Arab region prepares for prompt COVID-19 vaccine distribution

A handout image provided by Emirates News Agency on July 16, 2020 shows Sheikh Abdullah bin Mohammed Al-Hamed, chairman of Department of Health, undergoing a clinical trial for the third phase of the inactive vaccine for COVID-19 in Abu Dhabi. (AFP/File Photo)
Short Url
Updated 17 November 2020
Follow

Arab region prepares for prompt COVID-19 vaccine distribution

  • Behind-the-scenes negotiations under way to buy a working vaccine as soon as it becomes available
  • Governments, manufacturers, NGOs and philanthropist groups expected to play important roles

DUBAI: As scientists and drug companies race to develop a vaccine for COVID-19, extensive efforts are going on at many different levels to battle the pandemic.

What has mainly grabbed the headlines so far are efforts by pharmaceutical laboratories to come up with successful treatment options, vaccines in particular. Behind the scenes, complex negotiations are under way to buy a working vaccine as soon as it becomes available, according to experts.

Several countries, including some in the Middle East, are involved in talks with leading companies and research institutes engaged in various phases of trials.

The World Health Organization (WHO), meanwhile, is engaged in preparatory talks with countries on ways of ensuring prompt and fair distribution once a vaccine becomes available.

Should ongoing efforts succeed over the next few months, experts say, they would be the quickest in the history of vaccines.

All phases of vaccine trials are on the “fast track,” according to Dr. Abdinasir Abubakar, head of the Infectious Hazard Management Unit at WHO’s regional office in Cairo.

0 seconds of 55 secondsVolume 90%
Press shift question mark to access a list of keyboard shortcuts
00:00
00:55
00:55
 
(Dr. Abdinasir Abubakar, head of Infectious Hazard Management Unit at WHO’s Cairo office)

 

“There are three or four vaccines in Phase III trials, and we might be able to get one by the end of the year, or the beginning of next year,” he told Arab News. “That is really very fast compared to the normal procedure with vaccines, which normally take 18 months or longer.”

Where are we on a COVID-19 vaccine? Consultant Khawla Abu-Izza explains the progress made

Moderna (a US company), in collaboration with the US Biomedical Advanced Research and Development Authority (BARDA), which is part of the Department of Health and Human Services: This is the most advanced vaccine candidate in the US. It uses the relatively new mRNA (a nucleic acid) technology, which has not been introduced in commercially available vaccines. As the manufacturing process is not difficult, it may be easier to scale up production compared to conventional methods.

BioNTEch (a German company) in collaboration with Pfizer: This vaccine candidate also uses mRNA technology similar to Moderna’s. The study was initiated in the US and aims to enroll 30,000 subjects globally. The company says results will be available for regulatory review and potential approval as early as October 2020. If this is true, there has likely been an agreement with the FDA on an interim point to evaluate data from a smaller number of subjects (e.g. the first 1,000 subjects) while the study is still ongoing. This could potentially provide the basis for early conditional approval. Full approval would be granted only after the study is completed and the full NDA is submitted and reviewed.

AstraZeneca in collaboration with Oxford University (UK): This vaccine candidate uses a different technology called viral vector. This technology has a precedent in at least one approved vaccine. Phase III study is enrolling subjects in India.

Sinovac: This is the company developing the most advanced vaccine in China. Phase III clinical trials are being conducted globally. Sinovac is probably ahead of Western companies because it started earlier. Sinovac uses a well-established “conventional” vaccine technology (inactivated virus) and can be implemented in existing manufacturing facilities. However, it may prove more challenging to manufacture at a very large scale because it requires an actual virus (the virus is produced and deactivated in a way that renders it non-infectious but still able to trigger the production of antibodies).

Research is being fast-tracked for many reasons. “The burden of COVID-19 on both the social and economic fields is significant. We have not seen such a thing before,” Abubakar said. “Secondly, there is a political commitment, and, third, so much funding. Governments are actually pouring resources into the vaccine development and that is what makes the difference.”

Based on a protocol agreed by the international community, WHO is playing a “major role” in coordinating efforts of different groups, starting from registering their initiatives to producing a vaccine, according to Abubakar. “At the end of the day, we don’t want to come up with a vaccine that does not follow international standards and guidelines.”

WHO is organizing periodical meetings on COVID-19 vaccine trials, drugs and diagnostic tools, and offers a database and platform for all involved companies and entities, he explained.

More than 170 companies are in the vaccine race, including nearly 135 in the pre-clinical trials phase, 30 in the first two phases, and six in the third phase. Companies from Taiwan and India have recently joined the fray.

FASTFACTS

Arab countries in vaccine deals

* Saudi Arabia has agreed to play a key role in the development of a Russian vaccine as part of a Phase III study expected to begin in August.

* Kuwait has reached an agreement with Gavi to provide the country with 800,000 doses.

* The UAE has reached an agreement with a Chinese firm to be part of a Phase III study on its vaccine.

* Oman is negotiating with Gavi to obtain 700,000 doses once a vaccine is announced and produced.

* Egypt has signed a deal with AstraZeneca to receive an unannounced number of doses.

The third phase usually takes longer and typically ranges between one to several years because of the high number of volunteers, usually in the tens of thousands, and the several tests involved. Volunteers are randomly assigned to take either the vaccine or a placebo — a “fake” vaccine that could be just saline or a sterile buffer in an injection.

Both groups of subjects are continuously tested for antibodies and checked for any side effects, according to Khawla Abu-Izza, owner of Bayview CMC Consulting in Berkeley, California.

Phase III trials will also determine the duration of the protection the vaccine will offer, the Arab-American consultant told Arab News.

“If the subjects who took the vaccine are more protected for the first couple of months, but at four or six months we don’t see a difference between those on the active and those on the placebo, that means the protection is only short-lived,” she said.

The companies at the forefront of COVID-19 vaccine development include Moderna (US), BioNTech (Germany) in collaboration with Pfizer (American/Multinational), AstraZeneca in collaboration with Oxford University (UK), and Sinova (China). The first three announced phase III trials in July, after the Chinese company.

“It is difficult to predict which one will make it to the finish line first, but it’s almost certain that companies have agreements with regulatory agencies on interim early analysis of partial data well before completion of the entire study,” Khawla said.




Jose Muniz prepares a COVID-19 vaccination at Research Centers of America on August 07, 2020 in Hollywood, Florida. (AFP)

This means major regulatory bodies, including the US Food and Drug Administration (FDA) and the European Medicines Agency, could allow a shortening of the review period to a few months or to grant “conditional approval” as soon as they see “clinical results” without waiting for the full new drug application (NDA) to be submitted.

Since the search for drugs to treat COVID-19 requires fewer studies and because of the smaller size of clinical studies and shorter treatment or observation periods, Khawla said, “We may see more drugs approved for the treatment of COVID-19 before we see a successful approved vaccine.”

Another “most likely” scenario, according to her, is that more than one vaccine will be approved back to back.

“Vaccine companies will have more than one manufacturing site. Typically, it’s two sites; one in North America and one in Europe, or one in a Western country and another in Asia (China, India or Korea),” she said. “Japan typically likes to have drugs and vaccines for the local market manufactured within the country. So, companies try to find Japanese manufacturing partners. The same is true for China, but in this case, China is developing its own vaccine and may not need any US- or EU-developed vaccines.”

Questions such as how much the companies can produce and who would be the first recipients will become important, as manufacturers cannot cover the needs of the world’s 7 billion people at once. Depending on the number of production lines, experts say the optimistic scenario is between 240 million and 400 million doses a year in the early stages.

“I could see 50 percent of the production reserved for the countries developing the vaccine,” Belal Zuiter, senior consultant at Cambridge Pharma Consultancy in London, told Arab News. Countries severely affected by COVID-19 and those containing vulnerable groups can be expected to receive priority, Zuiter said, adding that Arab countries would not necessarily be low on the priority list.

0 seconds of 55 secondsVolume 90%
Press shift question mark to access a list of keyboard shortcuts
00:00
00:55
00:55
 
(Belal Zuiter, senior consultant at Cambridge Pharma Consultancy)

 

Many nations, including Arab countries with strong relations with potential producer states, have begun talks on obtaining the vaccine. “I know that most ministries of health have had talks with Moderna and AstraZeneca to book their quantities,” Zuiter said. “I think the Arab world will have enough doses within the first two or three months after a vaccine is produced.”

COVAX and Arab countries

Several Arab countries have joined scores of others officially expressing their interest in participating in the COVAX facility, described as an “insurance policy” to access COVID-19 vaccines. The mechanism is designed to guarantee rapid, fair, and equitable access to the world’s largest and most-diverse vaccine portfolio.

Once a vaccine has been approved by regulatory agencies and/or prequalified by WHO, the COVAX facility will then purchase these vaccines to try and initially provide doses for an average of 20 percent of each country’s population, focusing on healthcare workers and the most vulnerable groups, Gavi’s website says.

The goal is to deliver 2 billion doses by the end of 2021. According to the latest WHO estimates, more than 16.5 million people have been infected by COVID-19 and over 655,000 people have died from the virus. In the Eastern Mediterranean regional office of WHO, which includes the Arab countries and Iran and Afghanistan, latest figures show that there were 1,620,439 confirmed cases of COVID-19, with 42,701 deaths, and 1,353,859 recovered cases in the countries for which it is responsible.

- Low-income participants in COVAX: Somalia, South Sudan, Syria and Yemen.
- Lower-middle-income participants in COVAX: Algeria, Djibouti, Egypt, Morocco, Sudan, Tunisia, West Bank and Gaza.
- Countries that have expressed in writing their interest in Gavi’s COVAX facility and agreed to be named publicly: Saudi Arabia, the UAE, Iraq, Jordan, Kuwait, Lebanon and Qatar.

While governments will be responsible for distributing the vaccine, manufacturers, NGOs and philanthropist groups will have important roles to play. “There are two big groups (working with WHO), Gavi and CEPI,” Abubakar told Arab News. “Our three organizations are working together not only to coordinate the production of an effective vaccine, but also to ensure equitable distribution.”

Gavi, the Vaccine Alliance, is a public-private partnership established in 2000 to help vaccinate half of the world’s children. Among its members are developing and donor countries, the World Bank and the Bill and Melinda Gates Foundation. CEPI, the Coalition for Epidemic Preparedness Innovations, is a partnership between public, private, philanthropic and civil organizations launched at Davos in 2017 to develop vaccines and stop epidemics.

WHO, Gavi and CEPI established COVAX, a facilitation mechanism for countries, producers, manufacturers and users, according to Abubakar. While some countries can engage directly with the manufacturers, others cannot because of lack of cash. COVAX handles negotiations with manufacturers. He said discussions over prices have already started between potential producers and low- and middle-income countries.




A nurse shows a COVID-19 vaccine produced by Chinese company Sinovac Biotech at the Sao Lucas Hospital, in Porto Alegre, southern Brazil on August 08, 2020. (AFP)

“The idea behind COVAX is just to make sure all countries, whether rich or middle-income or low-income, will be able to access at least enough supplies of the vaccine for priority groups,” he told Arab News.

WHO is helping governments to prepare the regulatory groundwork for the vaccine and to put in place policies and necessary systems for widespread distribution.

“Remember, this vaccine is not for everyone, priority will be given to high-risk groups,” Abubakar said.

------------------------------------

Twitter: @jumanaaltamimi


Qatari minister of state, IAEA chief discuss ‘serious threat’ of Israeli strikes on Iran’s nuclear sites

Updated 17 June 2025
Follow

Qatari minister of state, IAEA chief discuss ‘serious threat’ of Israeli strikes on Iran’s nuclear sites

  • Mohammed bin Abdulaziz Al-Khulaifi reiterates Qatar’s condemnation of attacks on Iranian territory
  • He said targeting nuclear facilities threatens regional, international security

LONDON: The Qatari Minister of State for Foreign Affairs Mohammed bin Abdulaziz Al-Khulaifi on Tuesday discussed the conflict between Israel and Iran with Rafael Grossi, the director general of the International Atomic Energy Agency.

Al-Khulaifi discussed in a call the Israeli attacks on Iranian nuclear facilities that began on Friday, targeting the Natanz, Fordo, and Isfahan nuclear sites.

Al-Khulaifi stressed that targeting nuclear facilities was a serious threat to regional and international security. He reaffirmed Qatar’s commitment to dialogue to resolve conflicts and achieve peace in the region.

The officials discussed ways to improve the security of nuclear facilities and ensure they are safeguarded against threats, the Qatar News Agency reported.

Al-Khulaifi reiterated Qatar’s strong condemnation of the Israeli attacks on Iranian territory, deeming them blatant violations of Iran’s sovereignty and security, the QNA added.

The IAEA reported on Monday that the Israeli airstrike on Iran’s Natanz facility on Friday damaged the centrifuges of the underground uranium enrichment plant, raising concerns about potential radiological and chemical contamination in the area.


US pulls out of two more bases in Syria, worrying Kurdish forces

Updated 5 sec ago
Follow

US pulls out of two more bases in Syria, worrying Kurdish forces

  • The SDF did not respond to questions about the current number of troops and open US bases in northeastern Syria

AL-SHADADI BASE: US forces have pulled out of two more bases in northeastern Syria, visiting reporters found, accelerating a troop drawdown that the commander of US-backed Syrian Kurdish forces said was allowing a resurgence of Daesh.
The reporters who visited the two bases in the past week found them mostly deserted, both guarded by small contingents of the Syrian Democratic Forces — the Kurdish-led military group that Washington has backed in the fight against Daesh for a decade.
Cameras used on bases occupied by the US-led military coalition had been taken down, and razor wire on the outer perimeters had begun to sag.
A Kurdish politician who lives on one base said there were no longer US troops there. SDF guards at the second base said troops had left recently but refused to say when.

HIGHLIGHTS

• No US troops present at Al-Wazir and Tel Baydar bases.

• Daesh threat ‘has significantly increased’, SDF commander says.

The Pentagon refused to comment.
It is the first confirmation on the ground by reporters that the US has withdrawn from Al-Wazir and Tel Baydar bases in Hasaka province.
It brings to at least four the number of bases in Syria US troops have left since President Donald Trump took office.
Trump’s administration said this month it will scale down its military presence in Syria to one base from eight in parts of northeastern Syria that the SDF controls.
The New York Times reported in April that troops might be reduced from 2,000 to 500 in the drawdown.
The SDF did not respond to questions about the current number of troops and open US bases in northeastern Syria.
But SDF commander Mazloum Abdi, who spoke at another US base, Al-Shadadi, said the presence of a few hundred troops on one base would be “not enough” to contain the threat of Daesh.
“The threat of Daesh has significantly increased recently. But this is the US military’s plan. We’ve known about it for a long time ... and we’re working with them to make sure there are no gaps and we can maintain pressure on Daesh State,” he said.
Abdi spoke on Friday, hours after Israel launched its air war on Iran. He refused to comment on how the new Israel-Iran war would affect Syria, saying simply that he hoped it would not spill over there and that he felt safe on a US base.
Hours after the interview, three Iranian-made missiles targeted the Al-Shadadi base and were shot down by US defense systems, two SDF security sources said.
Daesh ruled vast swathes of Iraq and Syria from 2014 to 2017 during Syria’s civil war.

 


Regional war puts Palestinian disarmament in Lebanese camps on hold

Updated 17 June 2025
Follow

Regional war puts Palestinian disarmament in Lebanese camps on hold

  • Dimashkieh affirmed that “the dialogue committee is fully committed to the joint statement issued by the Lebanese and Palestinian presidents”
  • Palestinian sources told Arab News that significant resistance has emerged within Palestinian ranks over Abbas’s quick acceptance of disarmament deadlines

BEIRUT: A Palestinian official in Lebanon announced “the postponement of the scheduled collection of weapons from Palestinian refugee camps due to the current situation in the region.”

The announcement came just hours before the Lebanese government was set to begin disarming Palestinian refugee camps in Beirut and its suburbs this week.

Citing a Lebanese official familiar with Palestinian affairs in Lebanon, Palestinian news agency WAFA stated that “Palestine renewed its commitment to the joint statement issued on May 21 following the meeting held between Lebanese President Joseph Aoun and President Mahmoud Abbas in Beirut.”

He added that the statement emphasized “Lebanon’s sovereignty, the extension of state authority, and the exclusive right of the Lebanese state to bear arms, as well as the need to end any manifestations outside its authority.

“Palestinian security and military bodies will begin full cooperation with the Lebanese security forces as agreed upon when conditions permit and after the necessary preparations are completed,” the official said.

On the Lebanese side, the only statement issued in this regard was by Ramez Dimashkieh, head of the Lebanese-Palestinian Dialogue Committee, who said that “he received a call from Azzam Al-Ahmad, secretary-general of the Palestine Liberation Organization, during which they discussed the latest developments.”

Dimashkieh affirmed that “the dialogue committee is fully committed to the joint statement issued by the Lebanese and Palestinian presidents, which clearly emphasized respect for Lebanese sovereignty, the principle of exclusive state control over weapons, and the necessity of ending the visible presence of Palestinian arms, according to a specific timeline.”

Youssef Al-Zari’i, Fatah’s media representative in Sidon, confirmed that Palestinian factions, including Fatah and Islamic movements, all expressed willingness to hand over weapons and allow Lebanese authority throughout the country.

However, he argued that delays are “reasonable given the delicate regional situation,” with implementation tied to evolving Middle Eastern dynamics.

Palestinian sources told Arab News that significant resistance has emerged within Palestinian ranks over Abbas’s quick acceptance of disarmament deadlines. “Multiple Palestinian factions, particularly within Fatah, are uncomfortable with Abbas’s hasty agreement to weapon collection schedules,” one insider said.

Beyond regional timing issues, fundamental questions about execution mechanisms remain unresolved.

“Fatah claims it holds limited heavy weapons in Lebanese camps compared to other groups, especially Hamas,” a source said.

Since Fatah’s weapons belong to the internationally recognized Palestinian Authority and operate under Lebanese oversight, unilateral disarmament could create dangerous imbalances.

“If Fatah surrenders its arsenal while Hamas and affiliated groups retain theirs, Fatah becomes vulnerable within camp dynamics,” the source warned.

Hamas continues defending its Lebanese weapons as legitimate resistance tools while deflecting surrender demands through broader political arguments. The group links disarmament to comprehensive refugee solutions, including return rights and enhanced social protections for displaced populations in Lebanon.

Palestinian camps across Lebanon emphasize that sustainable solutions must address living standards, legal rights including property ownership, while maintaining respect for Lebanese sovereignty and law.

The Lebanese and Palestinian presidents announced in a joint statement issued following their meeting a few weeks ago “the formation of joint committees to address the issue of Palestinian weapons in refugee camps and to monitor the situation in the Palestinian camps.”

They affirmed their commitment to the principle of placing all weapons under Lebanese state control.

According to a joint Lebanese-Palestinian census conducted in 2017, the number of Palestinian refugees in Lebanon is estimated at around 200,000. Many live in harsh conditions within camps overseen by Palestinian factions and forces, which consider the possession of arms as integral to both the right of return and the broader struggle for the liberation of Palestine.

Lebanon is home to 12 official Palestinian refugee camps, along with dozens of other communities dispersed across the country.

The presence of weapons in Palestinian camps in Lebanon dates back to the 1969 Cairo Agreement between the PLO and the Lebanese government.

The agreement stipulated that Palestinians were permitted to establish military bases in southern Lebanon and conduct political activities within the camps, effectively legitimizing armed Palestinian presence on Lebanese soil and in camps.

However, following a civil war in which Palestinian weapons played a dominant role, Lebanon officially annulled the agreement in 1987.

Weapons are distributed unevenly among the camps. Heavy weapons are found in the Ain Al-Hilweh camp, the most overcrowded camp and home to the various politically and militarily diverse factions, and in the Rashidieh camp in the Tyre region.

This is in contrast to the Nahr Al-Bared camp in the north, which is completely devoid of weapons. It has been under the control of the Lebanese Army since 2007, following violent battles that lasted for more than three months between the Lebanese Army and Fatah Al-Islam, which launched attacks against the military that killed dozens.

The disarmament process was scheduled to begin this week in the Shatila, Mar Elias, and Burj Al-Barajneh camps in Beirut and its southern suburbs.

“A committee was supposed to be formed to oversee implementation. There were discussions about assigning this role to the Lebanese-Palestinian Dialogue Committee, which was seen by some as the appropriate authority. However, others dismissed it as a political body unrelated to the issue. This raised further questions: Who would assume responsibility for internal Palestinian affairs once weapons were handed over? Who would manage security inside the camps? And who would handle the cases of wanted individuals and those who had taken refuge there?” a Palestinian source stated.

In recent months, the Lebanese Army has confiscated weapons from Palestinian military sites supported by the Syrian regime and located in the Bekaa Valley on the border with Syria. The most important of these was a base in Qusaya belonging to the Popular Front for the Liberation of Palestine, General Command and Fatah Al-Intifada, confiscating their equipment and ammunition.

Before the outbreak of the Nahr Al-Bared camp battles, Lebanese political leaders had agreed during national dialogue talks to disarm Palestinians outside the camps within six months.

This commitment was later echoed in the 2008 Doha Agreement, which outlined a national defense strategy that included addressing Palestinian arms both inside and outside the camps.

However, these decisions were never implemented. In the years that followed, Ain Al-Hilweh, the largest Palestinian refugee camp in Lebanon, repeatedly witnessed violent clashes among rival Palestinian factions.


Israel closes Al-Aqsa Mosque, Church of the Holy Sepulchre under ‘emergency’ measures

Updated 17 June 2025
Follow

Israel closes Al-Aqsa Mosque, Church of the Holy Sepulchre under ‘emergency’ measures

  • Most shops in Jerusalem’s Old City have been closed, with only essential stores remaining open since Friday
  • Palestinians in Jerusalem fear for their safety due to lack of proper shelters amid Israel-Iran conflict

LONDON: Israeli authorities in occupied East Jerusalem have imposed a closure for the fifth consecutive day on the Al-Aqsa Mosque and the Church of the Holy Sepulchre while barring non-resident visitors from entering the Old City.

Israel announced a state of emergency after beginning airstrikes against Iran on Friday. Tehran retaliated by launching ballistic missiles at Israeli coastal towns and cities. Israel’s emergency measures prevented Palestinians and worshipers from entering the Al-Aqsa Mosque and its courtyards, as well as the Church of the Holy Sepulchre.

The Palestinian Authority’s Jerusalem Governorate added on Tuesday that most shops in the Old City had been closed, with only essential stores remaining open since Friday, Wafa news agency reported.

Israeli authorities have permitted settlers to visit the area surrounding the Al-Aqsa compound and perform Jewish prayers and rituals, while forces have intensified daily raids on Palestinian towns and suburbs in Jerusalem, including the Mount of Olives, Silwan, Issawiya, Shufaat, Hizma, Eizariya, Bir Nabala and Al-Ram, Wafa added. East Jerusalem is surrounded by 84 checkpoints and barriers, including recently installed earth mounds and gates.

Although Jerusalem has been spared so far from the Israel-Iran conflict, Palestinians in the city fear for their safety due to a lack of proper shelters within their towns and neighborhoods, Wafa reported.

Israeli authorities in Jerusalem have announced the opening of schools to be used as shelters from Iranian missile attacks. However, some Palestinian experts warned that the facilities may not be large enough to accommodate a significant number of residents, and some are even unsuitable for receiving civilians.


WHO says Gaza health care at breaking point as fuel runs out

Updated 8 min 6 sec ago
Follow

WHO says Gaza health care at breaking point as fuel runs out

  • “For over 100 days, no fuel has entered Gaza and attempts to retrieve stocks from evacuation zones have been denied,” said Peeperkorn
  • Peeperkorn said only 17 of Gaza’s 36 hospitals were currently minimally to partially functional

GENEVA: The World Health Organization on Tuesday pleaded for fuel to be allowed into Gaza to keep its remaining hospitals running, warning the Palestinian territory’s health system was at “breaking point.”

“For over 100 days, no fuel has entered Gaza and attempts to retrieve stocks from evacuation zones have been denied,” said Rik Peeperkorn, the WHO’s representative in the Palestinian territories.

“Combined with critical supply shortages, this is pushing the health system closer to the brink of collapse.”

Peeperkorn said only 17 of Gaza’s 36 hospitals were currently minimally to partially functional. They have a total of around 1,500 beds — around 45 percent fewer than before the conflict began.

He said all hospitals and primary health centers in north Gaza were currently out of service.

In Rafah in southern Gaza, health services are provided through the Red Cross field hospital and two partially-functioning medical points.

Speaking from Jerusalem, he said the 17 partially functioning hospitals and seven field hospitals were barely running on a minimum amount of daily fuel and “will soon have none left.”

“Without fuel, all levels of care will cease, leading to more preventable deaths and suffering.”

Hospitals were already switching between generators and batteries to power ventilators, dialysis machines and incubators, he said, and without fuel, ambulances cannot run and supplies cannot be delivered to hospitals.

Furthermore, field hospitals are entirely reliant on generators, and without electricity, the cold chain for keeping vaccines would fail.

The war was triggered by an unprecedented Hamas attack on Israel on October 7, 2023, which resulted in the deaths of 1,219 people, according to official Israeli figures.

The health ministry in Hamas-run Gaza said on Monday that 5,194 people have been killed since Israel resumed strikes on the territory on March 18 following a truce.

The overall death toll in Gaza since the war broke out on October 7, 2023 has reached 55,493 people, according to the health ministry.

“People often ask when Gaza is going to be out of fuel; Gaza is already out of fuel,” said WHO trauma surgeon and emergency officer Thanos Gargavanis, speaking from the Strip.

“We are walking already the fine line that separates disaster from saving lives. The shrinking humanitarian space makes every health activity way more difficult than the previous day.”