WHO Director General Dr Tedros Adhanom Ghebreyesus appealed to Israel to reverse this week’s decision by the country’s Knesset, or parliament, to close the Jerusalem-based operations of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), saying that “there is simply no other alternative to UNRWA.” 

Tedros also said that the third phase of a polio booster campaign in northern Gaza would get underway Tuesday, after Israel had agreed to a ‘humanitarian’ pause in the Gaza City metropolitan area.  But he also expressed fears that the significantly smaller in which health workers would be allowed to move about freely without fear of attack could mean that the campaign would not hit its target of 90% of children, under the age of 10 living in the northern region of the 365 square meter enclave. 

“The final phase of the campaign had aimed to reach an estimated 119,000 children under 10 years old,” Tedros said. “But achieving that target is now unlikely as conditions in northern Gaza get worse every day in the past two weeks.”

The WHO Director General was speaking at a WHO press conference in Geneva on Friday. 

‘Communications directly with Israel to reconsider’

Asked if he had tried to speak directly with Prime Minister Benjamin Netanyahu about the UNRWA closure, scheduled in 90 days time, Tedros sidestepped the question, saying: 

“There are communications directly to Israel to reconsider; and not implement the decision by the Knessset. And I hope that will be the case…we encourage Israel actually to reconsider.” 

Israel’s decision stems from allegations that UNRWA  employees participated in the bloody 7 October 2023 assault on Israeli communities along the border with Gaza, while it’s schools and health facilities have provided a base for Hamas weapons stores and operations.  Testimony by several former Israeli hostages in Gaza described their captors as being affiliated with UNRWA. But there also has been a longstanding Israeli grudge regarding UNRWA,  a sprawling institution with schools, clinics and welfare activities serving 6 million Palestinians in the Occupied West Bank and Gaza, as well as Jordan, Lebanon and Syria, and institutionally separate from the mandate of the UN High Commissioner for Refugees (UNHCR), which serves the rest of the world’s 32 million UN-registered refugees.

Tedros acknowledged that nine employees are being investigated for operating on behalf of Hamas, including during the 7 October 2023 rampage in Israeli communities and a music festival near the Gaza border. 

“But even if we said these people have relationships with Hamas, they cannot represent the whole of UNRWA,” he asserted.  “This ban will not make Israel safer. It will only deepen the suffering of the people of Gaza, and increase the risk of outbreaks.” 

“They (UNRWA) are the engine block of humanitarian support, education, (water and sanitation) WASH, shelter, logistical support,” added Dr Rick Peeperkorn, WHO’s representative to the Occupied Palestinian Territories, speaking from Gaza. “The UN will not replace UNRWA.”

Mass dislocation and siege in north limits effectiveness of second polio campaign phase

In terms of the polio campaign, where a second dose is set to be delivered in northern Gaza on Tuesday, vaccine workers won’t be able to reach the enclave’s northernmost areas, including Jabalia refugee camp, Beit Lahia and Beit Hanoun, WHO warned.

While mass Israeli evacuation orders have sent tens of thousands of Palestinians streaming south, and into safer areas close to Gaza City, tens of thousands of people still remain in those areas, where fierce fighting has been underway for weeks. 

“We currently have a humanitarian pause, necessary to conduct a campaign,” said Peeperkorn. “However, the area which this pause is covering has substantially been reduced compared to the first round of vaccination [in September]. 

“It’s mainly limited to the broader Gaza area, and while unfortunately, 100,000 people have been forced to evacuate from the northern Gaza, fleeing North Gaza to Gaza City, we still estimate…that approximately 15,000 children under 10 years in the towns of north Gaza, Jabalia, Beit Lahia and Beit Hanoun, still remain inaccessible and will be missed during the campaign. 

“So this is not an ideal campaign,” Peeperkorn said. “I want to stress that it’s a compromise campaign. And to interrupt poliovirus transmission, you want to get at least 90% of the children in every community, which will be challenging.”

Dysfunctional hospitals 

Along with the limitations of the polio campaign, WHO has been barred by Israel from operating  numerous relief and supply missions to northern Gaza’s hospitals, and particularly Kamal Adwan hospital, in Beit Lahia, which has been at the epicenter of fierce fighting over the past week. 

In the ensuing battles, the hospital’s pharmacy and an oxygen center were both destroyed, while two children in the intensive care unit died, according to Palestinian sources. Some 44 hospital staff were also detained in a two-day siege by Israel, which said it was trying to root out a Hamas command center on the hospital grounds.

The net result, however, is that the three main hospitals in northern Gaza, Kamal Adwan, Al Awda and the Indonesian hospital are barely functioning now, WHO officials said. 

On the brighter side, Shifa Hospital in Gaza City, which had been the site of a major Israeli siege and gun battles in mid-November, and again in the spring, has however, resumed partial operations, performing about ten surgeries a day, along with the reopening of its intensive care and dialysis services, as well as emergency trauma case, Peeperkorn said.

Over the past few weeks, WHO managed to operate six missions to the besieged hospitals of northern Gaza in October, including the evacuation of 60 critically ill patients from Kamal Adwan to other hospitals further south, added Peeperkorn. 

“But I want to stress that many of the missions in October were denied, delayed or, indeed on one of the missions, we were not allowed to bring in a fuel supply,” he added. Many of the WHO supplies that had been brought to Kamal Adwan also were destroyed or damaged during the destruction of the pharmacy. 

“Just to summarize, there were three partly functional hospitals in north Gaza: Kamal Adwan, Al Awda and the Indonesian Hospital.  The Indonesian is currently not functional anymore. It’s damaged. Kamal Adwan and Al Awda are minimally functional. WHO plans another support mission to Al Awda and to Kamal Adwan, this coming Sunday, bringing supplies and also, probably again, transferring critical patients to Shifa. I want to stress again, it is critically important that these hospitals remain functional.”

MPOX – new mechanism began allocating almost 900,000 vaccines this week

In other news, Tedros said that a new mpox Access and Allocation Mechanism (AAM) this week began allocating almost 900,000 doses of donated mpox vaccines to nine African countries, based on their public health need – “and especially those with significant transmission of Clade 1B virus.

“Countries are being informed of allocations today, and WHO and our partners will announce the details soon. This is the first allocation of almost 6 million vaccine doses that we expect to be available by the end of 2024,” he declared. 

The AAM mechanism was created by WHO last month, together with Africa CDC, the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) Gavi, the Vaccine Alliance, and UNICEF, with donations secured so far from the European Union, Canada, the United States and others.

More than 50,000 people in the Democratic Republic of Congo (DRC) and Rwanda had now been vaccinated against the mpox virus – since a campaign in those countries began in earnest at the beginning of October, he added.

While vaccination is an important step towards bringing the mpox outbreak under control, he stressed that, “it’s important to underscore that vaccination is only one part of that plan, alongside case finding, contact tracing, infection prevention and control, clinical care, risk communication and testing.

“Although testing rates have risen significantly this year, only 40 to 50% of suspected cases were tested in DRC in the two past weeks.”

Image Credits: WHO, @WHOoPt, @daniels_ugochi.