The director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said on Wednesday that polio had been detected in Gaza and warned that urgent preventive measures had to be taken to protect children from the infection, which can cause death or crippling paralysis.

“The detection of polio in Gaza is another reminder of the dire conditions the population is facing,” the WHO director wrote on X, referring to the Israeli military onslaught on the Palestinian enclave. “The persistence of the conflict hampers efforts to identify and respond to preventable threats such as polio.”

The WHO has dispatched a million doses of polio vaccine to the Israeli-occupied territory, but how they will reach the population, particularly the children, under conditions of continuous military violence is unknown.

The Gaza Health Ministry declared a polio epidemic Monday based on testing of wastewater samples. No actual cases have yet been reported, but the chaotic conditions in Gaza, with constant bombing and shelling and forced movements of population make any systematic monitoring for the disease impossible.

In a statement posted on Telegram, the ministry warned that polio “poses a health threat to the residents of Gaza and neighboring countries,” referring to both Israel and Egypt, the two countries which border on the Gaza Strip, as well as the wider Middle East.

Gaza has been polio-free for a quarter of a century, thanks to effective mass vaccination, but this health achievement, like all the social gains of the Palestinians, is threatened with utter destruction under the impact of Israeli bombs, missiles and tank shells.

Miles of tents line the beaches and empty lots and fields, people are piled into tents in clothes that have not been washed for months, children are playing in and drinking from puddles of water contaminated with sewage. 

The primary means of spread for polio is fecal-oral contamination, and the targeting of water and sanitary facilities by the Israel Defense Forces has as a conscious aim the spreading of infectious disease to decimate the Palestinian population. 

Repeatedly during the ongoing genocide, health authorities had warned that the destruction of critical infrastructure would bring with it a public health crisis. And last week, six of seven routine sewage samples detected the virus.

The UN noted that besides polio, diseases like Hepatitis A, dysentery, and other gastrointestinal disorders are widespread and continue to rise. More than one million respiratory infections have been documented. Scabies and lice are running rampant among the population. And as many have noted, this is only the beginning of the broader public health crisis that the exhausted and trodden population will see adding to their historic misery. 

Dr. Tanya Haj-Hassan, a pediatric intensive care physician, speaking with Al-Jazeera, called the detection of polio a “ticking time bomb.” She added, “Normally if you have a case of polio, you’re going to isolate them, you’re going to make sure that they use a bathroom that nobody else uses, make sure that they’re not in close proximity to other people, [but] that’s impossible. You have everybody clustering in refugee camps at the moment without vaccines for at least the past nine months, including children who would otherwise have been vaccinated for polio and adults who, in the setting of an outbreak, should receive a booster, including healthcare workers.”

Dr. Medhat Abbas, director general of Al Shifa Medical Complex, told the press that the streets were full of sewage. “Personal hygiene is absent. You can’t wash your hands, even after you’ve used the bathroom,” he said. “So, there’s pollution and this disease is spread through feces.”

In May, Oxfam’s Middle East director, Sally Abi Khalil, lamented, “The situation is desperate, with so many people in Gaza living in fear and being forced to endure inhumane and unsanitary conditions caused by sustained Israeli bombardment. One colleague told me there was so much human waste in the streets, it literally smelt like disease.”

She said at that time: “Israel’s military assault on Rafah could be devastating, not only because of the risk of mass civilian casualties, but also the repercussions of vast numbers of people being forced to move. With the infrastructure already beyond breaking point, little or no healthcare available, and widespread malnutrition this could quickly escalate into a major epidemic.”

This week, Dr. Ayadil Saparbekov, the World Health Organization’s (WHO) health emergency team lead for Gaza and the West Bank, told NPR, “It’s a very dangerous disease. And, in the situation of Gaza, it’s beyond dangerous.” The limited investigation indicates the virus came from Egypt sometime in September before the commencement of hostilities. 

Another important element in the policy of extermination through disease is the blockade-imposed famine, which starves some victims to death and weakens the resistance to infection among many more. 

This is combined with the military offensive on hospitals, clinics, and healthcare workers that has killed 500 physicians, 50 of them specialists. More than 200 medical staff have been imprisoned in detainee camps in Southern Israel where they undergo violent interrogations. Twenty of 36 hospitals have been completely destroyed and the rest are functioning under most barbaric conditions. The sick and injured have no place to turn to address any of their immediate and life-threatening injuries and illnesses. 

In response to the reports of polio, Israel said it was offering soldiers serving in the Gaza Strip the polio vaccine to be administered during routine troop turnover, although it was not mandatory for them to accept it. The Israeli army also indicated it would allow international groups to bring the polio vaccine into the enclave. According to the WHO, more than a million polio vaccine doses were being brought in to be given over the coming weeks. 

Even before the military assault on the defenseless enclave, in March 2023, Israeli physicians were urging the government and medical community to respond to an outbreak of polio and prioritize and vaccinate the 176,000 Israeli children who had never received any doses. At the time, four children had been diagnosed with polio, and one had paralysis in his limbs. Prior to that outbreak, Israel had no clinical cases of polio between 1988 and 2022.