Polio and the destruction of Gaza’s health infrastructure
Editor’s Note: The following article first appeared as a thread on X (formerly Twitter).
This past week, poliovirus was detected in sewage samples in the Gaza Strip. According to the World Health Organization (WHO) polio (poliomyelitis) is a “highly infectious disease” that “invades the nervous system and can cause total paralysis in a matter of hours”.
Like so much else in the Gaza Strip these days, polio according to the WHO “mainly affects children under 5 years of age” but can infect “anyone of any age who is unvaccinated”. Furthermore, “One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralyzed, 5-10% die when their breathing muscles become immobilized”.
Israel and its apologists can be expected to blame Hamas for this state of affairs, with canards about the Gaza health authorities prioritizing the construction of tunnels over inoculating those under their rule, dirty Arabs, and the like. The fact of the matter is that not only is polio not endemic in the Gaza Strip, it was eradicated from the territory several decades ago. The achievement was publicly touted by none other than Ted Tulchinksy, who from 1978-1994 served as the Coordinator for Health in the West Bank and Gaza Strip within Israel’s Ministry of Health. His testimony is significant because during his tenure Tulchinsky supervised the health departments of the military governments Israel established in each of the West Bank and Gaza Strip in 1967.
Writing on the website of the U.S. National Institutes of Health (NIH) in 2011, Tulchinsky writes that during the 1970s polio epidemics periodically erupted in Israel and the Palestinian territories it was in the process of annexing, and “despite high levels of [vaccination] coverage” in the Gaza Strip in particular, on account of its degraded sanitary infrastructure.
Tulchinsky recounts that in 1978 Israel consulted with Natan Goldblum and Joseph Melnick, two noted epidemiologists from Baylor University, to develop more effective anti-polio strategies. Their recommendation, to increase the four doses traditionally given to infants during their first year with an additional three of a different variety, was pioneered in the Gaza Strip. It proved so effective that the disease was eradicated from the territory within a few short years. Tulchinsky does not say so, but it seems likely that as with so much else the Gaza Strip here too functioned as a human laboratory for new Israeli methods. Indeed, the Goldblum-Melnick vaccination sequence was according to Tulchinsky “dubbed the Gaza system” and subsequently applied within Israel to quell a polio outbreak of its own in 1988. “As a result of this episode”, Tulchinsky wrote, “Israel adopted the Gaza system, and total eradication of polio was rapidly achieved”.
It is unclear how polio has suddenly re-appeared in the Gaza Strip. What is beyond doubt is how it’s spreading. Israel has systematically destroyed the Gaza Strip’s health, sanitary, water treatment, and power infrastructure, particularly since October 2023, leading to the collapse of systems that were already precarious. Contaminated water, untreated sewage, and uncollected garbage, particularly when paired with the severe overcrowding resulting from Israel’s genocidal campaign and repeated forced displacement of the civilian population, represent ideal conditions for its spread.
In the words of United Nations Secretary-General Antonio Guterres, speaking last December:
The people of Gaza are being told to move like human pinballs – ricocheting between ever-smaller slivers of the south, without any of the basics of survival … Conditions in shelters are overcrowded and unsanitary. People nurse open wounds. Hundreds of people stand in line for hours to use one shower or toilet … wearing clothes they have not changed for two months.
Such conditions have also created a breeding ground for other infectious diseases. As of June 30, the WHO reported nearly a million cases of acute respiratory infection (affecting almost half the population), over half a million cases of diarrhea (including nearly 200,000 cases of “acute watery diarrhea”), and over 100,000 cases of acute jaundice (suggesting hepatitis is widespread), and so on. The WHO notes these figures “should be interpreted with caution, due to delayed and incomplete data reporting”. As the summer intensifies, there have also been multiple warnings of a cholera outbreak.
With few and limited exceptions, Israel is preventing the entry of fuel, vaccines, medical supplies, and potable water into the Gaza Strip. As Israel’s Minister of Defense, Yoav Gallant, publicly announced on October 8, “We are imposing a complete siege on Gaza. There will be no electricity, no food, no water, no fuel. Everything will be closed”.
There was more to this policy of collective sadism than revenge. Giora Eiland is a retired major-general who previously served as head of Israel’s National Security Council and is an advisor to its current government. He also publishes a regular column in the Israeli newspaper Yedioth Ahronoth. Writing on October 29, he urged Israel to inflict “not only destruction in Gaza City, but a humanitarian disaster and absolute governmental chaos … [O]nly that outcome – the complete destruction of all systems in Gaza and desperate distress”, would in his view bring about victory. On November 19 he exhorted the government to continue its siege on the Gaza Strip, emphasizing that “severe epidemics in the southern Gaza Strip will bring victory closer and will reduce the number of IDF casualties.” The enthusiastic identification of an entire society as a military target, and the determination to inflict maximum levels of suffering to compensate for Israel’s military failures, has been a common refrain among Israel’s senior political and military leaders.
Central to this campaign has been the eradication of Gaza’s health infrastructure. The WHO speaks of the “continued dismantling of the health system”. In late May Doctors Without Borders (MSF) put it thus: “In the last seven months the healthcare system in the Gaza Strip has been systematically dismantled. According to OCHA [The United Nations Office for the Coordination of Humanitarian Affairs] 24 hospitals are now out of service, while 493 health workers have been killed”. By July 12 the WHO reported746 health workers killed, 967 injured, and 128 still incarcerated. Israel flunkies will no doubt denounce each and every one of them as Hamas, and claim the numerous ambulances bombed to smithereens were camouflaged rocket launchers.
Attention has primarily focused on the challenges Gaza’s disintegrating Palestinian medical facilities and their overworked and under-resourced staff confront in dealing with the overwhelming number of casualties resulting from Israel’s genocidal campaign. The accounts of young children enduring amputations without anesthetics and severe burns without pain management, of patients dying because of the unavailability of basic medical supplies like disinfectants, have become all too common. But the crisis also goes much deeper. Regular health care, for example for cancer patients or those who suffer a stroke, diabetics requiring insulin, a child or grandparent with a broken bone, and the like, has also all but disappeared. Mark Perlmutter and Feroze Sidhwa, two U.S. surgeons who recently volunteered at a hospital in the Gaza Strip, provide a particularly harrowing account of their experience. It is, unfortunately, just one of very many such testimonials.
At the beginning of July Rasha Khatib, Martin McKee, and Salim Yusuf published a letter in the prestigious British medical journal The Lancet in which they note that “Armed conflicts have indirect health implications beyond the direct harm from violence”, with “destroyed health-care infrastructure” prominently noted as a factor. The authors observe that “In recent conflicts, such indirect deaths range from three to 15 times the number of direct deaths”. Based on current conditions in the Gaza Strip the authors, “applying a conservative estimate of four indirect deaths per one direct death”, find it “not implausible to estimate that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza”, and note that this amounts to “7-9% of the population in the Gaza Strip”. That’s a lot of Pallywood for the Defamation League and other Israel flunkies to explain away.
Accounts of the destruction of the Palestinian health infrastructure typically focus on Israel’s destruction of al-Shifa Hospital, the largest medical complex in the Gaza Strip that was razed and burned to the ground by the most moral army since the Ku Klux Klan after none of its pretexts for attacking the complex were substantiated.
Before Al-Shifa there was the October 17 mass casualty bombing of Al-Ahli Arab Hospital, also known as Al-Ahli Baptist Hospital. Established in 1882, it is the only Christian hospital in the Gaza Strip and is managed by the Anglican Diocese of Jerusalem. Along with other hospitals, it also became a refuge of choice for civilians desperate for safe haven.
Three days earlier, on October 14, Human Rights Watch reported that “an artillery projectile struck the hospital’s diagnostic cancer treatment center”. Based on details of the shell, it concluded that “Israel is the only party to the [Gaza] conflict known to possess and use the artillery that fires this type of munition”.
Over the course of the next three days, the hospital’s director and staff received numerous direct Israeli warnings and threats, demanding they evacuate the premises. (Needless to say, they refused and continued to treat their patients). In the immediate aftermath of the October 17 bombing, Israel put out several and often contradictory accounts, before eventually settling on two points: the casualty figures were vastly exaggerated and, more importantly, were caused not by Israeli fire but by an errant Palestinian projectile.
As so often Israel’s purpose in rejecting culpability and blaming its victims is not to convince its audience so much as to confuse it. If journalists, Human Rights Watch, and others conclude they cannot clearly establish responsibility and must await a full and proper investigation when conditions permit, it is mission accomplished.
In this particular case, the ruse worked beyond expectations. Although the Anglican Diocese of Jerusalem pointed the finger squarely at Israel, the Archbishop of Canterbury and senior cleric of the Anglican Church, Justin Welby, shamelessly denounced accusations that Israel was responsible as a “blood libel”. “Don’t assume it’s Israel”, he stated. “You have no proof”.
For good measure Welby professed total ignorance on the numbers killed and injured, stating, “I’ve heard so many different figures”. Ever the knave, U.S. President and soon-to-be-former-nominee Joe Biden rushed to blame the Palestinians. Speaking in Israel, the same individual who claimed to have viewed non-existent images of beheaded infants on October 7 stated, “Based on what I’ve seen, it appears it was done by the other team, and not you”. The resulting outrage contributed to the abrupt cancellation of his scheduled conclave with an assortment of Arab client regimes in Amman several days later. Like these past several weeks, even his closest allies couldn’t stomach being associated with him.
The most comprehensive investigation I have come across to date has been conducted by Maher Arar, who has produced two extraordinarily detailed technical reports to demonstrate not only that it was an Israeli projectile that hit Al-Ahli Hospital, but that any other theory is inconsistent with the available evidence. While I found his reasoning entirely convincing, I’m not sufficiently technically proficient – to put it mildly – to rebut any challenges to his technical conclusions. I do however know enough to confidently dismiss any detractors who do not call for an immediate, comprehensive, independent international investigation and refuse to condemn Israel for refusing one.
Maher Arar makes the important point that Israel attacked Al-Ahli Hospital not despite its prominent international connections, but because of them. It was a test case. If it succeeded, and it could get the likes of Welby, the BBC, and Western governments to play along, that would send an unmistakable signal that every single Palestinian hospital was fair game and could be attacked with impunity. And that’s precisely what has happened. A fundamental principle of the laws of war that has survived for centuries if not millennia lies buried in the rubble of Gaza’s hospitals. It no longer exists, and the horrific consequences will – already do – reverberate far beyond the Gaza Strip.
In the words of noted Palestinian-British surgeon Ghassan Abu-Sitta, who was at Al-Ahli Hospital the night of the attack:
This incident served as a litmus test for what was to come: Israel’s full war on Gaza’s healthcare infrastructure. After Al-Ahli was hit, and no one was held to account, the domino pieces began to fall rapidly. Hospitals were targeted one after the other. It became obvious that the attacks were systemic.
Several months ago, I had the pleasure of meeting Dr. Chandra Hassan in Chicago. A dedicated medical professional and humanitarian, he had volunteered at Nasser Hospital in Khan Younis for some time during the current genocide and has remained in regular contact with Palestinian colleagues.
During our conversation, I asked him what he thought the underlying purpose of Israel’s systematic destruction of the Palestinian health infrastructure was. He responded – and here I paraphrase – that hospitals have a special sanctity and form the ultimate refuge and source of hope for people in crisis. They expect to have, and need the confidence they can have, access to a hospital and its staff should they or their loved ones require it, and refuge within its premises should this prove necessary. Remove that confidence, that hope, and replace it with the fear generated by the knowledge it is no longer there, that you will be left to your own devices when you most need hope and help, and you are well on your way to ensuring the disintegration of a society. Sounds about right.
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