Joint statement by WHO and UNICEF

1 November 2024, A third phase of the polio vaccination campaign is set to begin tomorrow in part of the northern Gaza Strip after being postponed from 23 October 2024 due to lack of access and assured, comprehensive humanitarian pauses, intense bombardment, and mass evacuation orders. These conditions made it impossible for families to safely bring their children for vaccination and to organize campaign activities.

The humanitarian pause necessary to conduct the campaign has been assured; however, the area of the pause has been substantially reduced compared to the first round of vaccination in northern Gaza, conducted in September 2024. It is now limited to just Gaza City. Though in the past few weeks, at least 100 000 people have been forced to evacuate from North Gaza towards Gaza City for safety, around 15 000 children under ten years in towns in North Gaza like Jabalia, Beit Lahiya and Beit Hanoun still remain inaccessible and will be missed during the campaign, compromising its effectiveness. To interrupt poliovirus transmission, at least 90% of all children in every community and neighborhood must be vaccinated. This will be challenging to achieve given the situation.

The final phase of the campaign had aimed to reach an estimated 119 000 children under ten years old in northern Gaza with a second dose of novel oral polio vaccine type 2 (nOPV2). However, achieving this target is now unlikely due to access constraints.

Despite the lack of access to all eligible children in northern Gaza, the Polio Technical Committee for Gaza, including the Palestinian Ministry of Health, World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and partners has taken the decision to resume the campaign. This aims to mitigate the risk of a long delay in reaching as many children as possible with polio vaccine and the opportunity to vaccinate those recently evacuated to Gaza City from other parts of North Gaza.

To overcome challenges posed by the volatile security situation and constant population movement, robust micro plans have been developed to ensure the campaign is responsive to the significant population shifts and displacement in the north, following the first round in September. The campaign will be delivered by 216 teams across 106 fixed sites, 22 of which have been added to ensure increased availability of vaccination in areas where recently displaced people are seeking refuge. Two hundred and nine social mobilizers will be deployed to engage communities and raise awareness around vaccination efforts. The time period for the humanitarian pause has been extended by two hours and is expected to run from 6am to 4pm daily. As in the first two phases, vitamin A will also be co-administered to children between two to ten years in the north to help boost overall immunity.

The campaign in northern Gaza follows the successful implementation of the first two phases of the second round in central and southern Gaza, which reached 451 216 children – 96% of the target in these areas. A total of 364 306 children aged between 2 and 10 years have received vitamin A so far in this round.

Despite the challenges, WHO and UNICEF urge for the humanitarian pauses to be respected to ensure the successful delivery of this second round of the polio vaccination campaign. This is crucial to help curb the spread of polio in Gaza and neighboring countries.

6 November 2024 – The second round of the polio vaccination campaign in the Gaza Strip was completed yesterday, with an overall 556 774 children under the age of 10 being vaccinated with a second dose of polio vaccine, and 448 425 children between 2- to 10-years-old receiving vitamin A, following the three phases conducted in the last weeks.

Administrative data confirm around 94% of the target population of 591 714 children under the age of 10 years received a second dose of nOPV2 across the Gaza Strip, which is a remarkable achievement given the extremely difficult circumstances the campaign was executed under. The campaign achieved 103% and 91% coverage in central and southern Gaza, respectively. However, in northern Gaza, where the campaign was compromised due to lack of access, approximately 88% coverage was achieved according to preliminary data. An estimated 7000-10 000 children in inaccessible areas like Jabalia, Beit Lahiya and Beit Hanoun remain unvaccinated and vulnerable to the poliovirus. This also increases the risk of further spread of poliovirus in the Gaza Strip and neighbouring countries.

The end of this second round concludes the polio vaccination campaign launched in September 2024. This round also took place in three phases across central, south and northern Gaza under area-specific humanitarian pauses. While the first two phases proceeded as planned, the third phase in northern Gaza had to be temporarily postponed on 23 October because of intense bombardments, mass displacements, lack of assured humanitarian pauses and access.

After careful assessment of the situation by the technical committee, comprising the Palestinian Ministry of Health, World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), the campaign resumed on 2 November. However, the area under the assured humanitarian pauses comprising the campaign was substantially reduced, compared to the first round, as the access was limited to Gaza City. Due to hostilities, more than 150 000 people were forced to evacuate from North Gaza to Gaza City.

Despite these challenges, and thanks to the tremendous dedication, engagement and courage of parents, children, communities and health workers, the phase in northern Gaza was completed.

At least two doses and a minimum of 90% vaccination coverage are needed in each community to stop circulation of the polio strain affecting Gaza. Efforts will now continue to boost immunity levels through routine immunization services offered at functional health facilities and to strengthen disease surveillance to rapidly detect any further poliovirus transmission (either in affected children or in environmental samples). The evolving epidemiology will determine if further outbreak response may be necessary.

To fully implement surveillance and routine immunization services, not just for polio but for all vaccine-preventable diseases, WHO and UNICEF continue to call for a ceasefire. Further, apart from the attack on the primary healthcare centre, the campaign underscores what can be achieved with humanitarian pauses. These actions must be systematically applied beyond the polio emergency response efforts to other health and humanitarian interventions to respond to dire needs.

28 December 2024 - WHO is appalled by yesterday’s raid on Kamal Adwan Hospital, which put the last major health facility in North Gaza out of service. The systematic dismantling of the health system and a siege for over 80 days on North Gaza puts the lives of the 75,000 Palestinians remaining in the area at risk.

Initial reports indicate that some areas of the hospital were burnt and severely damaged during the raid, including the laboratory, surgical unit, engineering and maintenance department, operations theatre, and the medical store. Earlier in the day, twelve patients and a female health staff were reportedly forced to evacuate to destroyed and non-functional Indonesian Hospital where it is not possible to provide any care, while the majority of the staff, stable patients and companions were moved to a nearby location. Additionally, some people were reportedly stripped and forced to walk toward southern Gaza. Over the last two months, the area around the hospital has remained highly volatile and attacks on the hospitals and on health workers have occurred almost daily. This week, bombardments in its vicinity reportedly killed 50 people, including five health workers from Kamal Adwan Hospital.

Kamal Adwan is now empty. Yesterday evening, the remaining 15 critical patients, 50 caregivers and 20 health workers were transferred to Indonesian Hospital, which lacks the necessary equipment and supplies to provide adequate care. The movement and treatment of these critical patients under such conditions pose grave risks to their survival. WHO is deeply concerned for their wellbeing, as well as for the Kamal Adwan Hospital director who has been reportedly detained during the raid. WHO lost contact with him since the raid began.

An urgent WHO mission to Indonesian Hospital is being planned for tomorrow to assess the situation at the facility, provide basic medical supplies, food and water, and safely move critical patients to Gaza City for continued care.

The raid on the Kamal Adwan hospital follows escalating restrictions on access and repeated attacks. Since early October 2024, WHO has verified at least 50 attacks on health on or near the hospital. Despite the increasingly dire needs for emergency and trauma services and supplies, only 10 out of 21 WHO missions to Kamal Adwan have been partially facilitated between early October and December. During these missions, 45 000 liters of fuel, medical supplies, blood, and food were delivered, and 114 patients along with 123 companions were transferred to Al-Shifa Hospital. But the deployment of international emergency medical teams has been repeatedly denied.

WHO and partners' efforts to sustain the hospitals’ operations have been undone. With Kamal Adwan and Indonesian hospitals entirely out of service, and Al-Awda Hospital barely able to function, and severely damaged due to recent airstrikes, the healthcare lifeline for those in North Gaza is reaching a breaking point.

WHO calls for urgently ensuring that hospitals in North Gaza can be supported to become functional again.

Hospitals have once again become battlegrounds, reminiscent of the destruction of the health system in Gaza City earlier this year.

Since October 2023, WHO has repeatedly issued urgent calls to protect health workers and hospitals as per international humanitarian law —yet these calls remain unheard. Health facilities, workers and patients are always off limits. They must be actively protected and never be attacked, nor used for military purposes. The principles of precaution, distinction and proportionality under International Humanitarian Law are absolute and always apply.