During humanitarian crises and armed conflicts, children are the most vulnerable to the devastating consequences, such as the outbreak and resurgence of diseases like polio. Mainly children under the age of five are affected by polio, with prevention proving the only effective strategy to confront it, as there are no proven curative approaches yet. Some Arab countries are at great risk of witnessing a polio outbreak, with protracted crises and ongoing instability, and the subsequent paralysis in health systems, making the region more prone to such epidemics. For instance, over half of the attacks reported during armed conflicts in 2024 on health care took place in the Middle East, revealing the extreme vulnerability of public health—especially the health of children—in the region.
As a result, armed crises and humanitarian disasters led to declined national and subnational polio vaccination coverage, putting the lives of children at grave risk in the Arab world. With the recent conflicts, a wave of new polio cases has emerged in the Arab region, raising critical concerns about the effectiveness and applicability of standard strategies for enhancing immunisation against polio in complex and crisis-prone settings.
Contextualizing polio in the Arab world
The ongoing securitisation and politicisation of polio immunisation in the Arab world undermined the health systems’ capacities to develop and implement prevention strategies. This further marginalised vulnerable populations and resulted in cycles of disease and health injustice.
Internationally, the Global Polio Eradication Initiative (GPEI) has contributed significantly to decreasing polio cases by 99.9 per cent. However, certain factors lead to the repeated failure of GPEI in crisis-affected contexts in the Arab world. These obstacles include limited access to healthcare institutions, deliberate targeting of hospitals and ambulances, weaponising medical aid and lack of safety and security for health workers to operate.
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In light of chronic conflicts, massive refugee crises and the collapse of health systems in the Arab world, new polio cases have been reported in the past decades. For instance, with the outbreak of the crisis in Gaza in 2023, a confirmed case of polio was detected in August, 2024, the first case in 25 years. However, the Israeli aid blockade and policies aimed at controlling what is going in Gaza played a critical role in undermining the effectiveness of response or prevention mechanisms to polio risks in Gaza. Syria is another prominent example of how political instability and security threats weaken health responses to polio crisis. The country experienced two polio outbreaks in 2013 and 2017, highlighting the fragility of Syria’s immunisation strategies, after which the outbreaks were controlled through intensive polio vaccination campaigns and surveillance. Other crisis-affected Arab countries, such as Yemen and Iraq, have also been affected by polio in the last decade. Thus, wars and humanitarian crises are the most significant drivers for the polio outbreaks and the inability of health systems to effectively face and contain such health crises.
Severe implications for the future generations
Ineffective polio immunisation poses a severe threat to future generations in the already deteriorated Arab world. Given the unprecedented cross-border displacement in the region and the cross-border poliovirus transmission, this underlines the urgency of the issue for the whole region. Millions of people are fleeing Syria, Iraq, Yemen and Palestine, carrying the risk of transmitting poliovirus to refugee-hosting countries, such as Lebanon and Jordan, that already struggle with responding to the increasing health needs of refugees. This not only puts the lives of millions of children in the region and the wider Global South, with a long history of conflicts and health inequity, at severe risk, but also raises concerns about the potential of polio becoming a global pandemic.
Recognising these and failing to act upon them forms an intentional killing of future generations, particularly children who are vulnerable among already marginalised populations, such as refugees and stateless children. The region has for decades been prone to intrastate and interstate conflicts. Thus, the absence of context-specific mechanisms to prevent the outbreak of diseases like polio is either a deliberate failure or an example of the ineffectiveness of global health governance. In the long run, overlooking the future of these children’s health damages trust in public health in conflict settings. Moreover, the hierarchical structure in the international order, where the Global North monopolises the essential health-related financial and technical resources, also plays a key role in depriving children of the right to polio immunisation.
The power of context-sensitive immunisation action plans for healthier generations
Due to the unique context of the Arab World, effective polio response and prevention necessitates strategies that are deeply attuned to local realities, driven by community-based health initiatives, and leverage diplomacy as a vital instrument.
There needs to be a medical focus, led by local health workers and medical humanitarian institutions, on pre-crisis polio prevention. Given the unique context of the conflict-prone Arab world, it is important to start with raising awareness about polio resistance through prevention and strengthening the immunisation infrastructure. These strategies are central in both peacetime and wartime, urging local medical mobilisation to fight polio in the Arab region. Moreover, in contexts affected by complex crises, local actors are situated as the most decisive actors to take on the role and alleviate the polio risks caused by armed conflicts. Thus, community-level and mobile vaccination campaigns, using inactivated polio vaccine (IPV) and oral polio vaccine (OPV), emerge as critical tools, leveraging the profound knowledge of local context and easier access to isolated areas.
In the face of politicisation and securitisation of polio vaccination efforts, a strong political and diplomatic commitment is essential to ensure effective and timely response and prevention mechanisms. Thus, the role of public health diplomacy must me highlighted, since it lies at the heart of effective immunisation strategies by engaging key stakeholders—including key states, World Health Organizations, and United Nations—towards one aim, that is protecting children from polio to build stronger generations in future. This is fundamental for both the response phase during or after crises and preparedness in crisis-prone settings to prevent any occurrence of polio case. More importantly, vaccine diplomacy—utilising polio vaccine development, distribution and safe access as a tool of diplomacy and foreign policy—emerges as a key policy and advocacy strategic approach not only to confront but also to put an end to polio.
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