Palestinians walk next to destroyed buildings and pools with stagnant water in Khan Younis, southern Gaza Strip, July 19, 2024. (Abed Rahim Khatib/Flash90)

For 25 years, the Gaza Strip was free of polio. No longer. Earlier this month, the health ministry reported that a 10-month-old baby had contracted the disease ; a week later, he was paralyzed. This came after poliovirus had been detected in sewage samples from six locations in the cities of Deir Al-Balah and Khan Younis.

With raw sewage flowing through Gaza’s streets, in close proximity to the tents of displaced people and the few remaining sources of freshwater, a potentially catastrophic epidemic could soon be afoot. A mass vaccination campaign is essential, but so long as Israel’s military offensive continues, such a campaign seems impossible — even as vaccines have started to be brought in. All across the Gaza Strip, Palestinians fear the consequences of the spread of the disease, especially to children who comprise half of the enclave’s population.

“When my children go out to play, we run after them, shouting not to go near the sewage water,” Reem Al-Masry, a 35-year-old mother of three displaced from Beit Hanoun to Deir al-Balah, told +972. “But they are bitten all the time by mosquitoes and flies that live on piles of garbage and sewage and transmit diseases to us. Every day, my children complain of stomach pain, fever, skin rashes, and other health problems.”

For Saeed Samour, 40, who was displaced from Gaza City to Khan Younis, “the presence of sewage around us — and close to the few available water sources — is a scary thing.” In recent weeks, Samour’s 3-year-old son Zaid showed signs of a skin infection, most likely due to the air pollution caused by the remnants of war. “These children need daily bathing,” he said. “But cleaning products are very few and very expensive. One bar of soap, which used to cost only $1, now sells for $4.”

Now, Samour is anxious that Zaid will get sick from exposure to pathogens in the sewage. “There is no area in the city without pools of sewage water, and no one can walk around because of these pools,” he said. “Our food and water needs to be sterilized and cooked several times to be suitable for drinking and eating, and the lack of cooking gas is a major obstacle.”

Palestinians walk next to destroyed buildings and pools with stagnant water in Khan Younis, southern Gaza Strip, July 19, 2024. (Abed Rahim Khatib/Flash90)

As Israel’s airstrikes, ground incursions, and evacuation orders continue to terrorize Palestinians throughout the Strip, the so-called “humanitarian zone” along the coast has become one of the most densely populated areas in the world. Adnan Abu Hasna, a spokesperson for the UN Relief and Works Agency (UNRWA), told +972 that 1.8 million Palestinians are crammed into the area extending from the north of Rafah through Deir al-Balah to Nuseirat refugee camp. “There are 60,000 people in every square kilometer, and the displacement process continues,” he added.

Combined with the breakdown in water and sewage infrastructure, this severe overcrowding has led inevitably to the outbreak and transmission of disease. And it’s not just polio that the health authorities are worried about.

“Before October 7, Gaza had 85 cases of hepatitis,” Abu Hasna explained. “Today, we are talking about a thousand cases per week and the number is increasing : about a month ago, we recorded 40,000 cases.” Based on this rapid transmission rate, Abu Hasna warned, “the discovery of the poliovirus is a dangerous development, and it will have disastrous consequences.”

 ‘If our children aren’t killed by missiles, they’ll die from disease’

Just hours before the first case of polio was reported in Gaza, UN Secretary General António Guterres called for an immediate, weeklong ceasefire — a “polio pause” — to allow for the rollout of a vaccination campaign. The World Health Organization (WHO) declared that it was ready to release 1.6 million doses, with UNRWA medical teams preparing to administer them to more than 640,000 Palestinian children under the age of 10.

Israel quickly began vaccinating its own soldiers against the disease, but waited several weeks before permitting the entry of vaccines for Gazans. Yet even as medical teams seek to inoculate the population, no ceasefire appears forthcoming.

“The oral polio vaccine is effective,” Sameer Sah, the UK director of programmes at Medical Aid for Palestinians (MAP), told +972. “The challenge is in delivering the vaccine in an area where people are being displaced on a near-daily basis, means of transport are difficult to find, roads are damaged, and health services are being attacked.

“Such a campaign would accomplish a lot, but the expansion of the red zone in Gaza [the areas from which Israel has ordered residents to evacuate] makes it difficult to reach every child,” Sah continued. “A complete ceasefire is required to deliver adequate health care, including vaccination not only for polio but also for other preventable diseases.”

Displaced Palestinians live in shelter tents next to sewage water, near the sea in Deir al-Balah, central Gaza Strip, August 19, 2024. (Abed Rahim Khatib/Flash90)

In recent days, patients and nurses have been forced to flee Al-Aqsa Martyrs Hospital in Deir Al-Balah as Israeli forces close in. D^r. Khalil Al-Daqran, director of the hospital’s nursing department, told +972 before the evacuation that the hospital had been serving approximately 1 million people displaced to Gaza’s central region ; the corridors and floors were full of patients due to the lack of empty rooms and beds.

With such dire conditions even in the hospitals that remain functional despite Israel’s bombardment, Al-Daqran was pessimistic about the prospects of combating the spread of polio. “We don’t even have the equipment to test for the epidemic,” he said.

In these circumstances, with other diseases running rampant throughout Gaza, parents are terrified for their children. “As mothers, these illnesses scare us,” Al-Masry, the mother of three, said. “If our children aren’t killed by the missiles, they will die from these strange diseases that appear due to pollution and lack of sanitation.”

 ‘Israel is using water as a weapon’

At the end of July, a video circulated widely on social media showing Israeli army combat engineers blowing up a water reservoir in the Tel al-Sultan neighborhood of Rafah. The soldier who uploaded the video dedicated the demolition “in honor of Shabbat,” drawing international condemnation, and the army now claims to be investigating the incident.

For Ayman Labad, a researcher at the Palestinian Center for Human Rights’ economic and social rights unit, the obliteration of the reservoir came as no surprise given that Israeli forces have destroyed about 67 percent of the Strip’s water and sanitation facilities over the past 10 months. The only surprise, he said, was that they filmed themselves doing it.

By mid-June, the facilities destroyed in the war included 194 water production wells, 40 large-scale water tanks, 55 sewage pumping stations, 76 municipal desalination plants, four sewage treatment plants, nine spare parts warehouses, and two water quality testing labs. “The meaning of this is clear : Israel is using water as a weapon in its genocide against the population of the Gaza Strip,” Labad argued.

Palestinians collect drinking water in Deir al-Balah, central Gaza Strip, August 3, 2024. (Abed Rahim Khatib/Flash90)

And with the forced closure of these facilities, Gaza’s water sources have become contaminated, leading to the rapid spread of illness. “The residents of the Strip currently live on just one-fifth of the amount of water available before October 7,” Labad stated. “About 66 percent of Gazans are suffering from water-borne diseases such as cholera, chronic diarrhea, gastroenteritis, and hepatitis.”

As sources of clean water have dwindled, Gazans have been forced to queue for hours to obtain what little water is available, and to sacrifice basic hygiene — a critical part of avoiding illness. “Every person needs dozens of liters of water, but we now stand in line and wait for about seven hours just to get two gallons,” Saeed Al-Jabri, a 38-year-old from Rafah, told +972. “Is it reasonable for a person to endure these conditions ?”

Like many displaced Palestinians, Al-Jabri has taken to bathing in the sea. “The seawater is salty and when it dries up, the salts settle on the skin and can cause inflammation,” he said.

Al-Jabri has seen the videos of Israeli soldiers targeting water sources, and cannot help but express his anger. “There is no military goal behind it,” he noted. “It’s simply revenge, with civilians being punished.”

Ruwaida Kamal Amer