On 27 August, the Israeli Occupation Army (IOF) fired at least ten bullets at a World Food Programme (WFP) humanitarian aid convoy as it approached an Israeli military checkpoint in northern Gaza.

While no one was hurt in the vehicle, which was clearly marked and cleared by the Israeli authorities, the WFP temporarily suspended the movement of its employees in Gaza.

The attack is the latest in a series targeting aid and humanitarian workers in the enclave since the war began in October 2023. While decimating the Strip and destroying the vast majority of its infrastructure, Israel has rejected both the entry of humanitarian assistance and the principle of humanitarian pauses, while enforcing a complete blockade that has deprived Gaza’s civilian population, half of whom are children, of life’s essentials.

The numerous pleas made at the UN Security Council and elsewhere to end the deliberate famine and disease outbreaks, such as of cholera, typhoid and tuberculosis, in Gaza have not been enough to bend Israel’s determination to continue its collective punishment of the enclave’s civilian population.

When tests confirmed in July that a strain of poliovirus was present in samples of wastewater in Gaza, Israel started offering polio vaccinations to its soldiers in the Strip.

The news reinforced Israel’s months of “genocidal violence,” in the words of the UN Special Rapporteur’s joint statement published in July, to thin out Gaza’s population by blocking humanitarian and medical assistance and purposefully dismantling its healthcare sector, inevitably leaving Palestinian children to die, if not by bombs then from malnourishment and infectious diseases.

A World Health Organisation (WHO)-led mass poliovirus vaccination campaign unrolled in Gaza on 1 September in an attempt to save the Strip’s child population from the epidemic. For that to happen, Israel agreed to an unprecedented series of “humanitarian pauses” over a period of nine days so that aid workers can administer the vaccine.

During that time the IOF will halt its military operations from 6:00am to 3:00pm for three consecutive days in central Gaza, followed by the north and then the south and finishing on 9 September.

The WHO vaccination campaign aims to inoculate 640,000 children under the age of ten with the novel oral polio vaccine type 2 (nOPV2).

The virus, which can cause death or paralysis, had been eradicated in Gaza for 25 years prior to the war. But months of Israeli destruction in the enclave has severely reduced access to clean water and functioning sewage systems, creating a breeding ground for infectious diseases and made worse by constant population displacement.

The poliovirus was detected in July in environmental samples from Khan Younis and Deir Al-Balah in central Gaza, where the first round of the vaccination campaign began on Sunday. Three samples of the variant type 2 poliovirus cVDPV2 have been found since then.

The WHO and its partners mobilised 708 teams to administer two rounds of vaccinations at hospitals, field hospitals, and primary healthcare centres in each municipality of the Gaza Strip. Around 2,700 health workers, including mobile teams and community outreach workers, will support the delivery of the campaign.

The WHO plans to use over 1.6 million doses of the oral vaccine nOPV2, which is used to stop poliovirus transmission. Israel has agreed to transit the doses and provide cold chain facilities through Ben Gurion Airport before their arrival in the Gaza Strip by the end of August.

According to WHO Spokeswoman Margaret Harris, health workers have not experienced any delays or obstacles from the Israeli authorities in facilitating the delivery or administration of the vaccine to date.

The WHO aims to vaccinate 156,583 children in the first three days of the campaign covering the first zone in central Gaza. Over 1.2 million doses have already been delivered to Gaza and another 400,000 are due to arrive, Harris said.

But this might not be enough, she told Al-Ahram Weekly in an email, considering that the campaign is scheduled to be completed in nine days after its commencement, while experience suggests that the WHO will need more days.

Additionally, the WHO is “always” concerned about the limited power and fuel supplies in the enclave in order to maintain the working cold chain that is crucial to the success of the vaccination process, she said.

The vaccine in question is considered the easiest and cheapest to administer in a warzone like Gaza and has been used for outbreak response under WHO emergency use since 2021 to control polio outbreaks.

It uses a weakened form of the poliovirus, which has drawn concerns out of fears that it will end up in Gaza’s damaged sewage system, thus spreading the disease amongst unvaccinated individuals.

The first child to be confirmed as having been paralysed with polio in Gaza was infected with a mutated strain of the virus that vaccinated people had shed in their waste, according to a recent AP report that cited scientists.

This has led to cases of vocal vaccination resistance in Gaza that have resonated on social media. “I don’t trust the polio vaccines that have entered the Gaza Strip. I don’t trust the WHO… I’m terrified,” Ali Tawil, a physician at Gaza’s Al-Aqsa Hospital, wrote on X, formerly known as Twitter, earlier this week.

The tweet, which gained high traction, highlighted the scepticism with which the polio vaccination campaign has been met by Palestinians.

“The world fears for our children lest they’re bombed without a vaccination,” tweeted Izzeddin Shaheen, another physician in Gaza.

Taleed Al-Sabawi, a public health researcher and law professor at Wayne State University in the US, downplayed any safety concerns relating to the vaccine.

The debate questions how the oral vaccine works but misses a key point, she said, which is that “the virus has reached epidemic levels and is [already] in all the sewage in Gaza. It doesn’t matter if they shed the virus in the sewage. At this point, the key goal is to try to vaccinate as many children as possible, so that when they come into contact with the virus (not if) they will only get mild symptoms.”

The biggest question that the WHO, the UN children’s agency UNICEF, and other partners in the international community, but more importantly also in Israel, have yet to answer is why is the poliovirus specifically getting so much attention in Gaza, while other infectious and equally dangerous diseases are not?

In order to enable the unrolling of the first phase of the WHO’s campaign, the IOF withdrew their troops from central Gaza on 30 August, in a sign that the Israeli authorities are not just cooperating with the WHO to contain the disease but are going to considerable lengths to enforce military pauses, something it has otherwise refused to do for 11 months.

This unprecedented posture aligns with the alarmed statements fearing international outbreaks issued by the EU and international agencies since reports of polio were confirmed in Gaza two months ago.

The primary reason the WHO’s campaign has been effectively unrolled in Gaza, said Al-Sabawi, is that powerful organisations across the world have been striving for decades to eradicate polio and billions have been spent by countries trying to eradicate it globally.

The level of the threat of its now crossing borders may have increased significantly, she added, “and this is why other governments may have put pressure on Israel at this point because they don’t want a global polio pandemic.”

* A version of this article appears in print in the 5 September, 2024 edition of Al-Ahram Weekly