A portent for COVID-19

A girl receives a measles vaccine at a hospital in Gaza in 2014. Until 2019, Gaza had suffered only one case of measles in over 30 years. Ashraf AmraZUMA Press

Sarah Algherbawi -29 April 2020

With coronavirus stalking the earth, we in Gaza have braced for maximum impact.
Overcrowded, impoverished and under an Israeli blockade that has left our health services decimated, a full-blown outbreak here would be a disaster.

This is not hyperbole. In fact, we already know what a deadly concoction we face in Gaza, because it nearly happened just a few months ago.

Disaster struck the al-Louh family in Deir al-Balah in the central Gaza Strip on 7 December, when 30 relatives contracted measles. All of them were transferred to al-Aqsa hospital.

The extended al-Louh family lives in one building – eight units over three floors – housing some 50 individuals, not uncommon in Gaza’s crowded and limited environs. The first infected person recorded with the disease was a child aged 4. But the virus spread like wildfire among relatives: in all 17 children, eight men and five women were infected.

Over the course of a month, members of the al-Louh family – from infants to adults – fought the virus. They were mostly successful. Karam, 31, married with a child, lost his battle. According to his doctor, Reem Abu Arban, Karam suffered an underlying health condition that compromised his immunity.

It was a family tragedy compounded by its spread through everyone, old and young. Members of the family did not want to speak to the media, but one relative, the mother of one of the infected children, did agree to speak to The Electronic Intifada on condition of anonymity.

“Within three days, most of the family was infected. We didn’t know it was measles, we thought it was a normal flu.”

The woman said she was deeply distraught when her only child, nine at the time, caught the virus.
“At the beginning, doctors told us that his condition was very dangerous. But after five days of medication he started to improve. Thank God, he’s healthy now and has returned to normal.”

Sudden outbreak

Measles is a highly infectious virus that leads to serious and sometimes fatal complications. The infection is usually transmitted through direct contact or through the air and settles in the airways before spreading to the body.

Measles remains one of the leading causes of death among young children globally, according to the World Health Organization (WHO).

The al-Louh infections were among 965 suspected cases of measles and 549 confirmed cases in Gaza between June 2019 and 10 February, according to the WHO.

In addition to Karam, the outbreak caused one other death.

Gaza began a program of indicator-based public health surveillance in 1986. Since then, only in 2000 had there been one confirmed case of measles.

Health ministry officials said they suspected the measles had been imported. According to the WHO, vaccinations for measles in Gaza is a largely successful project with a 97 percent coverage rate between 2009 and 2018.

Majdi Dhuhair, director for preventive medicine at the health ministry, said he suspected the last outbreak came from abroad.

“Some neighboring countries have cases of measles as a result of individuals not committing to the international vaccination program. We believe that it reached Gaza with travelers.”

Nevertheless, not everyone in Gaza gets vaccinated. That seemed to be the case with the al-Louh family, Dhuhair said.

Spread

The Ministry of Health launched another vaccination campaign during the first week of 2020 for all children between six months and one year.

In addition, the ministry vaccinated some 3,000 health workers across Gaza after two doctors and 25 nurses were infected with measles as a result of direct contact with patients.

Among the infected health workers was a three-months pregnant doctor. The doctor – who has remained anonymous – had to isolate until she recovered. Vaccinations cannot be administered to pregnant people.

Two former colleagues also surprised me by answering a social media plea for contacts for anyone infected.

Aysar Nasrallah, 31, and his brother Ahmad, 29, both contracted measles.

It started with Ahmad, who went to hospital complaining of severe pain in his bones. There, a blood test revealed he had measles..

“We don’t know how Ahmad was infected,” said Aysar. “He stayed in bed for 16 days and red spots spread all over his body.”

After Ahmad recovered, the same symptoms emerged in his brother.

“I didn’t know how measles transmitted from one person to another, and it didn’t occur to me that I would be infected as I play sports and eat a healthy diet.”

On the brink

While the 2019 Gaza measles outbreak was probably imported, and fairly quickly brought under control, Gaza’s health sector offers little cause for confidence as Covid-19 silently stalks the earth.
Devastated after 13 years of blockade and sanctions imposed by Israel, the lack of drugs, protective equipment and isolation and emergency beds is a chronic reality in Gaza.

Human rights activists and health experts have long feared a humanitarian disaster should a pandemic take hold in Gaza.

Few professionals were surprised by the measles outbreak. All fear the corona pandemic. Munir al-Bursh, head of the pharmacy department at Gaza’s Ministry of Health, said the overall collapse of Gaza’s health sector only makes the spread of additional diseases “more likely.”

Half of all vital medicines are simply not available in Gaza, according to the Ministry of Health here, and half are at less than a month’s stock, according to the UN.

Officials blame Israel because the occupying power has a legal responsibility for the well-being of Palestinians in Gaza. But they do not hold blameless Egypt and the Palestinian Authority in the West Bank, said Ashraf al-Qedra, health ministry spokesperson.

Both Israel and Egypt impede Palestinians from Gaza from seeking medical treatment abroad, al-Qedra said. The never-resolved rivalry between Hamas and Fatah, the faction that dominates the West Bank PA, has caused financial assistance from the West Bank dwindle. Al-Bursh said the PA spent less than 10 percent of a $40 million health budget on Gaza in 2019.

But even if official hands are tied by a chronic lack of resources and no political progress, whether with the PA or with Israel, some in Gaza did learn lessons from the 2019 measles outbreak.

In Deir al-Balah, the al-Louh family member who spoke to The Electronic Intifada is happy her son recovered from measles. But she fears even more the contagious coronavirus. She is exercising absolute caution.

“I was very close to losing my child that time,” she told The Electronic Intifada. “Now, with coronavirus, I am obsessed with trying to protect him, especially because Gaza’s health sector is so poor.”
Sarah Algherbawi is a freelance writer and translator from Gaza.