken brought up the issue with Netanyahu in their meeting and his vague response on the subject, at the press conference in Tel Aviv on Monday, does not give much room for hope: “We largely share the concern about the possibility of the reappearance [de la polio] and we have been working on a detailed plan to make sure that those who need to be vaccinated can do so. We are working on this with the Israeli government and I believe that we will be able to move forward on a plan to do so in the coming weeks.”
The prospect of weeks of planning is the exact opposite of what the humanitarian sector is proposing. “Now that polio is confirmed, the response must be measured in hours, not weeks,” said Action Against Hunger’s Middle East chief, Natalia Anguera, in an appeal issued on Tuesday by some 40 medical professionals and NGOs, such as the Norwegian Refugee Council, CARE and Oxfam.
Waters with feces and mountains of garbage
It would not be enough to open another dubious “humanitarian corridor” because everything is connected in a territory where the priority is to get water and food and puddles of water with feces and mountains of garbage have become the new daily reality. 70% of the sewage pumps are destroyed and no sewage treatment plant is working permanently.
Latrines are holes in the sand marked out as such. Since it is not always possible to wash one’s hands afterwards and water is collected in unsanitary containers that Gazans carry from one place to another, according to the UN, cases of acute diarrhoea reached 415,766 in the first seven months of the war, a quarter of them in children under five. And since many live in overcrowded tents on the sand in stifling heat, cases of scabies, lice, skin rashes, chickenpox and acute jaundice number in the tens of thousands.
On 12th, the UN World Food Programme said that many community kitchens in central and southern Gaza are struggling due to the instability of humanitarian supplies and the lack of food and fuel, especially in the wake of the latest evacuation orders, which were once the subject of international condemnation, but are now part of the daily life of Gazans. There have been 12 in August, one every two days, affecting some 250,000 people, more than a tenth of the population. The latest were in Khan Yunis and Deir Al Balah, where some families have spent the night on roads or on the beach after fleeing the advance of tanks from the east and west. 90% of Gazans do not live today where they did before the war, and most live in subhuman conditions in tents or crowded in apartments, sometimes damaged.
Sofía Piñeiro has been to Gaza twice as a nursing coordinator for Doctors Without Borders Spain. On the first occasion, between February and March, her mission focused on Rafah, which has yet to be invaded. The second ended last week, in paediatrics and maternity at the Al Nasser hospital in Khan Yunis. The atmosphere, she says, is “very different”. “Before, there was the burden of refugees, but Rafah was considered a safe zone. And the war was further away. That boundary has completely blurred,” she says by telephone. The army has also just reduced the so-called “humanitarian zone” to 11%.
This time, Piñeiro has encountered the usual: simple wounds that end up becoming infected and requiring an antibiotic (due to lack of water and material to do a simple cleaning at the time), respiratory and skin infections, insect bites… But also with “a level of overflow” that makes it impossible to isolate the area needed to prevent the spread of hepatitis A, which already exceeds 100,000 cases, according to data from the United Nations.
“In a 60-bed hospital we have had up to 180 patients […] In a room for four children, seven. We have had four-month-old babies with fever in the hallway because there is nowhere to care for them,” she recalls. “In the postpartum period, the women themselves asked to be discharged. They did not feel safe in the hospital, because others have been attacked,” she points out.
It is a vicious circle. Meningitis, for example, is transmitted by droplets from the mouth, as is Covid, so isolation is essential, also to ensure that they follow the necessary diet. Since primary care cannot cope, some patients go directly to already overwhelmed hospitals, where they are faced with the dilemma of treating them or returning them to their lives in a tent with up to 14 other people and glued to other tents. Even more so when reaching health care points is complicated and dangerous (both for families and for health professionals) and the population rarely manages to settle in one place.
There is also a cumulative effect after 10 months of war. Bodies pay the price for so much time in such precarious conditions. Children, Piñeiro explains, have fewer defenses after 10 months of “a very basic diet based on carbohydrates.” Israeli Finance Minister Bezalel Smotrich said earlier this month that starving “two million people” (referring to all Gazans) “might be fair and moral until the Israeli hostages in Hamas hands return,” but “no one” in the world would allow it. “We bring [permitimos la entrada) de ayuda porque no tenemos elección […] “We need international legitimacy for this war,” he added.
The Israeli army has vaccinated its soldiers, following the discovery of the virus in the water. It has done so on its territory, during leave and replacements, both for those stationed inside Gaza and those who will be there soon. However, it does not solve the risk that in autumn the rains will carry the contaminated water to an aquifer from which Israel, Egypt and Jordan also obtain water.
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