At least $7 billion is needed to rebuild Gaza’s health system, which has no fully functioning hospitals, and critical shortages of essential medicines, equipment and health workers, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

While Tedros welcomed the ceasefire negotiated by US President Donald Trump on 10 October as “the best medicine”, he portrayed a grim picture of the impact of Israel’s attack on the territory in retaliation for Hamas’s attacks on 7 October 2023.

“More than 170,000 people have injuries in Gaza, including more than 5,000 amputees and 3,600 people with major burns,” said Tedros.

“At least 42,000 people have injuries that require long-term rehabilitation, and every month, 4,000 women give birth in unsafe conditions. Hunger and disease have not stopped, and children’s lives are still at risk.”

The WHO’s immediate focus since the ceasefire took effect has been on sending medical supplies to hospitals, deploying additional emergency medical teams and scaling up medical evacuations. 

Around 15,000 patients need specialist treatment outside Gaza, including 4,000 children, and Tedros appealed for more countries to assist in their treatment and for referrals to the West Bank, including East Jerusalem, to resume.

In the coming days, the WHO will focus on four areas: maintaining life-saving and life-sustaining essential health services; strengthening public health intelligence, early warning and prevention and control of communicable diseases; coordinating health partners; and supporting the recovery, rehabilitation and reconstruction of the health system. 

“Our 60-day ceasefire plan calls for $45 billion, but the total cost for rebuilding Gaza’s health system will be at least $7 billion,” said Tedros.

Israel obliged to ensure Gaza’s ‘basic needs’

On Wednesday, the International Court of Justice issued an advisory opinion that Israel, as Gaza’s occupying power, is obliged to “ensure the basic needs of the local population, including the supplies essential for their survival” and “not to impede the provision of these supplies”.

However, the Rafah Crossing between Israel and Egypt remains closed, although Israel had agreed to open it last week.

Dr Rik Peeperkorn, WHO’s Representative in Occupied Palestinian territory (oPT), said that while the Kerem Shalom and Kissufim crossings between Israel and Gaza were open, the flow of aid was too slow and opening the Rafah passage between Egypt’s Sinai and Gaza is “urgent”.

Since the ceasefire, the WHO has been able to bring in one of 39 pallets of vital supplies, but it still has 2,100 pallets of medical supplies ready to move, said Peeperkorn.

Less than half the 600 agreed-on daily number of trucks have been able to enter Gaza since the ceasefire, which meant that people were not getting the food they needed, said Tedros.

“Over 600,000 people in Gaza are facing a catastrophic level of food insecurity. It is our collective duty to also make sure they do not lose their lives because we have not been able to scale up the aid at the level that we require,” stressed Dr Theresa Zakaria, WHO unit head for humanitarian and disaster action.

30% polio budget cut threatens progress seen to date

Tedros also took up the new challenges faced in polio eradication, noting that Friday, October 24, is World Polio Day. Polio incidence has dropped by 99% since 1988, when the Global Polio Eradication Initiative was launched by WHO, with the United States, Rotary International and UNICEF as founding partners.

“When we launched the Global Polio Eradication Initiative (GPEI),  more than 350,000 children were paralysed by polio every year,” Tedros noted. “Today, that number has dropped by more than 99%.” Just 39 cases of wild poliovirus have been reported so far this year, 9 in Afghanistan and 30 in Pakistan, according to the latest WHO and GPEI data.   

However, that progress is also threatened today by the 30% budget cut that GPEI will see next year.  The 2026 budget of $786.456 million was  released on 13 October,  following a New York City meeting of GPEI partner agencies. That’s as compared to $1.1 billion in 2025. There is also a $1.7 billion funding gap for the GPEI 2022-2029 strategy,  revised last year.

The budget cuts include a 26% reduction for outbreak response, and a 34% reduction in surveillance activities in WHO’s African Region and the Eastern Mediterranean regions outside of Pakistan and Afghanistan – the two countries where wild poliovirus continues to be transmitted. These two countries remain, according to WHO, the highest priority “as they are key to a polio-free world.”

Cases down this year in Afghanistan and Pakistan

Both Afghanistan and Pakistan have so far seen a decline in cases this year, with 30 cases of wild poliovirus recorded in Pakistan – as compared to 74 in 2024. Afghanistan’s Taliban regime conducted their first polio vaccination campaign in April  2025, and as of 22 October,  just nine cases had been confirmed in the country as compared to 25 in 2024, according to GPEI.

However, along with budget cuts, devastating floods and the recent earthquakes in Afghanistan have hampered continuing surveillance, as well as the Taliban’s continued suspension of door-to-door campaigns as well as the ban on female health workers delivering vaccines.

In other lower risk areas, “more extensive active surveillance, supervision and training, will need to be reduced,” the plan states, warning that these countries, particularly in low-income countries in Africa,  “face the greatest risk for surveillance gaps that may lead to missed transmission and delayed outbreak response.”

Those cuts could affect detection and response to outbreaks like the wild poliovirus outbreak detected in Malawi and Mozambique in 2022 – beginning with a case that had reportedly been imported from Pakistan several years earlier, and leading to a mass vaccination campaign. Currently, there are ongoing outbreaks of circulating vaccine-derived poliovirus (cVDPV) in the Lake Chad Basin and the Horn of Africa. Madagascar officially ended its cVDPV1 outbreak in May 2025. Circulating virus type 3 (cVDPV3) has also been detected in the last 12 months in Algeria, Cameroon, Nigeria, and Chad.

Vaccine-derived cases are the main concern in the world today, occuring when unvaccinated or undervaccinated groups are exposed to live virus shedded by other, vaccinated people through contact with feces or sewage.  Poliovirus is still found in the sewage of WHO’s European and American regions – with vaccine-derived cases periodically surfacing in those regions too. While new, more genetically stable oral vaccine formulations are gradually being introduced to limit vaccine-derived cases, they are not a magic bullet. 

US Congress pledging continued support but….

Leading Republican members of the US Congress  have pledged to continue supporting polio elimination efforts in 2026, at the same level as this year’s $265 million. However, it’s unclear how the money will be distributed insofar as USAID, one major channel, has been dismantled while the United States withdrew in January from the World Health Organization, which typically implemented 40% of the polio elimination programme, while UNICEF handled the other 40%.  The US is today GPEI’s second leading donor after the Gates Foundation, while Rotary International is third.

Tedros and other WHO officials did not discuss the details of how GPEI monies would now be distributed in light of the US freezeout – but stressed that political and geopolitical tensions shouldn’t be allowed to set back progress.

After all smallpox was eradicated in the midst of the Cold War, WHO’s Director of Polio Eradication, Dr Ahmed Jamal, noted: “It wasn’t an easy time. There were so many other conflicts that were going on. So the mission is possible. We all committed to ending polio.”

Added Tedros, “Decades ago, the world overcame geopolitical and geographic barriers to end smallpox. Let’s do the same for polio. Let’s finish the job.”

-Elaine Ruth Fletcher contributed to reporting on GPEI. 

Image Credits: WHO, Pakistan Polio Eradication Program , WHO/GISC.