The humanitarian crisis in Ukraine: Detecting infectious diseases, distributing vaccines and monitoring in Gaza’s public health system (after the Russian-occupied Ukraine), says WHO Emergency Director Rick Brennan
Covid was the top priority for me when I started this role. Suddenly, in late February, it was Ukraine. The Russian government’s invasion cut off pharmaceutical supplies, attacked hospitals and the systems they depend on and drove outbreaks of disease among the displaced, potentially endangering even more lives than Russian weapons did. More than 100,000 Ukrainians with H.I.V., for example, were threatened with losing access to the lifesaving antiretroviral medications they needed. We had to move fast to help Ukraine solve how to keep pharmacies, clinics, hospitals and public health capacity functioning.
One emergency after another distracts focus from longer-term public health goals. There is no sign that this is letting up. Displacement and activities have increased contact between humans and animals, which has lead to diseases leaping to humans. (The Ebola virus, for example, has been linked to bats as a possible source of spread.) As laboratories grow and safety measures lag, the risk of accidents in laboratories is a concern. On average, between 1979 and 2015, more than 80 laboratory-acquired infections were reported per year, several involving transmission beyond those initially infected, and underreporting is rife. The growing field of synthetic virology has simultaneously generated lifesaving new treatments (mRNA vaccines, for example) and made it easier for bad actors to turn infectious diseases into weapons of mass destruction.
Before the war, despite the Israeli blockade, humanitarian groups say Gaza’s public health system was doing a pretty good job. The 2 million-plus Palestinians living there had solid vaccination rates, access to three dozen hospitals and effective disease surveillance.
“It’s our way of detecting the emergence of diseases that can result in an epidemic very, very, very quickly,” says Rick Brennan, the WHO’s Regional Emergency Director for the Eastern Mediterranean Region.
Brennan says there was a good system to detect disease outbreaks and then transfer cases to the laboratories for testing.
“If you can’t get to the doctor because you have no access to antibiotics, something that’s so simple to treat can turn into something deadly,” she says. This is a disaster in waiting.
She has seen a lot of respiratory illnesses. “I’ve had cases that didn’t respond to any treatment,” she says. “But I can’t tell [the shelter whether] they have COVID, and I can’t diagnose it because I don’t have the equipment.”
“Wherever there’s overcrowding,” explains Marwan Al-Homs, director of the Mohammed Yousef El-Najar Hospital in Rafah, “these epidemics exist — inside shelters, even in tiny apartments where the number of inhabitants is 35 people.”
Juliette Toumas, director of communications for UNRWA, the United Nations Relief and Works Agency, visited the Khan Younis Training Center in south Gaza, a shelter intended for 1,000 people but now hosting more than 30,000. She says there are 400 people sharing one toilet. There is the same thing for showers. “There’s not a lot of water to begin with, which means either to wash or stay clean.” There’s not a lot of hygiene supplies.
The Doctors Without Borders team in the Palestinian territories think it’s a cauldron of infectious disease.
Last weekend, Ayadil Saparbekov, WHO team lead for health emergencies in the Palestinian territories, traveled from Jerusalem to Gaza to ferry rapid diagnostics for hepatitis and cholera into the enclave.
“I am bringing the testing kits to timely detect and to respond to different infectious disease outbreaks,” he said in a video posted on X, the site previously known as Twitter.
UNRWA’s Toumas underscores the importance of regular and sustained humanitarian aid, including hygiene supplies, vaccines and chlorine tablets. She says that “all those things are critical in disease prevention.”
It will take effort and time for WHO to resuscitate one or two laboratories in Gaza that were involved in pathogen screening before the war.
In addition, they hope “to even bring a mobile laboratory from outside,” says Brennan. “And we’re also looking at options for bringing specimens outside the country, particularly to Egypt, for testing. That has been more challenging than we had expected.
“If we get an influenza outbreak into those massively overcrowded shelters,” says Brennan, “if we’ve got shigella dysentery, that could rip through a community very quickly and really impact the most vulnerable. To be honest, I’m grateful that we’ve got to this point. We have increased rates, but we haven’t had a deadly outbreak yet.
Whether that good fortune lasts may depend on disease surveillance to identify the first handful of cases of something sinister — ideally, while it can still be contained.