Health workers on Sunday were set to begin a polio vaccination drive in the Gaza Strip aimed at preventing an outbreak of the quick-spreading disease -- a daunting challenge in a besieged enclave shattered by 10 months of war and dependent on commitments by the war's combatants, Israel and Hamas, to abide by pledged "humanitarian pauses."
Israel, facing international pressure to prevent a wider outbreak of the crippling disease, moved with relative speed to allow agencies of the United Nations, supported by local health officials, to tackle the crisis in Gaza, where it launched a war in response to a Hamas-led attack on October 7.
Although the official start of the vaccination drive was set for early Sunday, Gaza health authorities began the campaign Saturday at Nasser hospital in the southern city of Khan Younis, according to Palestinian news media reports. Videos showed doctors and health workers squeezing droplets of the poliovirus vaccine into the mouths of children who were being treated at the hospital.
"I knew about this campaign by chance. I was frightened when I heard the word polio," said Maysaa Abu Daqqa, a mother of a 9-year-old, Habib Nizam. Abu Daqqa was waiting in a patients' room at Nasser. "When I saw other women accepting the vaccinations for their children, I was encouraged to follow them," she said.
Both Hamas and Israel have agreed to the pauses in the fighting to allow the vaccinations to take place, but the campaign will be tricky to execute. With much of Gaza's infrastructure destroyed, and some 90 per cent of the enclave's roughly 2 million residents having repeatedly fled Israeli bombardment, it may be impossible to ensure the immunization of all of the enclave's estimated 640,000 children under age 10.
For families seeking to get their children vaccinated, the challenges are layered and fraught: Not only must they trust that the cessations in fighting will hold, but many will have to navigate blocked and broken roads and expose themselves to danger and widespread lawlessness to reach the sites where vaccinations take place.
The 2,100 people trained to conduct the vaccination drive will face risks, too, including anxieties over a history of deadly assaults on aid workers since the war began.
Poliovirus, which is highly contagious, can cause paralysis and death in the unvaccinated. Largely eradicated around the world by decades of public health campaigns, it can thrive in unsanitary conditions and in places where vaccination rates are not high enough. Such rates in Gaza, which health officials have said were at about 99 per cent as recently as 2022, have dropped significantly among babies because of the war.
The vaccine drive will be conducted through staggered pauses of fighting in different regions of the Gaza Strip designed to allow aid workers to try to vaccinate children at roughly 700 medical facilities, mobile clinics and shelters.
Israel will "allow a humanitarian corridor" for vaccination personnel to travel and will establish "designated safe areas" for them to administer vaccines during certain hours, the office of Prime Minister Benjamin Netanyahu said in a statement Saturday.
"Israel views with importance the prevention of a polio outbreak in the Gaza Strip, including for the purpose of preventing the spread of diseases in the region," it said.
The campaign was set to begin Sunday in central Gaza and was expected to last for three days, with each humanitarian pause lasting from early morning until midafternoon. There will be an option to extend the vaccine drive if necessary, and then local health officials will shift their focus to southern Gaza. The northern region of the enclave will be treated last, according to the staggered schedule announced by global health officials Thursday.
Gaza residents received a text message from the Health Ministry Saturday, announcing the beginning of the vaccination drive for children under 10 years old across different parts of the strip starting Sunday.
The World Health Organization and UNICEF, the UN children's fund, have already rushed more than 1.2 million doses of oral polio vaccines to the region, and say that another 400,000 doses are on their way.
Once the first round of vaccinations is complete, a second, booster round of immunizations will need to be administered four weeks later. Israel has agreed to repeat the staggered humanitarian pauses for the boosters as well.
The scale, ambition and logistics of the vaccination campaign are unprecedented in the Israel-Hamas war. The fact that the plan for it came together in only six weeks of negotiations after the virus was first detected is a sign of just how serious public health officials believe an outbreak could be.
Because polio can strike and spread rapidly, it is not only a risk to those in Gaza, but also could spread to neighboring Egypt or Israel, and potentially beyond. Whether the disease can now be contained is impossible to determine, health experts have said.
Israel has begun to offer booster vaccines for soldiers operating in Gaza. But a public health expert, writing in Foreign Policy, warned that effort may not be enough to stop the spread of an outbreak to Israel, citing vaccine opposition among Israel's ultra-Orthodox, who make up some 17 per cent of the population, that has left tens of thousands of the community's children vulnerable.
Polio is transmitted by contact with the feces of an infected person, or consumption of water or food contaminated by fecal matter.
Aid and rights groups say Israeli strikes have badly damaged access to sanitation and clean water in Gaza, not only risking the spread of preventable diseases but also possibly constituting a war crime. In June, the aid organization Oxfam released a report accusing Israel of destroying more than two-thirds of the enclave's sewage pumps and all of its wastewater treatment plants.
After the virus was detected in sewage samples from Gaza in July, the WHO director-general, Tedros Adhanom Ghebreyesus, warned that the conditions created "the perfect environment for diseases like polio to spread."
Such warnings became more urgent when, two weeks ago, Gaza confirmed its first case of polio in 25 years, in a nearly 1-year-old boy.
Facing repeated displacement, tens of thousands of Palestinians have crammed themselves into camps with little access to water and sanitation. As a result, some 340,000 tons of solid waste have accumulated in or around populated areas, according to a UN assessment.
Among some Palestinians on social media, there was cynicism over the vaccine drive, asking what the point was in saving Gaza's children from the disease as long as fighting raged.
Ghebreyesus stressed that the most important objective was reaching a cease-fire, over which negotiations have repeatedly stalled.
"Humanitarian pauses are welcome," he said in an online video statement. "But ultimately the only solution to safeguard the health of the children of Gaza is a cease-fire. The best medicine is peace."