Health Disaster Looms in Gaza: Poliovirus Detected in Sewage Amidst Ongoing Conflict

A severe health crisis is emerging in the Gaza Strip as sewage contamination and conflict exacerbate the risk of disease among displaced Palestinians. The detection of circulating variant type 2 poliovirus (cVDPV2) in the region’s wastewater has placed thousands at risk of contracting the highly infectious disease that can cause paralysis. This development comes amid deteriorating sanitary conditions and an overwhelmed healthcare system.

Detection of Poliovirus:

• Date of Detection: July 19, 2024
• Locations: Two sites in the Gaza Strip
• Virus Type: Circulating variant type 2 poliovirus (cVDPV2)
• Reported By: Global Polio Eradication Initiative (GPEI) and Gaza’s Ministry of Health, in coordination with UNICEF
• Risk: Thousands of Palestinians are at risk, though no paralysis cases have been detected yet.
• Genetic Analysis: The virus strains are related to each other and to a variant circulating in Egypt in late 2023. The virus may have been introduced to Gaza as early as September 2023.

Public Health Impact:

• Ministry Statement: Detection of the poliovirus in wastewater signals a potential health disaster, exposing thousands to the risk of polio.
• Sewage: Flows freely among tent camps, contaminating the already scarce drinking water supplies.
• Authorities in Deir el-Balah: Predict that roads will be flooded with wastewater, leading to the spread of diseases.

Escalation of Health Risks:

• Increased Attacks: Israeli military attacks on water wells, sanitation, and wastewater treatment facilities, along with blocking essential hygiene supplies, have worsened conditions.
• Al Jazeera’s Tareq Abu Azzoum: Described the situation as a “very grim medical reality.”

Decline in Immunization Rates:

• Polio Vaccine Coverage: In the occupied Palestinian territory was 99% in 2022 but declined to 89% in 2023 due to the conflict, as per the latest estimate from the global health group.
• Healthcare Facilities: Only 16 of 36 hospitals are partially functional, and only 45 of 105 primary health facilities are operational. Poor water quality and weakened sanitation have contributed to reduced immunization rates and increased risk of vaccine-preventable diseases.

Ongoing Surveillance and Challenges:

• Health Ministry: Assessing the effectiveness of the surveillance system in detecting acute flaccid paralysis and monitoring wastewater to gauge subnational immunity levels.
• GPEI Statement: The crisis poses significant challenges to disease surveillance and immunization outreach. Routine immunization rates have declined due to health system disruptions, insecurity, inaccessibility, population displacement, and medical supply shortages.
• World Health Organisation (WHO): Considers the risk of further spread of poliovirus within Gaza as high due to the compounded issues of poor sanitation, disrupted healthcare services, and ongoing conflict.