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From the grey rubble of Gaza’s bombed water treatment plants, a rare and deadly paralytic disease has emerged that has brought a new crisis to a region already devastated by starvation and illness.
An unprecedented surge in acute flaccid paralysis (AFP) – a condition which causes a rapid onset of muscle weakness and paralysis – has seen 110 people diagnosed in the past three months. In previous years, Gaza saw just one or two cases of AFP per year.
The symptoms occur when the body’s immune system is triggered by certain viruses, in some cases causing it to attack its own nervous system. In Gaza, the rapid spread of water-borne infectious diseases has led to a striking rise in AFP cases.
The World Health Organisation (WHO) and Dr Ahmed al-Farra, head of paediatrics at Nasser Hospital in Khan Younis, told The Independent that Israel’s destruction of Gaza’s vital water treatment plants is largely responsible for the spread of these diseases.
“To see 110 cases, this is incredible. This is an outbreak, it is alarming for us to see that number,” Dr Farra said, describing the situation as “one of the most challenging” medical incidents Gaza has seen since 2023.
Acute flaccid paralysis is associated with a variety of causes, including Guillain–Barre syndrome (GBS), a rare autoimmune condition and the main cause of AFP in Gaza. Severe cases of AFP and GBS can cause lifetime paralysis, or respiratory failure, potentially resulting in death.
Gaza’s health ministry says 36 per cent of the reported cases of GBS were in children aged under 15. In Nasser Hospital and Al-Shifa hospital, the hotspots of the outbreak, at least nine people have died of AFP so far.
Senior Palestinian and Israeli medics, along with the WHO, have told The Independent that critical and lifesaving treatments are not available anywhere in the ravaged enclave.
The Israeli military denies that it prevents the entry of medicine into the strip, and says it “continuously and consistently facilitates the operation of medical services” in Gaza. It blames its destruction of water infrastructure on Hamas, which it accused of “embedding its military assets among the civilian population”.
Other factors such as overcrowding in shelters, malnutrition, and restricted access to healthcare have all exacerbated the crisis, a WHO spokesperson said, adding that the abrupt nature of the recent surge in cases is partly due to improved monitoring processes.
Lab testing samples came back positive with enterovirus, a group of viruses which typically spreads through humans or water. Most samples also contained Campylobacter jejuni, a species of bacteria commonly found in animal faeces, Dr Farra said.
The lab findings show that “water that the patients are receiving is completely polluted by sewage” due to the “destruction of the sewage system”, he said.
In July last year, Oxfam reported that Israel had destroyed 70 per cent of all sewage pumps and 100 per cent of wastewater treatment plants in Gaza. It accused Israel of restricting the entry of Oxfam’s water testing equipment.
Medecins Sans Frontieres (MSF) said on Thursday that Israel is “deliberately depriving people of water in Gaza”. Since June 2024, Israel has only approved one in every 10 import requests of items for water desalination, the charity said.
“Israel must begin allowing the importation of critical equipment for water supply and distribution, at scale,” MSF added. “The Israeli military must stop its destruction of water infrastructure and allow the immediate repair of water systems that have been damaged to ensure people have life-sustaining access to water.”
Such is the desperation for clean water that health officials in Gaza are advising people to place water which they want to drink in sunlight, so it is as sterilised as possible before they drink it, Dr Farra said.
An IDF spokesperson said the military “does not seek to harm civilian infrastructure and strikes only military targets, in accordance with international law”.
It added that the IDF “works to ensure humanitarian water supply in Gaza”, and said millions of litres are provided daily via Israel’s water lines alongside the local water system.
But medics and humanitarian organisations in Gaza say that a shortage of clean water is behind the increase of AFP – which they are struggling to address without the proper treatments.
Severe cases can need months to recover in hospital, but beds are in high demand. An Australian medic who recently left Gaza told The Independent that all 50 intensive care beds in Nasser Hospital are filled up, each and every day.
AFP requires a “long time” for recovery with “challenging treatment”, Dr Farra said.
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Intravenous immunoglobulin (IVIG), an expensive treatment for GBS which prevents respiratory failure, is not available in Gaza. Neither is plasma exchange, a procedure in which blood is filtered.
Israeli paediatrician Prof Dan Turner, a human rights activist and deputy dean of the medical faculty at the University of Hebrew, helps coordinate the entry of medical aid into Gaza. He told The Independent he had received an “urgent call” for IVIG from physicians within the strip last week.
The WHO said it needs “unimpeded access to get medical supplies” into Gaza and to “rehabilitate the water, sanitation, food and health systems”.
But the Israeli military denies that it prevents the entry of medicines and other aid into the Gaza Strip, and said that “45,000 tons of medical equipment have been transferred to Gaza via more than 3,000 trucks”.
It added: “The IDF continuously and consistently facilitates the operation of medical services through aid organisations and the international community, maintaining ongoing communication with international aid agencies in the Strip to meet hospital needs.”
Diagnosis with AFP – which can lead to long-term or even permanent paralysis, particularly if not treated properly – has been made more difficult due to the lack of MRI machines and cerebral spinal fluid analysis, Dr Farra said.
Many are asking to be medically evacuated to undergo comprehensive treatment in foreign countries.
“Unfortunately, when the approval comes for the evacuation, and lots of connections and phone calls are made, the patient is already dead,” Dr Farra said.
