Over half a million Gazan children have been vaccinated against the deadly polio virus over the past 12 days, WHO said on Thursday, on the final day of a campaign that began 1 September, and which officials said appears to have attained the goal of reaching over 90% of the population of children under 10 years of age – at least in its first phase. 

But the longer-term health challenges faced in the war-torn enclave were underlined by a new WHO report, stating that some 22,500 Gazans who have sustained ”life-changing” injuries in the grinding 11-month Israel-Hamas war, will need long-term rehabilitation services that are unavailable from a shattered health system. 

Brief humanitarian ‘pauses’ against grim background of conflict

The polio vaccine campaign has unrolled in the shadow of new Israeli military evacuation orders and aerial bombings in parts of Gaza where displaced Palestinians were sheltering, along with the Israeli military’s discovery of six dead Israeli hostages in a tunnel under the southern city of Rafah, reportedly shot dead by Hamas shortly before the army’s arrival. 

Even so, brief lulls in fighting due to a series of ‘humanitarian pauses’ agreed to by all sides enabled local medical teams, coordinated by WHO, to conduct the three stage polio immunization drive across the central, southern and northern regions of the 365 square kilometre Palestinian enclave. The campaign, involving hundreds of local medical staff, was planned and launched after the initial discovery of poliovirus in Gaza sewage in July, followed by the confirmation of an active polio case in a 10-month old baby in August. 

The case was traced to a vaccine-derived strain of poliovirus, which is commonly emitted in feces, but can mutate and infect other under-immunized children, particularly in degraded sanitation conditions like those faced in wartime Gaza today.      

“So far in the north we have reached 105,909 children under ten years of age. In the middle area: 195,722 and in the south 250,820,” said Dr Rik Peeperkorn, WHO coordinator for the Occupied Palestinian Territories (OPT), in a WHO press briefing on Thursday. 

“This brings the total number of children vaccinated as of yesterday to 552,451. Numbers for today are still awaited,” he said. 

While the original 90% target involved reaching 640,000 children, that estimate of the under-10 population is being revised downward, in light of actual findings during the campaign, Peeperkorn stated. The same outreach must be repeated in a month’s time to deliver a second polio vaccine dose. 

‘Heartening to see response’

“It has been heartening to see the response to the campaign,” Peeperkorn told reporters at a briefing, broadcast from Gaza. “Everywhere the team has gone, parents are doing all they can to ensure their child does not miss vaccination. Many vaccination sites received more than expected crowds. Special coordinated missions were also conducted to reach children in insecure and hard to reach areas.

“I think that it’s amazing what has happened and what is possible where you have specific humanitarian policies, especially for the children, for the families, for everyone. 

“I don’t want to use that word, but it has even a bit of a ‘festive’ environment. Children came out [to be vaccinated] very well dressed. Many children on the streets …were.so joyful, joyful on the which haven’t been the case for the last 11 months. 

“So if this is possible in polio, why can’t we not translate this for other areas?”

Need to extend the polio ‘bubble’ to other humanitarian response efforts

“We are, and we were, and we are a little bit in a polio bubble,” Peeperkorn continued. 

“But we need to extend that, of course, to all the other humanitarian priorities,” he stressed, adding that food, fuel and medical supply distribution remain extremely difficult, while the area also faces looming winter cold and rain, after the scorching heat of the past summer. 

“We still face all of the same challenges we have for the last 11 months, if you talk about security, about getting the right goods and supplies humanitarian goods into Gaza,distributing those humanitarian goods across Gaza, and a deconfliction mechanism.  A lot of our humanitarian missions are still canceled.

“Over the last three weeks, we probably have nine missions to the North, many of those critically essential fuel missions for hospitals. Only four happened. 

“So if it is possible with polio, why can’t we do that in in a much broader area, and make sure that you establish these proper humanitarian corridors, even in a time of conflict?” 

Rehabilitation needs are huge and entirely unmet

Along with the constant interruptions in daily humanitariana relief efforts, the rehabilitation needs for injured Gazans constitute a huge, unmet need, for which almost no health services currently exist.

Without quick access to rehabilitation, many injuries will rapidly become even worse, noted Peeperkorn and other WHO experts at the briefing, citing the examples of spinal injuries that can cause knock-on bladder dysfunction, if not treated in time.

The new WHO report estimates trauma injury rehab needs using data from 8,878 injured patients, who were treated by Emergency Medical Teams (EMTs) between January and May, 2024. Based on that data, it extrapolates that at least one quarter of the esetimated 95,000 Palestinians injured in Gaza since the start of hostilities on 7 October, 2023, are estimated to have “life changing injuries that require rehabilitation services now and for years to come.”

Some 13 455 -17 550 people are estimated to have undergone severe limb injuries, which constitute “the main driver of the need for rehabilitation,” Peeperkorn stated, quoting the report. Many of those injured have more than one injury, the analysis found. The most common injury is to a major extremity,  followed by amputation, burn, spinal cord injury and traumatic brain injury. Between 3105 and 4050 limb amputations have been conducted.

The analysis does not distinguish between injured combatants and non-combatants – a distinction the Hamas-controlled Gaza Ministry of Health also has avoided in its 11 months of reporting on injuries and deaths – the latter now estimated at more than 40,000 lives lost.

The WHO analysis also made no estimate of the distribution of such injuries between men, women and children – despite the detailed breakdown in injury types and needs. Asked why age and gender were not at least considered, a WHO spokesperson cited the “limited availability of data” as noted in the report.

Gaza rehab services decimated

At the same time needs are mounting, Gaza’s pre-war rehab services have been decimated, the report underlines.  The enclave’s only limb reconstruction and rehabilitation center, located in Nasser Medical Complex and supported by WHO, ceased operations in December 2023, due to a lack of supplies and the flight of specialized health workers.  The hospital was further damanged during bitter fighting in February. Additionally:

• The three pre-existing inpatient rehabilitation units (Al Amal, Sheikh Hammad, Al Wafaa) are not operational.
• The only 2 prosthetic centres were located in Gaza city. One was damaged, one has been inaccessible throughout the war. Some basic repair services have newly restarted at one and a new service is being established in the South.
• At least 39 rehabilitation professionals are reported killed. Many others are displaced.

Currently, only 17 of 36 hospitals remain partially functional in Gaza, while primary health care and community-level services are frequently suspended or rendered inaccessible due to insecurity, attacks, and repeated evacuation orders, WHO noted.

“The huge surge in rehabilitation needs occurs in parallel with the ongoing decimation of the health system,” said Peeperkorn. “Patients can’t get the care they need. Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients’ lives at risk. Immediate and long-term support is urgently needed to address the enormous rehabilitation needs.” 

Image Credits: WHO, HPW, WHO.