Polio Outbreak in Gaza ‘Knows No Borders,’ Expert Tells TML
A polio outbreak in Gaza, fueled by war-related conditions, threatens both Gaza and Israel. Unvaccinated infants, soldiers, and hostages are at high risk, leading to calls for a cease-fire and urgent vaccination to prevent a wider epidemic
A polio outbreak has been reported in Gaza, fueled by war-related damage to sanitation, living conditions, and limited vaccine access. The disease now threatens public health in both Gaza and Israel, putting unvaccinated infants, soldiers, and hostages at serious risk of lifelong paralysis or spreading the virus to vulnerable populations.
We published many times that diseases, especially infectious diseases, know no borders
“We published many times that diseases, especially infectious diseases, know no borders,” Prof. Nadav Davidovitch, head of Ben-Gurion University of the Negev’s School of Public Health, told The Media Line.
He said displacement, inadequate access to safe water, sanitation, and hygiene, malfunctioning of the sewage system, crowded shelters, food insecurity, and a collapse of the health care infrastructure make Gaza fertile ground for infectious diseases. He, together with members of the Israeli public health community, has called on Israel to take swift action to implement a humanitarian cease-fire and vaccinate Gazans.
“This is in the interest of Israel, of course,” he said. “There is a danger that infectious diseases will boomerang into Israel.”
Polio is a highly infectious disease transmitted from person to person, especially in children. It enters through the mouth and is excreted in the feces. For the majority of infected people, there are no signs of illness, though one in about a thousand unvaccinated people can develop severe symptoms.
The Israeli Society for Infectious Diseases specifically highlighted in a position paper released Monday that Israeli soldiers in Gaza, those caring for prisoners from Gaza, and the hostages—including 1-year-old Kfir Bibas, who was abducted as an infant and has missed critical vaccinations—are all at high risk.
In Gaza, those at greatest risk are babies and infants who have not completed their required vaccinations due to health service disruptions or their young age.
“They are not guilty of any crime, other than the dangerous circumstances they were born into,” a group of Israeli public health professionals, including Davidovitch, wrote in a recent open letter published on the Haaretz website.
Polio was first identified in Gaza wastewater in mid-July. Over the weekend, a first childhood case was diagnosed. As the public health professionals wrote in their letter, polio can spread for weeks by infected individuals who have no symptoms. As such, the Israeli Ministry of Health “is stressed about,” said Dr. Dorit Nitzan, the former World Health Organization (WHO) European Region Health Emergencies Coordinator. She now works in the School of Public Health at Ben-Gurion University.
Dr. Dorit Nitzan (Courtesy)
She said that the ministry’s polio eradication committee is working day and night now to ensure not only the children of Gaza are vaccinated but also the soldiers and all Israeli children. She said soldiers could come home carrying the virus and infect their unvaccinated babies.
“These viruses are so smart,” Nitzan said. “They are waiting to meet their heaven, and heaven is an unvaccinated kid.”
While only one case has been diagnosed so far, the virus was discovered in six locations in Khan Yunis and Deir al-Balah, in the south and center of Gaza. Davidovitch stressed that there are probably many more cases, but poor surveillance during the war has hindered the ability of the Hamas-run Health Ministry to find them.
We want to stop it when it is still small and controlled. We do not want to wait for a full-blown outbreak.
This holiday season, give to:
Truth and understanding
The Media Line's intrepid correspondents are in Israel, Gaza, Lebanon, Syria and Pakistan providing first-person reporting.
They all said they cover it.
We see it.
We report with just one agenda: the truth.
Please support TML's boots on the ground.Donate
“This is the tip of the iceberg,” he told The Media Line. “We want to stop it when it is still small and controlled. We do not want to wait for a full-blown outbreak.”
In March 2022, when the first case of polio was detected in Israel in 30 years, the country quickly responded by screening all children who had come into contact with the infected child, a member of the ultra-Orthodox community. The Health Ministry swiftly launched a targeted communications campaign and enlisted nurses to administer vaccines during off-hours and in nontraditional settings, ensuring the virus was contained.
Gaza’s Polio Vaccination Rate Drops by 9%
Davidovitch emphasized that Israel has a similar obligation to help curb the virus in Gaza. As a member of the WHO’s European Region, declared polio-free in 2002 according to the European Centre for Disease Prevention and Control, Israel played a key role in establishing Gaza’s polio vaccination program, leading to the disease’s eradication in the enclave 25 years ago.
WHO reported that vaccination rates in Gaza have declined since the onset of the war. In 2023, 99% of Gaza’s population was vaccinated against polio, but by early 2024, that rate had fallen to 90%. Although this decline may appear minor, Davidovitch warned that it could be sufficient to trigger a polio outbreak.
However, COGAT, the division of the IDF responsible for activities in the territories, including the Gaza Strip, said that 282,126 vials of the polio vaccine, sufficient for 2,821,260 doses, have been sent to Gaza since the start of the war.
Since the virus was discovered in July, 9,000 vials have been brought through the Kerem Shalom crossing as part of the vaccination campaign, providing 90,000 additional vaccine doses. In the coming weeks, 43,250 vials of vaccine, tailored to the virus found in environmental samples, are expected to arrive in Israel and enter the Gaza Strip.
“COGAT conducts in-depth situational assessments twice a week with the Ministry of Health, the WHO, and UNICEF to understand the status of the spread of the virus in the Gaza Strip,” the organization said in a statement. “Additionally, specific meetings are held to implement vaccinations among the population in Gaza in cooperation with USAID.”
COGAT said that Israel has helped establish 14 field hospitals in the Gaza Strip since the start of the war and allowed 2,566 trucks carrying 25,955 tons of medications and medical equipment into Gaza, which have been distributed to the population.
‘War is Detrimental to Public Health’
The spread of infectious diseases is not uncommon during war, even in countries where these diseases, like polio, have been eradicated. The Israeli Society for Infectious Diseases highlighted similar incidents in Ukraine, Ethiopia, Sudan, Syria, and Yemen, among other places. Society members are calling for an immediate cease-fire to facilitate a series of essential public health measures, including a widespread and rapid vaccination campaign in Gaza, intensive sewage monitoring, improved access to health services, better hygienic and sanitary conditions, access to safe water, and the establishment of health-defining conditions such as improved food security, shelter, housing and the rehabilitation of medical services.
In 2001, the United Nations negotiated a week-long cease-fire in Afghanistan between the Taliban and the Northern Alliance to promote polio immunization. At the time, UNICEF reported that some 35,000 health workers and volunteers could work in the country to reach 5.7 million children under five in a countrywide polio vaccination campaign.
The campaign was conducted in synchronicity with a campaign in neighboring Pakistan, where more than 70,000 health teams vaccinated nearly 29 million children under age five to help prevent cross-border transmission of the virus.
In 2013, during the height of the Syrian civil war, the country experienced its first polio outbreak in 14 years. In response, the international NGO Save the Children and the WHO negotiated “vaccination cease-fires” between rebel forces and the government to protect the half a million children under the age of five who were at risk of contracting the virus. Health officials were particularly concerned that the mass exodus of Syrians fleeing to neighboring countries could significantly increase the risk of the virus spreading.
War is detrimental to public health
“War is detrimental to public health,” Davidovitch said.
Nitzan warned that not only polio but other infectious diseases, especially measles, can spread and become prevalent during times of war when vaccination coverage decreases, and water, sanitation, and hygiene become compromised.
“Measles is disseminated in communities that are not vaccinated and have low vitamin A levels, so Gazan children are likely at high risk for that,” Nitzan told The Media Line. “I have not been to Gaza but can only imagine the situation.”
She said damage to sewage infrastructure heightens the risk of bacterial and fungal contamination, potentially jeopardizing the safety of the local food supply. Unless soil contaminated with pathogens is properly treated, consuming produce grown in such conditions can lead to illness. Food poisoning is often linked to crops irrigated with water or grown in soil tainted by harmful bacteria.
Rainwater runoff can carry these pollutants into the Mediterranean Sea, degrading water quality and contaminating the fish population. Consuming these fish would pose a significant health risk to individuals.
Additionally, animals such as mice, rats, foxes, and stray dogs often move in when homes are abandoned. These vacant houses also become breeding grounds for flies and mosquitoes, which can transmit infectious diseases like shigellosis (dysentery caused by Shigella bacteria) and West Nile virus.
Animals do not know borders. Mice, rats, snakes, and mosquitoes will all bring these diseases to us.
“Animals do not know borders,” she stressed. “Mice, rats, snakes, and mosquitoes will all bring these diseases to us.”
‘We Must Act Quickly and Decisively’
Israel administers four doses of the polio vaccine between the ages of two and seven: two injections of the inactivated virus vaccine and two doses of the oral polio vaccine containing live attenuated virus, given as liquid drops. The live virus protects the digestive tract where polio is contracted.
According to the Health Ministry, Israel has a 98% vaccination rate against polio overall. However, there are pockets of society, especially among the ultra-Orthodox community, where vaccination rates are lower. In this community, not vaccinating is partially due to ideological reasons and a lack of trust in the government and its systems, as well as partially due to technical reasons. Ultra-Orthodox families tend to be large, and parents may struggle to adhere to each child’s vaccination calendar.
When polio was discovered in Israel in 2022, the now-former head of public services for the Health Ministry, Dr. Sharon Alroy-Preis, told reporters that vaccination rates were less than 50% among some communities in Jerusalem.
“The virus spreads quickly and without borders,” wrote the Israeli Society for Infectious Diseases. “We must act quickly and decisively.”
