(The Conversation) – A ten-month-old boy in the Gaza Strip was recently paralysed by poliovirus – the first such case in the region this century. Israel and Hamas have agreed to a limited ceasefire to allow 640,000 children in the enclave to be vaccinated against the virus.

We asked a virologist to explain how the virus emerged in the region after all this time, and how it will be dealt with.

Given that polio was all but eradicated in this region of the world, how might the ten-month-old baby in Gaza have caught it?

The sequences of the polioviruses detected in Gaza in July 2024 suggest that these viruses may be related to a strain circulating in Egypt, with the virus potentially being introduced to Gaza as early as September 2023.

This is probably due to the nature of the oral poliovirus vaccine (OPV), which contains a weakened live poliovirus that can be shed by vaccinated people. This suggests the virus may have been introduced by someone travelling to the region.

The war in Gaza has also provided an ideal environment for the virus to thrive and spread, due to the unhygienic conditions caused by little access to clean water and sanitation.

Can the virus “survive” (remain viable) for long periods without a human host?

Yes, poliovirus is an incredibly stable virus that can remain infectious for long periods outside of the human body, depending on the environmental conditions. For example, polioviruses are capable of surviving in groundwater for several weeks.

Can you explain what “wild type” poliovirus is, compared with vaccine-derived “variants”?

Wild type poliovirus is a virus that is circulating naturally in the environment, whereas vaccine-derived strains are related to the weakened virus present in the OPV, which in extremely rare cases is capable of reverting to a form capable of causing paralysis.

“Polio Swallows Gaza,” Digital, Dream / Dreamland v3, 2024.

Is the wild type still endemic anywhere in the world?

Due to the success of the Global Polio Eradication Initiative, led by the World Health Organization, that began in 1988, type 2 and type 3 polioviruses have been declared eradicated. Only type 1 poliovirus is currently circulating in Afghanistan and Pakistan where there have been 27 recorded cases so far in 2024.

Why are most cases of polio vaccine-derived variants?

Most cases of paralytic polio are now vaccine-derived due to the success of the Global Polio Eradication Initiative. OPV has been instrumental in the near-eradication of wild polioviruses around the world. However, in areas where vaccination rates drop and enough people are susceptible to infection, the weakened virus can replicate. Unfortunately, each round of replication increases the potential for the virus to revert to a form that causes illness and paralysis.

Why was the old oral polio vaccine shelved in 2016?

Following the eradication of type 2 poliovirus in 1999, the only cases of type 2 paralytic polio were vaccine derived. Therefore, to stop these cases, there was a decision to shift from the original trivalent OPV, which contained all three poliovirus serotypes, to a bivalent OPV vaccine, which only contained type 1 and type 3 poliovirus strains. With an additional type 2 specific monovalent vaccine available to contain any vaccine-derived type 2 should any cases arise.

Was that a mistake, as some experts have suggested?

Although this decision was well-intentioned, hindsight suggests that the level of vaccine-derived type 2 poliovirus was underestimated. The Global Polio Eradication Initiative commissioned a report into this decision and the draft report, which is open for public comment, has described the switch to bivalent OPV as an “unqualified failure”.

What type of poliovirus vaccine is being used in the current campaign in Gaza?

Over 1.6 million doses of the novel oral poliovirus vaccine type 2 (nOPV2) – a new poliovirus vaccine – will be delivered to the Gaza Strip to provide two doses to more than 640,000 children under the age of ten.

Will it have the same risks as the old poliovirus vaccine? That is, might it get in the wastewater and cause more polio cases?

No, the nOPV2 is a next-generation version of the traditional type 2 monovalent oral polio vaccine that is used to respond to vaccine-derived type 2 poliovirus outbreaks. The key difference is that the new vaccine contains a weakened virus that has been modified to make it more genetically stable and significantly less likely to revert to a more virulent form capable of causing paralysis, thereby increasing the chances of stopping these outbreaks for good.

What other diseases are likely to emerge in Gaza, given the interrupted vaccination campaigns?

Other vaccine-preventable diseases such as measles, pneumonia and diarrhoeal diseases, such as rotavirus, all have the potential to emerge. Each with its own dangers and complications, therefore it is really important that as many vaccines as possible are delivered into Gaza.

Lee Sherry, Postdoctoral Research Associate, School of Infection and Immunity, University of Glasgow

This article is republished from The Conversation under a Creative Commons license. Read the original article.

There is no cure for polio once it is contracted. Its victims can be paralyzed or can die.

Without a ceasefire, UNICEF points out, you cannot get the families to line up their children to receive the vaccine by mouth. Some 95% of the infants in Gaza need to have the vaccine administered to prevent an outbreak, and they need two doses. Without a ceasefire, the aid workers cannot even safely move around to make arrangements for giving out the doses. The aid organizations want to use Deir al-Balah to store and distribute the vaccines, but the Israeli army has just once again ordered everyone out of it and has invaded it, risking destroying the remaining medical infrastructure there. Some 250,000 Palestinians have once again been expelled from their shelters since the beginning of August.

UNRWA head Philippe Lazzarini warned regarding Gaza, “Delaying a humanitarian pause will increase the risk of spread among children.” He suggested that some Israeli children could suffer from an epidemic, as well, but of course Israeli children have largely been vaccinated continually. Palestinian children had also been almost entirely vaccinated up until the Israeli total war on Gaza was implemented last fall.

UNICEF wrote of another war, Ukraine, “UNICEF helps vaccinate over 400 million children globally against polio every year, to eradicate polio worldwide. In Ukraine, UNICEF works to secure uninterrupted availability of life-saving vaccines for children and adults and to maintain high routine immunization coverage. As the war and subsequent displacement continues, gaps in immunization coverage put children’s health at risk.”

Although children in Ukraine are also at risk from polio outbreaks, the human toll of that war pales in comparison to Gaza. Some 2,000 children have been killed as a result of Vladimir Putin’s invasion of Ukraine.

Israeli Prime Minister Benjamin Netanyahu’s total war on the Gaza population has blown over 15,000 children to smithereens.

Whereas Putin’s Russia has been massively sanctioned for its illegal occupation and warfare in Ukraine by the US and most NATO countries, Israel’s government, which illegally occupied Gaza in 1967 and which has shown a reckless disregard for civilian life that may amount to genocide, has been given tens of billions of dollars by the Biden administration.

Type 2 polio vaccinations are substantially down over the past ten months, since the population and the aid workers have been constantly expelled from a succession of supposed safe zones by the Israeli military, medical facilities have been destroyed, and medicine deliveries have been made difficult or impossible by the bombings, artillery barrages, machine gun fire, drone strikes, lack of fuel and general chaos deliberately inflicted on the entire population by monstrously permissive Israeli rules of engagement — which entirely disregard the value of civilian, noncombatant life.

“Gaza Polio,” by Juan Cole, Digital, Dream / Dreamland v. 3 / Clip2Comic, 2024

Although Israeli authorities are allowing the delivery of the refrigerated trucks necessary for the vaccines, as well as the vaccine doses themselves, through the Kerem Shalom crossing, the aid workers are pointing out that these steps do no good at all unless there is a ceasefire that allows the aid workers to move around and give the vaccines to the children. Borger quotes Lazzarini as saying, “It is not enough to bring the vaccines into Gaza and protect the cold chain. To have an impact, the vaccines must end up in the mouths of every child under the age of 10.”

UNICEF points out that “The world has made tremendous progress against polio in the past three decades, vaccinating over 2.5 billion children and reducing cases by 99 percent. But this progress is fragile, and we cannot afford to lose focus. Millions of children are still missing out on routine vaccinations because of pandemic disruptions, conflict, climate disasters and displacement.”

It quotes Yuliia Dovjanych, Head Doctor at the ‘Dbayu’ medical centre “Infectious diseases do not disappear during the war. The fight against them is our ‘medical front’ where we must remain resilient. Therefore, we must continue to get vaccinated, take care of our health and the health of our children!” Some 11,520 civilians have been killed in the Ukraine war, whereas over 40,000 people have been killed in Gaza, a majority of them women and children.

At the medical front in Gaza, the war to save the children is going very badly. It will be lost without a ceasefire.

For instance, Stobbe wrote, “In the 1946-48 study, American scientists infected prisoners and patients in a mental hospital in Guatemala with syphilis, apparently to test whether penicillin could prevent some sexually transmitted disease. The study came up with no useful information and was hidden for decades.”

The Israeli government is now conducting a massive experiment on over 2 million Palestinians in Gaza, half of them children, to see whether being compelled to live in completely unsanitary conditions will cause health epidemics among them and much reduce their numbers. The World Health Organization estimates tens of thousands of people to be at risk from this experiment, which recalls those not only of federal scientists in the US but of Josef Mengele.

The UN Relief and Works Agency reports that there have been 40,000 cases of hepatitis A in Gaza since Israel’s total war on its civilians began last October. There were only 85 such cases in the same period the previous year. The disease is a liver inflammation and damage, spread by exposure to raw sewage or contact with an infected person.

The World Health organization says that more people in Gaza could die from infectious diseases than from being bombed by the Israeli Air Force. Officially over 39,000 are dead in military violence, though medical professionals on the ground estimate that the true toll is likely around 100,000 by now. So WHO is saying that 40,000 to 100,000 people could die of disease, a major epidemic in a country of a little over 2 million, or at the higher estimate as much as 4.5 percent of the population. That would be equivalent to 15 million Americans — more than the entire population of Pennsylvania — being forced into such unsanitary living conditions that they died of disease.

WHO also announced that it is sending a million polio vaccines to Gaza in hopes of averting an epidemic outbreak, since the polio virus has been found in wastewater there. Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, said at an informational meeting, “I witnessed at first hand living conditions that are highly favourable for the spread of polio and other diseases. This is an important time…to come together to act swiftly and decisively to contain this outbreak, for the children of Gaza.” Severe polio can cause paralysis for life or death.

Getting the vaccines into the Strip and having enough medical personnel to administer them is, however, a severe problem. Also, polio vaccines need to be refrigerated at 36°to 46°F (2°to 8°C), which is impossible in Gaza, where there is almost no electricity and where most hospitals have been rendered defunct by the Israeli military’s attacks.

Hepatitis A is a virus that causes acute infection. NIH notes that in some cases “hepatitis A can be severe and lead to liver failure and the need for an emergency liver transplant to survive.” For many, it lasts weeks and then goes away. There are only about 3,000 cases a year in the United States, a country of 340 million people, so 40,000 cases in a population of 2.2 million (or 2.1 million, since the Israelis have almost certainly rubbed out at least 100,000 people) is an enormous outbreak. The disease can cause loss of appetite and nausea, putting children at risk of malnutrition, especially in Gaza where so many children already suffer from it.

We should be clear that Israel is deliberately inflicting such disease outbreaks on the civilians of Gaza. By constantly keeping them on the run, destroying sewage treatment facilities or denying people the fuel and electricity needed to run them, and destroying buildings with toilets in them, the Israeli government is exposing millions of noncombatants to unsanitary conditions with malice and forethought.

The United Nations says that satellite images show that Israeli Air Force and armor have damaged or destroyed nearly two-thirds of the buildings in Gaza: “”Of these, 30 percent were destroyed, 12 percent severely damaged, 36 percent moderately damaged, and 20 percent possibly damaged, representing approximately 63 percent of the total structures in the region.” The destruction has left behind 42 metric tons of rubble, 82% more than in January. Many residential complexes were targeted with 2000-pound bombs, wiping out entire extended families.

Mohammed Naserallah, a displaced Palestinian in Gaza, said this week, “We have been displaced from the north. They told us: ‘Leave to central Gaza, then to Rafah.’ We went to Rafah, then went back up to Nuseirat. We got stuck. Then we received instructions to move farther south towards al-Mawasi.”

After Israel issued new displacement orders for central Gaza earlier this week, Al Jazeera’s Hani Mahmoud reported from the ground, “The majority of the displaced population is flowing to the Deir el-Balah city that is already packed with displaced families and has no sufficient space or resources to accommodate people.” Some 86 percent of Gaza is under Israeli “evacuation” orders, i.e. ethnic cleansing.

In its assassination of Ismail Haniyeh in Iran, the Israeli military and intelligence apparatus demonstrated that it is perfectly capable of precisely targeting Hamas personnel without killing thousands of other people. Israeli investigative reporters have revealed that the Israeli army’s rules of engagement allow 15 to 20 civilian deaths for every militant killed, and that a tracking program is used to kill al-Qassam Brigade paramilitary members when they come home to their families in the evening, ensuring that their children, wives, relatives and neighbors are also blown away by drones and rockets.

—

Bonus Video:

“Gaza health officials declare polio ‘epidemic’ as virus spreads | Al Jazeera Newsfeed ”

(The Conversation) – As war continues to devastate Gaza and its people, we learnt last week that a variant of poliovirus has been detected in the region. The virus was isolated in six sewage samples collected in late June from Khan Younis and Deir al Balah.

Most infections with poliovirus don’t cause symptoms, but a minority of those who contract the virus develop paralysis (paralytic polio).

No cases of paralytic polio have been reported in Gaza. But detecting the virus in wastewater is concerning nonetheless.

There are different types of polio

The cases of polio we’ve seen historically have generally been caused by “wild poliovirus”. For centuries, wild poliovirus affected both poor and wealthy countries, including Australia. The deployment of effective vaccines in the 1960s led to a dramatic decrease in cases in the following decades among those countries that could afford the vaccines.

The introduction of the Global Polio Eradication Initiative in 1988 enabled more equitable vaccination. There were only 12 cases of paralysis caused by wild poliovirus in 2023, in just two countries: Pakistan and Afghanistan.

However, as the number of wild poliovirus cases decreased there was an increase in cases of vaccine-derived poliovirus causing paralysis.

There are two types of polio vaccines: one is given orally, and the other by injection (the type used in Australia). The oral polio vaccine is based on a weakened virus – so it doesn’t cause disease, but can still reproduce. Vaccine-derived poliovirus emerges when people vaccinated with the oral polio vaccine excrete the vaccine virus in their stool and it spreads to other people.

Over time, it may mutate to become a virus that circulates and causes paralysis in populations with low levels of immunity. In 2023, there were 524 polio cases in 32 countries caused by vaccine-derived poliovirus.

It’s a strain of vaccine-derived poliovirus that has been detected in the wastewater in Gaza – type 2.

High vaccination coverage is key, but not always enough

The most important indicator of eradicating polio, both wild and vaccine-derived, is vaccine coverage. This is usually measured as the percentage of children under five who have received at least four vaccine doses, ideally 95%.

High vaccination coverage has been achieved by a combination of routine immunisation in early childhood plus national or local catch-up vaccination campaigns, particularly in areas where the virus pops up.

However, high vaccination coverage is not always enough to eliminate the virus.

Early in the 21st century, India and Nigeria were reporting the highest number of polio cases in the world. After an accelerated immunisation campaign in India, vaccine coverage rates were high by 2007 and cases were decreasing. But many cases continued to be reported in impoverished districts of western Uttar Pradesh (a state in northern India), where access to clean water and sanitation was poor.

Research shows a high level of pathogens in children’s intestines can make the absorption of the oral vaccine less effective, while unsanitary conditions make it easier for the virus to spread. After a sanitation and hygiene project began in 2007, the last case of polio in Uttar Pradesh occurred in 2010, and the entire country eradicated polio in 2014.

Wild polio was eradicated from Gaza more than 25 years ago. But it’s possible the re-emergence of vaccine-derived poliovirus is due to a combination of poor hygiene and sanitation, as we saw in Uttar Pradesh, and reduced vaccine coverage.

Polio vaccination coverage in the Palestinian territories was 99% in 2022. By the end of 2023, coverage had dropped to 89%. However, the data were not separated by each of the territories (the West Bank, East Jerusalem and Gaza), so coverage may be lower in Gaza.

Recent outbreaks

We saw the detection of a similar strain of poliovirus in wastewater in Jerusalem, London and New York in early 2022.

Parts of these cities have high concentrations of ultra-Orthodox Jews, which may have lower rates of vaccination than the overall population. In Rockland County, 65 kilometres north of New York City, a young, unimmunised Orthodox Jewish man became the first case of polio transmitted locally in the United States in 30 years.

There’s no evidence of vaccination hesitancy among Ultra-Orthodox Jews in Australia. However, there are other communities where vaccination rates are low, including some shires in the Northern Rivers district of New South Wales.

Communities with low vaccination rates, whatever the reason, are vulnerable to infectious diseases such as polio.

So where did this virus come from?

The oral vaccine used in Gaza has not contained type 2 since 2016, so it must have come from elsewhere.

In 2023, most outbreaks of type 2 vaccine-derived poliovirus were in the Democratic Republic of Congo, Yemen, Nigeria, Sudan and Somalia. There was also one case in Egypt, which borders on Gaza. Egypt could be the source of this virus, but we’ll need further investigation.

It’s unlikely to have come from Israel as there have been no detections of poliovirus in wastewater there since 2022.

What can the world learn?

First, we must not forget that poliovirus can cross borders and maintaining high vaccination rates in Australia and elsewhere is the most effective protective strategy. It’s also crucial to contain the virus inside Gaza. UNICEF and partners are preparing for a vaccination campaign focusing on young children.

Second, it’s important to maintain wastewater surveillance for polio, which is an early warning mechanism that can initiate public health action before symptomatic cases occur.

In 2022, Victoria was the only Australian state conducting routine polio wastewater surveillance until NSW adopted the practice when the outbreaks in Jerusalem, New York and London occurred. Wastewater surveillance is worthwhile in all states and territories.

Third, but not least, this should be a wake-up call highlighting the need to cease hostilities and provide unrestricted access by aid agencies to improve the provision of clean water, sanitation and effective health services throughout Gaza. This is an urgent global health priority.

Michael Toole, Associate Principal Research Fellow, Burnet Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Bonus video added by Informed Comment:

Gaza: WHO warns of potential polio outbreak | DW News Video

“Detecting the virus that causes polio in wastewater heralds a real health disaster,” Gaza’s health ministry said.

By Edward Carver | –

( Commondreams.org ) – Poliovirus has been detected in sewage samples at six locations in the Gaza Strip, the World Health Organization said on Friday, following announcements from both the Israel and Gaza health ministries.

Vaccine-derived poliovirus type 2 was found in samples taken on June 23 from sites in Khan Younis and Deir al-Balah.

Public health authorities expressed grave concerns about the findings, which, though no cases have yet been discovered, raise the possibility of an outbreak of polio, a highly infectious disease that often causes paralysis and can be fatal.

“Detecting the virus that causes polio in wastewater heralds a real health disaster and exposes thousands of residents to the risk of contracting polio,” Gaza’s health ministry said in a statement.

Tanya Haj-Hassan, a pediatric intensive care physician, toldAl Jazeera the presence of the poliovirus was a “ticking time bomb,” especially given the lack of ability to isolate and care for people who contract the disease.

Haj-Hassan warned that it would be “catastrophic” if the disease spread among healthcare workers, given that the medical system has already been “annihilated by direct targeting, by abductions of healthcare workers, by [the] killing of healthcare workers.”

Dahlia Scheindlin, a Tel Aviv-based political analyst, called news of the presence poliovirus “absolutely shocking, stunning, [and] unthinkable” in a series of social media posts.

“The health crisis in Gaza has been catastrophic from the start,” Scheindlin wrote, seemingly addressing Israelis. “If you’re incapable of realizing that civilians should never have been in this situation, maybe the prospect of anyone getting polio, river to sea, where we are ‘one epidemiological family,’ will get through.”

Conditions in Gaza have been ripe for an outbreak of infectious disease—the “perfect environment” for transmission, as WHO spokesperson Christian Lindmeier called it, citing “decimation of the health system, lack of security, access obstruction, constant population displacement, shortages of medical supplies, poor quality of water and weakened sanitation.”

In late June, The Associated Pressreported on the nightmarish situation in Deir al-Balah, one of the areas where the poliovirus has since been discovered:

Children in sandals trudge through water contaminated with sewage and scale growing mounds of garbage in Gaza’s crowded tent camps for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.

“Polio virus found in Gaza as soaring temperatures threaten drought • FRANCE 24 English Video”

Polio, which can spread through contact with the stool of an infected person, has been eliminated from much of the world following the development of a vaccine in the early 1950s and a campaign by U.N. agencies that began in 1980. Still, it hasn’t been eradicated globally, and there’s been a resurgence in Afghanistan and Pakistan in recent years.

Gaza has been polio-free for 25 years and 95% of the population was vaccinated against the disease as of 2022, according to the WHO, though Haj-Hassan, the pediatrician, said that many Gazans, including newborns, have gone without vaccines or boosters for the last nine months.

The WHO said that it’s working with other U.N. agencies and health authorities in Gaza to assess how much the poliovirus has spread and determine what measures may be needed, including a “prompt” vaccination campaign.

Combatting any infectious diseases will present challenges for Gaza’s public healthcare system, which has been embattled and largely destroyed by Israeli forces. Only 16 out of the enclave’s 36 hospitals are even partially functional, and only 45 of the 105 primary health care facilities are operational, according to the WHO.

The lack of medical care is part of a broader public health disaster, people on the ground in Gaza say.

“We’re talking about a very grim medical reality,” said Tareq Abu Azzoum, an Al Jazeera journalist reporting from Deir al-Balah, which faces severe overcrowding due to the roughly 700,000 displaced Gazans who have fled there.

Abu Azzoum cited Israeli military tactics as a reason for the dire conditions, arguing that the problems stem from attacks on “water wells, sanitation, and water waste treatment” and the blocking of “essential hygiene supplies.”

Licensed under Creative Commons (CC BY-NC-ND 3.0).

600,000 is only a little less than the population of Boston within city limits. Imagine Boston as populated only by children. Then imagine them all, every one, as injured by shrapnel, or suffering gastrointestinal and liver diseases, or as wasting away with hunger from lack of food. And imagine the monster that puts this many children in this box deliberately.

Israeli airstrikes on Rafah have continued daily, often killing or wounding children. Since Israel has destroyed the hospital system, children have to have operations or limbs amputated without anesthesia or antibiotics.

It should be underlined that these injuries, maladies and food deficits have been imposed on these children by Israeli military policy, which displays a reckless disregard for civilian welfare. Israeli rules of engagement, the most inhumane in the world, permit 15 to 20 civilian deaths per militant killed. Typically in warfare 3 persons are wounded for every one killed, so this ROE likely must be interpreted as allowing the wounding of 45 to 60 civilians in each strike on a member of the Hamas paramilitary.

The UN reports from the Gaza Ministry of Health that since October 7, “34,622 Palestinians were killed in Gaza and 77,867 Palestinians were injured.” Some 70% of the killed have been women and children.

The UN adds, “Between the afternoons of 1 and 3 May, according to the Ministry of Health (MoH) in Gaza, 54 Palestinians were killed and 102 injured, including 26 killed and 51 injured in the last 24 hours.”

In addition, according to the UN, Palestinian civil defense estimates that a further 10,000 bodies lie under the rubble of the apartment buildings that Israeli airstrikes destroyed, knowing that families were inside them. The Israelis have destroyed all the equipment that could be used to retrieve the bodies, which are decomposing in the heat. Decomposing corpses leaking into ground water pose a dire threat of disease outbreaks.

CBC’s Matt Galloway interviewed Nyka Alexander, a communications officer with the UN’s World Health Organization. Alexander explained what it meant for over a million people to be forced suddenly down to Rafah (which had a population of about 300,000 before the Israeli assault). He described people sleeping rough or in makeshift tents amidst mountains of garbage and open air toilets. Jaundice, an inflammation of the liver is spreading in the population, including among children. Flies land on feces and then on food, which can’t be washed except in dirty water.

Alexander said, “Imagine all the sidewalks covered in tents and in these makeshift shelters. Imagine the streets flowing with greeny, bluey, black water that is feces mixed with garbage. Imagine there’s no garbage cans, there’s no garbage collection. There’s just piles of garbage . . . The flies are everywhere as well, and they’re very aggressive. They want to go in your eyes, they want to go in your mouth. From a public health point of view, it’s a really disastrous situation.”

Reuters Video: “Waste is piling up in Gaza, bringing misery and hazards | REUTERS”

As for starvation and sickness, the UN says that between 27 April and 2 May the Israeli military impeded or denied 60% of attempted aid deliveries in the north of Gaza. In southern Gaza, of aid and food deliveries requiring coordination, a third were impeded or denied by the Israeli authorities. All this interference in deliveries of food and medicine by Israel comes at a time when US AID says that famine is already inevitable.

This week Doctors without Borders underlined the ways in which the Israeli military has cruelly denied key medical equipment to the children and women they have wounded with their bombs:

“Delivering lifesaving supplies into Gaza is nearly impossible amidst Israeli authorities’ blockades, delays, and restrictions on humanitarian aid and essential medical supplies, explains Mari Carmen Viñoles, head of emergency programmes at Médecins Sans Frontières (MSF).

An oxygen concentrator is a medical device that filters out the nitrogen in air, delivering purified oxygen to patients. For malnourished children with severe anaemia, injured people with severe blood loss and newborns with breathing difficulties, this device can be the difference between life and death.

But despite being essential to our patients’ survival, we have no idea if or when an oxygen concentrator will reach a hospital in Gaza, Palestine.

As Israeli authorities maintain full control over the entry and exit points into Gaza, they have repeatedly refused our requests to bring in biomedical equipment such as oxygen concentrators.

Without this simple device, our medical teams in Gaza are forced to witness their patients die from entirely preventable causes.”

The petty and cruel denial of medical equipment to the civilian Gaza population has been a mark of the current extremist Israeli government. The Israelis have also just ignored requests to bring in solar-powered medical equipment. It can’t be shipped without approval and lots of procedures can’t be done without it. The Israeli authorities have told bald-faced lies about there being no limit to the entry of humanitarian goods into the Strip, a claim that Doctors without Borders called “absurd.”

Speaking at a special session organised by the WHO executive board on the health situation in the occupied Palestinian territories, Tedros emphasised the catastrophic impact of conflicts on the health situation in Gaza, Anadolu Agency reports.

“More than 17,000 people are reported to have died in Gaza, including 7,000 children and we don’t know how many are buried under the rubble of their homes. More than 46,000 injuries have been reported,” he said.

World Health Organization: Dr Tedros’s remarks at the opening of the WHO #EBSpecial on the health conditions in oPt

As many as “1.9 million people have been displaced – almost the entire population of the Gaza Strip – and are looking for shelter anywhere they can find it. Nowhere and no one is safe in Gaza,” he added.

He emphasised that health should never be a target, saying on average, there is one shower unit for every 700 people and one toilet for every 150 people, and there are worrying signals of epidemic diseases including bloody diarrhoea, and jaundice. According to him, only 14 hospitals out of the original 36 are partially functional.

“As more and more people move to a smaller and smaller area, overcrowding, combined with the lack of adequate food, water, shelter and sanitation, are creating the ideal conditions for disease to spread,” he said.

The WHO chief emphasised their support for UN Secretary-General Antonio Guterres’ call for a permanent and urgent humanitarian cease-fire to ensure the delivery of critical aid to those in urgent need in the Gaza Strip.

“A cease-fire is the only way to truly protect and promote the health of the people of Gaza. I deeply regret that the Security Council was unable to adapt a resolution on such a cease-fire last Friday,” he said, referring to the US veto blocking the international calls for a truce.

Israel, in response to the Oct. 7 attack by Palestinian group Hamas, launched air and ground attacks on the besieged enclave, killing thousands of Palestinians, mostly civilians, and forced some 1.9 million people to flee their homes. Gazans also face severe shortages of food, water and other basic goods as only a trickle of aid is allowed in.

Via Middle East Monitor

This work by Middle East Monitor is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

(The Conversation) – After more than a month of being subjected to sustained bombing, the besieged people of the Gaza Strip are now confronted with another threat to life: disease.

Overcrowding at shelters, a breakdown of basic sanitation, the rising number of unburied dead and a scarcity of clean drinking water have left the enclave “on the precipice of major disease outbreaks,” according to the World Health Organization.

As an expert in Palestinian public health systems who wrote about the many relationships between war and health for my forthcoming book “How War Kills: The Overlooked Threats to Our Health,” I believe that the looming crisis cannot be underestimated. The easy spread of infectious disease in wartime conditions can be just as devastating as airstrikes to health and mortality – if not more so. Health care services in Gaza – already vulnerable prior to the Israeli bombing campaign – have essentially no capacity to cope with a major outbreak.

Disease already rampant

History has proved time and again that war zones can be a breeding ground for disease. Anywhere impoverished and underresourced people crowd for shelter or access to resources – often in facilities with inadequate living conditions, sanitation services or access to clean water – is prone to the spread of disease. This can be through airborne or droplet transmission, contaminated food or water, living vectors like fleas, mosquitoes or lice, or improperly cleaned and managed wounds.

In any situation of armed conflict or mass displacement, the threat of infectious disease is among the primary concerns of public health professionals. And from the outset of the Israeli bombing campaign, experts have predicted dire health consequences for Gaza.

After all, the Gaza Strip had fragile health and water, sanitation and hygiene sectors long before the Oct. 7, 2023, Hamas attack that killed 1,200 Israelis and prompted the retaliatory airstrikes. The health system of Gaza, one of the most densely populated places in the world, has long been plagued by underfunding and the effects of the blockade imposed by Israel in 2007.

Waterborne illness was already a major cause of child mortality – the result of the contamination of most of Gaza’s water. In early 2023, an estimated 97% of water in the enclave was unfit to drink, and more than 12% of child mortality cases were caused by waterborne ailments, like typhoid fever, cholera and hepatitis A, that are very rare in areas with functional and adequate water systems.

Other forms of infectious disease spread have also been reported in recent years. Gaza had experienced several previous outbreaks of meningitis – an inflammation of the tissues surrounding the brain and spinal cord typically caused by infection – notably in 1997, 2004 and 2013.

In late 2019, a small outbreak of measles – a highly contagious, airborne virus – was reported in Gaza, with almost half of reported cases in unvaccinated people. Despite a relatively high vaccination rate in Gaza generally, these gaps in vaccination and the inability to respond quickly to outbreaks were attributed by the WHO to “the continuous socio-economic decline since 2009, conflict, and closure.”

And the COVID-19 pandemic hit the Gaza Strip hard, exacerbated by the Israeli blockade that prevented or delayed the import of vital personal protective equipment, testing kits and vaccines.

France 24: “Hunger, disease ‘inevitable’ in Gaza as fuel runs out • FRANCE 24 English”

A system overwhelmed

The vulnerability of Gaza’s health care meant that from the outset of the latest conflict, organizations such as the WHO voiced concern that the violence and deprivation could quickly overwhelm the system.

There are several ways war in general, and the conflict in Gaza in particular, accelerates and promotes infectious disease risk.

Almost concurrently with the start of the bombing campaign, Israel imposed siege conditions on Gaza. This prevented the import of fuel needed to run generators for vital infrastructure. Generators are needed because Israel shut off electricity to Gaza.

As fuel has essentially run out in recent days, this has meant no power for desalination plants or for solid waste collection. As a consequence, many people have been forced to consume contaminated water or live in conditions where living carriers of disease, like rodents and insects, thrive.

Even basic cleaning supplies are scarce, and equipment used to sterilize everything from medical equipment to baby bottles is inoperable.

These unhygienic conditions come as hundreds of thousands of Palestinians in Gaza attempt to flee the bombing to the few remaining places left to shelter. This has caused massive overcrowding, which increases the risk of an infectious disease outbreak.

Children especially vulnerable

Already, the WHO has reported worrying trends since mid-October 2023, including more than 44,000 cases of diarrhea in Gaza.

Diarrhea is a particular risk for young children who are prone to profound dehydration. It represents the second-leading cause of death worldwide in children younger than 5 years of age. Half of the diarrhea cases reported in Gaza since the Israeli bombing campaign began have been in children under 5.

Meanwhile, nearly 9,000 cases of scabies – a skin rash caused by mites – have been reported, as have more than 1,000 cases of chickenpox.

More than 70,000 cases of upper respiratory infections have been documented, far higher than what would be expected otherwise. These are just cases that were reported; undoubtedly, more people who were unable to get to a health facility for diagnosis are also sick.

Reports of the spread of chickenpox and upper respiratory infections like influenza and COVID-19 are particularly dangerous considering children’s vaccination schedules are being highly disrupted by conflict. With health services overstretched and the mass movement of families, young children and newborns are likely going without vital, lifesaving inoculations just as winter – the peak season for respiratory infections – arrives.

Upper respiratory infections are also exacerbated by the amount of dust and other pollutants in the air due to the destruction of buildings during bombing.

Then there is the direct impact of the bombing campaign. A lack of antibiotics – due to both the siege and the destruction of health facilities – means physicians are unable to adequately treat thousands of patients with open wounds or in need of medical operations, including amputations.

More death and suffering

Increasingly, doctors are even running out of wound dressings to protect injuries from exposure. Poor infection prevention controls, high casualty rates and high concentrations of toxic heavy metals, among other factors, are leading to reports of antimicrobial resistance, which occurs when bacteria and viruses evolve over time to no longer respond to antibiotics and other antimicrobial medications. This has the potential to lead to health issues long after the bombing stops. Similar trends were also seen in Iraq, where antimicrobial resistance rates remain high despite the peak of bombing campaigns ending many years ago.

And with many bodies laying under rubble, unable to be retrieved, and the necessity of digging multiple mass graves near sites where people are sheltering, there is also increased risk of disease arising from an inability to adequately dispose of the dead.

While the images and photos from Gaza of areas and people that have been bombed are devastating and have caused a massive death toll – at least 12,000 by mid-November, according to Gaza health authorities – the rapid spread of infectious disease has the ability to cause even greater mortality and suffering to a population reeling from weeks of sustained bombing.

Yara M. Asi, Assistant Professor of Global Health Management and Informatics, University of Central Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In fact, the Times did have daily figures until March 23rd when, noting that data on the pandemic from state and local health officials was fast disappearing, it added: “After more than three years of daily reporting of coronavirus data in the United States, the New York Times is ending its Covid-19 data-gathering operation. The Times will continue to publish virus data from the federal government weekly on a new set of tracking pages, but this page will no longer be updated.” Still, if you do look at those weekly figures, there were 94,000 weekly cases reported in this country and — yes — 1,160 weekly deaths as of the moment I wrote this introduction. It’s true that, at least for now, those numbers continue to decline, adding ever fewer Americans to the — hold your breath for a moment — 1,123,836 deaths the Johns Hopkins Coronavirus Resource Center reported on March 10th of this year when it, too, stopped collecting data.

And yes, there is indeed a new Covid booster (which I plan to get) for older adults and the immunocompromised, but I’m sure you won’t be surprised to learn that ever fewer Americans are even bothering. Of course, since Donald Trump and crew made the pandemic into a deeply divisive issue, for many of us, including significant numbers who died, not boosting or masking was part of our politics, not our health. Grimmer yet, the figures do show that Republicans died of Covid at a significantly higher rate than Democrats.

So, today, I felt a certain kinship with TomDispatch regular and co-chair of the Poor People’s Campaign Liz Theoharis when she reminded us of the devastation the pandemic brought our way and the even more devastating urge now to cancel what was done in the midst of its horror to help the poor. One thing should be clear from her piece today: however the Covid crisis ends, our crisis will certainly continue. Tom

The Pandemic Portal View

Lessons for Moral Standard-Bearers in a Sick Society

By Liz Theoharis

“In order to fully recover, we must first recover the society that has made us sick.”

I can still hear those prophetic words, now a quarter-century old, echoing through the Church Center of the United Nations. At the podium was David, a leader with New Jerusalem Laura, a residential drug recovery program in North Philadelphia that was free and accessible to people, no matter their insurance and income status. It was June 1998 and hundreds of poor and low-income people had gathered for the culminating event of the “New Freedom Bus Tour: Freedom from Unemployment, Hunger, and Homelessness,” a month-long, cross-country organizing event led by welfare rights activists. Two years earlier, President Bill Clinton had signed welfare “reform” into law, gutting life-saving protections and delivering a punishing blow to millions of Americans who depended on them.

That line of David’s has stuck with me over all these years. He was acutely aware of how one’s own health — whether from illness, addiction, or the emotional wear and tear of life — is inextricably connected to larger issues of systemic injustice and inequality. After years on the frontlines of addiction prevention and treatment, he also understood that personal recovery can only happen en masse in a society willing to deal with the deeper malady of poverty and racism. This month, his words have been on my mind again as I’ve grieved over the death of Reverend Paul Chapman, a friend and mentor who was with me at that gathering in 1998. The issue of “recovery” has, in fact, been much on my mind as the Biden administration prepares to announce the official end of the public-health emergency that accompanied the first three years of the Covid-19 pandemic.

For our society, that decision is more than just a psychological turning of the page. Even though new daily cases continue to number in the thousands nationally, free testing will no longer be available for many, and other pandemic-era public-health measures — including broader access to medication for opioid addiction — will also soon come to an end. Worse yet, a host of temporary health and nutrition protections are now on the chopping block, too (and given the debate on the debt ceiling in Congress, the need for such programs is particularly dire).

When the pandemic first hit, the federal government temporarily banned any Medicaid or Children’s Health Insurance Program (CHIP) cuts, mandating that states offer continuous coverage. As a result, enrollment in both swelled, as many people in need of health insurance found at least some coverage. But that ban just expired and tens of millions of adults and children are now at risk of losing access to those programs over the next year. Many of them also just lost access to critically important Supplemental Nutrition Assistance Program (SNAP) benefits, as pandemic-era expansions of that program were cut last month.

Of course, the announced “end’ of the public-health emergency doesn’t mean the pandemic is really over. Thousands of people are still dying from it, while 20% of those who had it are experiencing some form of long Covid and many elderly and immunocompromised Americans continue to feel unsafe. Nor, by the way, does that announcement diminish a longer-term, slow-burning public health crisis in this country.

Early in the pandemic, Reverend William Barber II, co-chair of the Poor People’s Campaign, warned that the virus was exploiting deeply entrenched fissures in our society. Before the pandemic, there had already been all too many preconditions for a future health calamity: in 2020, for instance, there were 140 million people too poor to afford a $400 emergency, nearly 10 million people homeless or on the brink of homelessness, and 87 million underinsured or uninsured.

Last year, the Poor People’s Campaign commissioned a study on the connections between Covid-19, poverty, and race. Sadly, researchers found the fact that all too many Americans refused to be vaccinated did not alone explain why this country had the highest pandemic death toll in the world. The lack of affordable and accessible health care contributed significantly to the mortality rate. The study concluded that, despite early claims that Covid-19 could be a “great equalizer,” it’s distinctly proven to be a “poor people’s pandemic” with two to five times as many inhabitants of poor counties dying of it in 2020 and 2021 as in wealthy ones.

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The pandemic not only exposed social fissures; it exacerbated them. While life expectancy continues to rise across much of the industrialized world, it stagnated in the United States over the last decade. Then, during the first three years of the pandemic, it dropped in a way that experts claim is unprecedented in modern global history.

In comparison, peer countries initially experienced just one-third as much of a decline in life expectancy and then, as they adopted effective Covid-19 responses, saw it increase. In our country, the stagnation in life expectancy before the pandemic and the seemingly unending plunge after it hit mark us as unique not just among wealthy countries, but even among some poorer ones. The Trump administration’s disastrous pandemic response was significantly to blame for the drop, but beyond that, our track record over the last decade speaks volumes about our inability to provide a healthy life for so many in this country. As always, the poor suffer first and worst in such a situation.

The Pandemic as a Portal

In the early weeks of those Covid-19 lockdowns, Indian writer Arundhati Roy reflected on the societal change often wrought by pandemics in history. And she suggested that this sudden crisis could be an opportunity to embrace necessary change:

“Historically, pandemics have forced humans to break with the past and imagine the world anew. This one is no different. It is a portal, a gateway, between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.”

There was hope in Roy’s words but also caution. As she suggested, what would emerge from that portal was hardly guaranteed to be better. Positive change is never a certainty (in actuality, anything but!). Still, a choice had to be made, action taken. While contending with the great challenges of our day — widespread poverty, unprecedented inequality, racial reckoning, rising authoritarianism, and climate disaster — it’s important to reflect soberly on just how we’ve chosen to walk through the portal of this pandemic. The sure-footed decisions, as well as the national missteps, have much to teach us about how to chart a better path forward as a society.

Consider the federal programs and policies temporarily created or expanded during the first years of the pandemic. While protecting Medicaid, CHIP, and SNAP, the government instituted eviction moratoriums, extended unemployment insurance, issued stimulus payments directly to tens of millions of households, and expanded the Child Tax Credit (CTC). Such proactive policy decisions did not by any means deal with the full extent of need nationwide. Still, for a time, they did mark a departure from the neoliberal consensus of the previous decades and were powerful proof that we could house, feed, and care for one another. The explosion of Covid cases and the lockdown shuttering of the economy may have initially triggered many of these policies, but once in place, millions of people did experience just how sensible and feasible they are.

The Child Tax Credit is a good example. In March 2021, the program was expanded through the American Rescue Plan, and by December the results were staggering. More than 61 million children had benefited and four million children were lifted above the official poverty line, a historic drop in the overall child poverty rate. A report found that the up to $300 monthly payments significantly improved the ability of families to catch up on rent, afford food more regularly, cover child-care expenses, and attend to other needs. Survey data also suggested that the CTC helped improve the parental depression, stress, and anxiety that often accompany poverty and the suffering of children.

How extraordinary, then, that, rather than being embraced for offering the glimmer of something new on the other side of that pandemic portal, the expanded CTC was abandoned as 2022 ended. The oppressive weight of our “dead ideas,” to use Roy’s term, crushed that hopeful possibility. Last year, led by a block of unified Republicans, Congress axed it, invoking the tired and time-worn myth of scarcity as a justification. When asked about the CTC, Congressman Kevin Brady (R-TX) claimed that “the country frankly doesn’t have the time or the money for the partisan, expensive provisions such as the Child Tax Credit.” Consider such a response especially disingenuous given that Brady and a majority of congressional Republicans and Democrats voted to increase the military budget to a record $858 billion that same year.

In so many other ways, our society has refused to relinquish old and odious thinking and is instead “dragging the carcasses of our prejudice and hatred” through the portal of the pandemic.

There are continued attacks on the health of women and the autonomy of those who can get pregnant; on LGBTQ+ people, including a wave of anti-trans legislation; on homeless people who are criminalized for their poverty; and on poor communities as a whole, including disinvestment, racist police abuse, and deadly mass incarceration at sites like New York City’s Rikers Island and the Southern Regional Jail in the mountains of West Virginia. And while weathering a storm of Christian nationalist and white supremacist mass shootings, this country is a global outlier on the issue of public safety, fueled by endless stonewalling on sensible gun legislation.

To add insult to injury, economic inequality in the United States rose to unprecedented heights in the pandemic years (which proved a godsend for America’s billionaires), with millions hanging on by a thread and inflation continuing to balloon. And as pandemic-era protections for the poor are being cut, ongoing protections for the rich — including Donald Trump’s historic tax breaks — remain untouched.

Another World Is Possible

In the office of the Employment Project where I worked upon first moving to New York City in 2001, there was a poster whose slogan — “Another World Is Possible” — still stays with me. It hung above my head, while I labored alongside my friend and mentor Paul Chapman.

Paul died this April and we just held a memorial for him. He was an activist in welfare rights and workers’ rights, director of the Employment Project, and one of the founders of the Poverty Initiative, a predecessor to the Kairos Center for Religions, Rights, and Social Justice that I currently direct.

Paul did pioneering work to bring together Protestant and Catholic communities in Boston, organized delegations of northern clergy to support civil rights struggles in small towns in North Carolina, and sponsored significant fundraisers for the movement, alongside his friend, theologian Harvey Cox. He also spent time in Brazil connecting with liberation theologians and others who went on to found the World Social Forum (WSF), an annual gathering of social movements from across the globe whose founding mantra was “Another World Is Possible.” Over the course of his long life, Paul would do what Black Freedom Struggle leader Ella Baker called “the spadework,” the slow, often overlooked labor of building trust, caring for people, planting seeds, and tilling the ground so that transformative movements might someday blossom. His life was a constant reminder that every organizing moment, no matter how small, is a fundamentally important part of how we build toward collective liberation.

Paul explained many things, including that powerful movements for social change depend on the leadership of those most impacted by injustice. Right next to the WSF poster there was another that read: “Nothing about us, without us, is for us.” Paul spoke regularly about how poor and oppressed people had to be the moral-standard bearers for society. He was unyielding in his belief that it was the duty of clergy and faith communities to stand alongside the poor in their struggles for respect and dignity. As a young antipoverty organizer and seminarian, I was deeply inspired by the way he modeled a principled blending of political and pastoral work.

Perhaps the most important lesson I learned from him was about the idea of “kairos” time. Paul taught me that, in ancient Greece, there were two conceptions of time. Chronos was normal, chronological time, while kairos was a particular moment when normal time was disrupted and something new promised — or threatened — to emerge. In our hours of “theological reflection,” he would say that during kairos time, as the old ways of the world were dying and new ones were struggling to be born, there was no way you could remain neutral. You had to decide whether to dedicate your life to change or block its path. In some fashion, his description of kairos time perfectly matched Roy’s evocative metaphor of that pandemic portal and when I first read her essay I instantly thought of Paul.

In antiquity, Greek archers were trained to recognize the brief kairos moment, the opening when their arrow had the best chance of reaching its target. The image of the vigilant archer remains a powerful one for me, especially because kairos time represents both tremendous possibility and imminent danger. The moment can be seized and the arrow shot true or it can be missed with the archer just as quickly becoming the target. Paul lived his life as an archer for justice, ever vigilant, ever patient, ever hopeful that another better world was indeed possible.

Despite our bleak current moment, I retain the same hope. However briefly, the pandemic showed us that such an American world is not only possible, but right at our fingertips. As the public-health emergency draws to an “official” end, it’s hardly a surprise to me that so many of those in power have chosen to double down on policies that protect their interests. But like Paul, it’s not the leadership of the rich and powerful that I choose to follow. As our communities continue to fight for healthcare, housing, decent wages, and so much more, I believe that, given half a chance, the poor, the hurting, and the abandoned, already standing in the gap between our wounded old world and a possible new one, could help usher us into a far better future.

Copyright 2023 Liz Theoharis

Via Tomdispatch.com