Polio and Israel’s attrition genocide in Gaza

Nicola Perugini

In August, the Palestinian Health Ministry announced Gaza’s first proven case of polio infection in 25 years. The virus had infected a 10-month-old baby in Deir el-Balah, leaving him paralysed. While only one case has been confirmed so far, this does not mean it is the only one or that the spread of the virus is limited.

While polio can cause paralysis and even death, many of those who are infected with the virus do not show any symptoms. That is why testing and medical evaluation are needed to properly determine the scale of the breakout. But that is nearly impossible in Gaza, given Israel’s wholesale destruction of its healthcare sector.

We do know that the type 2 poliovirus (cVDPV) was identified in six sewage samples, collected from two different sites in Khan Younis and Deir el-Balah in July. After these findings were made public, World Health Organization Director-General Tedros Ghebreyesus warned that it is “just a matter of time before [the virus] reaches the thousands of children who have been left unprotected”.

Israel rejected calls by the United Nations for a ceasefire and agreed to localised “humanitarian pauses” for just a few days. In parallel, it intensified its bombing of Gaza and mass expulsions of civilians. Between 19 and 24 August, the Israeli army issued the highest number of evacuation orders in one week since October 7, leading the UN to temporarily halt humanitarian operations.

Nevertheless, a vaccination campaign was officially launched on Sunday. The rollout started in the central Gaza Strip – Deir el-Balah governorate – and in the coming days is supposed to be extended to Khan Younis in the southern Strip and then the northern governorates, where Israel has been severely limiting aid and mobility.

It is unclear if the UN will reach its target of vaccinating 640,000 children given the difficult conditions of operation, the dramatic number of displaced people, the Israeli restriction on fuel supplies needed to run generators and fridges to store the vaccines and Israel’s refusal to fully stop fighting.

For the vaccine to be effective, two doses need to be administered at least one month apart. There is still no guarantee that conditions will be in place for the second stage of the vaccination drive.

Unfortunately, a polio outbreak is not the only health emergency Palestinians in Gaza are facing. Other dangerous infectious diseases, including hepatitis and meningitis, are also spreading across the Strip. More than 995,000 cases of acute respiratory infections and 577,000 cases of acute watery diarrhoea have also been registered in Gaza since October.

In addition, hundreds of thousands of chronically ill people are not getting the adequate care they need, which leads to many preventable deaths that are not recorded in the official Gaza death toll.

All of this is a reflection of Israel’s attrition genocide: that is, the destruction of the conditions of survival of Palestinians as a group through techniques of killing less visible than the horrific livestreamed violence we have been witnessing for the last 11 months.

To borrow from Jewish-Polish lawyer Raphael Lemkin, who introduced the notion of genocide in 1944, the “endangering of health” and the creation of conditions of life “inimical to health” constitute one of the main techniques of genocide.

Over the past 11 months, Israel has all but obliterated Gaza’s health system. Recent data published by the WHO Global Health Cluster speak for itself: in the first 300 days of the war, 32 out of 36 hospitals were damaged, 20 (out of 36) hospitals and 70 primary healthcare centres (out of 119) are not functioning. Some 492 attacks on healthcare were reported, which resulted in the death of 747 people.

The Israeli army has also systematically destroyed the water and sewage system in Gaza. According to an Oxfam report published in July, people in Gaza are left with only 4.74 litres of water per person per day for all uses, including drinking, cooking, and washing.

This means a 94 percent reduction in the amount of water available before October, and a level significantly below the internationally accepted minimum standard of 15 litres of water per person per day for basic survival in emergencies.

Simultaneously, Israel has destroyed 70 percent of all sewage pumps and 100 percent of wastewater treatment plants since October. The destruction and obstruction of Gaza’s water and sanitation infrastructures have had catastrophic effects on public health, certainly causing a significant number of indirect deaths.

Prominent public health reports have projected terrifying scenarios when it comes to deaths caused by the spread of infectious diseases in Gaza. According to a London School of Hygiene and Johns Hopkins University study, thousands of Palestinians may have died in the last six months due to infectious diseases.

Israel’s narrative to justify these deaths is that they are the result of a tragic humanitarian crisis provoked by Palestinians. But they were not unintended, as more honest statements of Israeli officials have revealed.

In November 2023, former head of Israel’s National Security Council Giora Eiland and current adviser to Defence Minister Yoav Gallant wrote on Yedioth Aharonoth that “the international community warns us of a humanitarian disaster in Gaza and of severe epidemics. We must not shy away from this, as difficult as that may be”, adding that “after all, severe epidemics in the south of the Gaza Strip will bring victory closer and reduce casualties among army soldiers”.

Netanyahu’s finance minister, Bezalel Smotrich, tweeted that he agreed with “every word” written by Eiland in his column. In other words, infectious diseases are among the genocide-by-attrition tools considered by the Israeli leadership.

This is not a completely new story. Israel has already subjected Palestinians to systematic policies of slow death and disablement, with the highest peaks during the two Intifadas. But since October 7, these policies have reached an unprecedented level and they meet two key standards of the Genocide Convention.

First, by obliterating the healthcare sector and obstructing the distribution of healthcare supplies and services, Israel is ensuring that Palestinians in Gaza face serious bodily and mental harm.

Second, by destroying almost entirely the water and sewage system and creating a debilitating environment, the Israeli military has inflicted on Gaza Palestinians conditions of life calculated to bring about its physical destruction in whole or in part.

This is how Israel pursues attrition genocide in Gaza.