TueWhen a 10-month-old boy in Gaza tested positive for poliovirus in late August, the discovery spurred an urgent and desperate public health campaign in the region. Amid the bombings and airstrikes that have rocked Gaza for nearly a year since Hamas attacks last fall triggered an Israeli push, health workers there continue to push a vaccination initiative that started September 1st. A significant victory in campaign came as hundreds of thousands of children have received their first dose: about 560,000, the WHO announced Friday. But because of the war and the logistics of this particular vaccine, it will be weeks before the ultimate success of the effort is known.
The vaccination campaign initially aimed to reach at least 640,000 children in the Gaza Strip, with vaccines administered in hundreds of sites throughout the territory. (The discrepancy between this number and 560,000 was explained by the WHO revaluation (Target population.) The campaign was designed to be carried out in two rounds, each divided into three phases, targeting the central, northern and southern regions. The first round was completed on Thursday, covering the period from September 1 to 12.
“Despite repeated attacks on schools and shelters for children displaced from their homes, debilitating displacement orders that have forced families to move again and again, and widespread hunger that has at times brought parts of Gaza to the brink of famine, families have made efforts to turn out in large numbers for vaccinations,” said Adel Khodr, UNICEF Regional Director for the Middle East and North Africa, in a statement. statement“They know there is no time to waste in protecting their children.”
But for the vaccine to really work, a second dose would need to be given four weeks after the first dose to these hundreds of thousands of children – no easy task given the children's lack of documentation, harsh living conditions and limited time during short “breaks” in the fight against polio.
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“The whole operation is quite complex because you’re trying to reach a population that probably has a lot on their minds other than vaccination,” says Samir Sah, director of health programs for the Palestinians. “You’re talking about people who have been displaced 10 to 15 times, who have seen horrific scenes, who have lost everything they had in their lives.”
Medical Aid for Palestinians (MAP), an independent international NGO, has been working with WHO to monitor the campaign. According to MAP, they are using a Google Sheets form to manually record and track vaccinated children and send it back to WHO. They plan to review this log for the second round, which is expected to begin in late September or early October. The campaign is a joint effort between the Palestinian Ministry of Health (MOH), WHO, the UN Children’s Emergency Fund (UNICEF), and the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).
UNICEF’s role in this context included the delivery of 1.6 million nOPV2 vaccines, as well as cold chain equipment used to preserve the vaccines and hundreds of ice packs and boxes, which were critical in the region’s heatwave. According to Jonathan Kricks, UNICEF’s head of communications in Palestine, three-quarters of the cold chain capacity in Gaza was severely damaged or destroyed by the war.
“Let’s not forget that we are in a war zone, devastated by 11 months of extreme, intense fighting and bombing,” says Crixx. Up to 800 people are forced to share a toilet, he says, and residents can only shower once a week. Immunities are weakened by food shortages and hundreds of tons of waste dumped in the open; polio is far from the only disease that worries UNICEF. “Technically, it’s a perfect, horrible, terrible recipe for disease to emerge and spread.”
A post-campaign coverage assessment will be available before the second round begins. The aim is to show any complications or successes that relevant organisations can use to improve the second round. “If the evidence shows that we are missing more children, then additional campaigns will be needed,” says Dr Hamid Jafari, director of polio eradication in the WHO Eastern Mediterranean Region.
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However, the problems that health workers will face when implementing the second round have already become obvious.
Mass displacement is one of the most obvious problems: as children move with their families across different management zones, tracking them becomes increasingly difficult. In Rafah, for example, vaccination points are not really functioning; the area is a red zone and families cannot move freely, according to MAP.
“This creates a problem for the children who are inside [Rafah]who are not getting the vaccine,” Sah says. MAP doesn't have exact numbers on how many children it's supposed to reach there; more than a million have been displaced from Rafah. The organization says mobile teams are being sent into the region to try to reach children outside the humanitarian zones. “Of course, it’s risky, but we have no choice. If you want to reach people and vaccinate children who are not in safe zones, then we have to go outside the safe zones,” Sah emphasizes.
The northern region is likely to pose an even greater danger trial; UN envoys have limited access and very few trucks can pass through the checkpoints. Israeli Security Forces (ISF) stopped a UN convoy that was en route to the area for more than eight hours earlier this week, according to UNRWA, despite prior coordination. Of the three regions, the north had the least According to the WHO, medical teams have been dispatched to the scene.
The time allotted for vaccination – a humanitarian pause in hostilities from 6:00 a.m. to 3:00 p.m. – could be another obstacle. “From the first stage it looks like this [time frame] “There was enough to vaccinate the children, do the assessment, and have the health workers come, prepare and leave on time,” says WHO’s Jafari, speaking specifically of the central region, “so so far it’s working.”
But others believe that more flexible scheduling will be needed in the future. “It should be from sunup to sundown, because then people will have more time to do more than just their most basic needs,” Sah says. If people have family members who are in critical condition woundedThey may be more focused on caring for the wounded than taking their children to the hospital. “It takes time and space to get everything organized properly.”
Dr. Naina Bhalla, a doctor with Doctors Without Borders (MSF) in Gaza, points out that the schedule itself, not just the time frame, can cause a number of problems. “We have the same amount of time to vaccinate almost twice the target population in the central area,” Bhalla tells TIME from her medical camp in Al-Mawasi, near Khan Younis. The target population in the central region is 157,000 children, but the target population in the southern region is 340,000 children, in both cases on a three-day schedule with one extra day.
Bhalla says the schedule was not the organizations' initial request. initial request For the first round, there was a five-day, 24-hour humanitarian pause, with two extra days given for catch-up. “I think WHO, UNICEF and the Ministry of Health have done everything they can to make this campaign a success, but a lot of it is out of their control,” Bhalla says.
Some areas in the south are not actually covered by the humanitarian pauses. “Just like with the first round, it is absolutely essential that the humanitarian pauses are in place,” says Crixx. “To ensure that we don’t miss a single child, we will actually be coordinating special missions there.”
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Even in designated safe zones, civilians and health workers alike are worried about what might happen after 3 p.m. “As we have seen in recent months, there is no guarantee that being in a humanitarian zone will give anyone any security,” says Bhalla. “The humanitarian pause is supposed to last nine hours a day, but it is only nine hours.” She quotes events which signify the danger that humanitarian workers and civilians must endure. The day before the southern zone phase began, an airstrike near a hospital four people died and many were injured.
Despite the restrictions and safety concerns faced by health workers during the first round, participating organizations are cautiously optimistic about the future of the campaign and the second round.
“Humanitarians will continue to do the best they can under the circumstances, which they have been doing so far,” says Dr. Bhalla, who calls the national health workers and locally recruited staff “heroes.”
Some even hope that it will be successful polio– the vaccination campaign could lead to improved health for children in Gas more generally. “In parallel with these campaigns, we are looking at how we can re-establish and increase the number of immunization points,” says Jafari, “so that routine vaccination of children with all vaccines, not just polio, can resume.”
But such hopes are, of course, tempered by the ongoing war, which continues to threaten both the medical teams administering the vaccine and civilians. Without a lull in the fighting, doctors say they will be playing catch-up with the virus for the foreseeable future.
“The main priority is to stop this outbreak by reaching a very high coverage,” says Jafari, anticipating Israel’s commitment to a second round. “Ideally, of course, we ask for peace in Gaza.”