Dangerous viruses that cause severe paralytic illness are thriving in Gaza, where starving children living under an Israeli blockade can’t access the food or treatments they need to recover.

For months, health officials have warned that the destruction of the Gaza Strip’s sanitation facilities by Israel could fuel the surge of infectious diseases, as seen in last year’s polio outbreak. Now, doctors are reporting a surge in cases of acute flaccid paralysis, a rare syndrome causing muscle weakness that can make it hard to breathe and swallow.

Cases in Gaza include acute flaccid myelitis, which mostly affects children, and the better-known Guillain-Barré syndrome, said Ahmed al-Farra, head of pediatrics at Nasser Hospital in Khan Younis, Gaza. 

Before October 2023, acute flaccid paralysis was “something strange and very rare,” with one or two cases turning up each year, al-Farra said. But in the last three months, according to al-Farra, doctors have seen nearly 100 cases.

Lab samples sent to Jordan and Israel were positive for enterovirus, a group of bugs spread between people or through contaminated water, according to al-Farra. Enteroviruses, which also include poliovirus, are typically spread via the fecal-oral route. He said it was no surprise that one of the hot spots is Khan Younis, where there is raw sewage pooling in the streets. 

International condemnation of Israel is growing and, in the strongest remarks from an EU official so far, European Commission Vice President Teresa Ribera told POLITICO’s Brussels Playbook earlier this month that Israel’s conduct in Gaza “looks very much” like genocide — a charge denied by Israel.

A statement from the World Health Organization said there had been 32 cases of acute flaccid paralysis reported among under-15s as of July 31. The surge is partly down to better monitoring, the WHO said, but also reflects the collapse of water and sanitation infrastructure, malnutrition and restricted access to health care.

In almost 70 percent of samples sent for testing, the cause was identified as a non-polio enterovirus, compared to 26 percent in previous years, the WHO said.

Critical clinical assessment, its statement said, “is extremely difficult in Gaza at the moment due to the lack of diagnostic, lab and testing capacities.”

Likewise, doctors say they have few options to treat patients. Staff at Al-Shifa Hospital in Gaza, mostly destroyed by Israel in early 2024, have diagnosed 22 cases of Guillain-Barré syndrome so far, said hospital director Muhammed Abu Salmiya. Three patients died, while 12 developed paralysis and were referred to rehab centers. 

Treatment for acute flaccid myelitis and Guillain-Barré syndrome includes intravenous immunoglobulins — antibodies used to neutralize the infection — or plasma exchange, which involves filtering the blood. None of these are readily available in Gaza, where there is a chronic shortage of basic medical supplies due to the Israeli blockade.

“Unfortunately, the treatment is not available to us,” Abu Salmiya said.

Doctors in Gaza have appealed to colleagues volunteering with foreign groups to try and bring filters for plasma exchange with them, but these are often confiscated by Israeli authorities, al-Farra said.

The Israeli government had not responded to POLITICO’s request for comment by the time of publication.

Children in Gaza are especially vulnerable to the condition due to mass starvation and a lack of vitamins to support nerve regeneration, al-Farra explained. “No one has a good amount of vitamins B1, B6, B12,” al-Farra said. That’s because there are “no fruits, no vegetables, no meat, no eggs, no yogurt, no everything.”

Israel has severely restricted the entry of food into Gaza since October 2023, leading to chronic malnutrition and mass starvation. Health officials in Gaza say 188 people have died from hunger since October 2023, most of them children. The Gaza Health Ministry, which is part of the Hamas-run government, maintains detailed casualty records that are seen as generally reliable by independent experts.

The United Nations estimates at least 1,373 Palestinians have died seeking food, including 859 at sites run by the Israel- and United States-backed Gaza Humanitarian Foundation.

In December 2024, Amnesty International cited Israel’s blockade and the destruction of sanitation facilities in its report concluding Israel was committing genocide in Gaza.

Israeli Prime Minister Benjamin Netanyahu says his government intends to move forward with a full takeover of Gaza. The International Court of Justice has already ruled that Israel’s occupation of the territory is illegal.