(New York) – Israeli military attacks on healthcare infrastructure and water supplies and ongoing aid obstruction are contributing to a potentially catastrophic polio outbreak in Gaza, Human Rights Watch said today. Polio, which is entirely preventable but spreads fast, particularly among children under 5, can cause disabilities, including paralysis, and death among unvaccinated children.
On August 16, 2024, the Palestinian Ministry of Health confirmed the first case of polio in an unvaccinated 10-month old child in Gaza. On the same date, the World Health Organization (WHO) reported that three children were showing symptoms of acute flaccid paralysis, raising concern that the virus could be spreading among children in Gaza. On August 23, WHO confirmed that the 10-month old child is now paralyzed. The cases are emerging one month after WHO raised the alarm that vaccine-derived poliovirus had been found in Gaza’s wastewater.
“If the Israeli government continues to block urgent aid and destroy water and waste management infrastructure, it will facilitate the spread of a disease that has been nearly eradicated globally,” said Julia Bleckner, senior health and human rights researcher at Human Rights Watch. “Israel’s partners should press the government to lift the blockade immediately and ensure unfettered humanitarian access in Gaza to enable the timely distribution of vaccines to contain the unfolding polio outbreak.”
Before the case was confirmed on August 16, Palestine had been polio-free for more than 25 years, thanks to a successful childhood vaccination program. However, Israel’s ongoing decimation of healthcare, water, and sanitation facilities in Gaza and its obstruction of aid and humanitarian access have created “the perfect environment for diseases like polio to spread,” according to WHO Director-General Dr. Tedros Adhanom Ghebreyesus.
The spread of the polio virus poses significant risk for the hundreds of thousands of children in Gaza who may have missed routine vaccinations since the escalation of hostilities in October 2023, Human Rights Watch said. In 2022, polio vaccination rates in Gaza were “optimal,” at around 99 percent. By early 2024, those rates had dropped to below 90 percent.
When vaccine-derived polio had previously been detected in wastewater, authorities intervened with targeted vaccine campaigns to protect children. But Dr. Hamid Jafari, WHO’s polio eradication director for the eastern Mediterranean region, told Human Rights Watch on July 27 that “[t]he impact on [the] health system, insecurity, inaccessibility, population displacement, and shortages of medical supplies have contributed to reduced routine immunization rates.”
WHO is planning to initiate two rounds of a polio vaccination campaign in Gaza, starting at the end of August. Humanitarian actors are raising the alarm that it will be impossible to reach the more than 640,000 children who need polio vaccines if Israel continues its ongoing bombardments on civilians and civilian infrastructure and obstruction of humanitarian access.
In addition to security risks, Gaza’s severely weakened public health system makes it difficult for humanitarian workers to ensure that these vaccines reach the children who need them, a problem exacerbated by the Israeli military’s repeated displacement of virtually the entire population. The Israeli military has obstructed humanitarian missions inside Gaza and attacked medical and other aid workers who shared their precise coordinates.
Furthermore, the Israeli military has obstructed aid entering Gaza, first by banning it outright and later by imposing onerous restrictions. According to the United Nations Office for the Coordination of Humanitarian Affairs, humanitarian aid entering Gaza has dropped by over 50 percent since April and about a third of humanitarian aid missions were denied access to Gaza by Israeli authorities since August 1.
International humanitarian law requires Israel, as the occupying power in Gaza, to ensure that the basic needs of the civilian population are provided for. In addition, all parties to the conflict are obligated to “allow and facilitate rapid and unimpeded passage of humanitarian relief for civilians in need.” This is a positive obligation that requires Israel to ensure that the civilian population can access medical supplies, including vaccines.
Preventable diseases tend to emerge alongside systemic rights abuses. Violations of the right to clean drinking water, sanitation, and hygiene and obstruction of access to vaccines and health care services create the conditions for otherwise preventable disease to spread through vulnerable populations, Human Rights Watch said.
Israeli military strikes have destroyed key civilian infrastructure in Gaza required to prevent and respond to disease outbreak, including hospitals, drinking water sources, and waste management infrastructure. Israeli forces have also destroyed the main water quality testing laboratories in Gaza, making epidemiological surveillance of the poliovirus and other waterborne diseases extremely difficult.
The Israeli military has used starvation as a weapon of war in Gaza, blocking access to food and water-related supplies, which is a war crime. People in Gaza have only had an average of 1.5 to 9 liters of water per day since November, less than the 15 liters per day that is the minimum needed for survival, according to WHO. Intentionally depriving civilians of clean water is a war crime.
An Oxfam report published in July found that Israeli forces have destroyed 70 percent of sewage pumps and all wastewater treatment plants in Gaza, leading to the accumulation of 340,000 tons of solid waste near populated areas. According to the Health Ministry in Gaza, the poliovirus was found in sewage that runs between overcrowded tents of people displaced by Israeli air strikes.
Waterborne diseases are already spiking in Gaza. More than a quarter of the population is sick with preventable water and sanitation-related diseases, such as acute diarrhea, skin diseases, and hepatitis A. Human Rights Watch has documented the Israeli military’s repeated, apparently unlawful, attacks on medical facilities, which should be investigated as war crimes, severely hindering capacity to respond to outbreaks of disease. Only 16 of the 36 hospitals in Gaza are even partially functional, and even fewer are accessible.
The International Criminal Court is considering issuing arrest warrants for senior Israeli officials for depriving the civilian population in Gaza of “objects indispensable to human survival,” including “clean water.” Israel is contravening the International Court of Justice’s legally binding orders by obstructing the entry of lifesaving aid and services into Gaza, Human Rights Watch said. Since January, the court has three times ordered provisional measures requiring Israel to ensure the provision of basic services and humanitarian assistance as part of South Africa’s case alleging that Israel is violating the Genocide Convention of 1948.
The Israeli government should immediately end its blockade of Gaza and ensure full and unfettered humanitarian access, including access to vaccines and medicines, Human Rights Watch said. Countries should use leverage such as targeted sanctions and embargoes to press the Israeli government to comply with the court’s binding orders.
“Children in Gaza are already suffering from starvation and rampant infectious disease as a result of Israel’s blockade and attacks on civilian infrastructure and are now facing an unprecedented polio outbreak without vaccines to protect them,” Bleckner said. “Israel’s allies should unequivocally press for an end to the siege of Gaza.”
