Leveraging community insights and navigating logistical challenges: a case study of the 2024 polio vaccination campaign in Gaza, State of Palestine.

This case study describes how high vaccination coverage was achieved during the 2024 polio vaccination campaign in Gaza amid an ongoing humanitarian crisis marked by damaged critical infrastructure, an obstruction of the entry of health supplies, mass displacement and security concerns for health workers. Despite the immense challenges, 559 161 children were vaccinated in the first round (94% of the revised target of 591 714) and 556 774 in the second round, exceeding expectations. While this represents an impressive achievement, some areas remained inaccessible, which prevented an estimated 7000-10 000 children from being reached for vaccination.Strong coordination and collaboration stewarded by the Gaza Ministry of Health with support from national and international partners.Negotiated humanitarian pauses in the form of 'days of tranquillity' agreed to by parties to the conflict enabling safe access for vaccinators, outreach teams and families.Prevaccination campaign sociobehavioural research to identify barriers and map information flows.Community engagement led by locally recruited volunteers embedded within affected communities, many of whom had themselves experienced displacement, supporting trust and acceptance.Culturally responsive communication strategies using multiple channels and feedback mechanisms.Adaptive vaccine management strategies and the development of a mobile cold chain.The campaign's success was underpinned by a multifaceted approach that included:Strong coordination and collaboration stewarded by the Gaza Ministry of Health with support from national and international partners.Negotiated humanitarian pauses in the form of 'days of tranquillity' agreed to by parties to the conflict enabling safe access for vaccinators, outreach teams and families.Prevaccination campaign sociobehavioural research to identify barriers and map information flows.Community engagement led by locally recruited volunteers embedded within affected communities, many of whom had themselves experienced displacement, supporting trust and acceptance.Culturally responsive communication strategies using multiple channels and feedback mechanisms.Adaptive vaccine management strategies and the development of a mobile cold chain.This case demonstrates that even in complex humanitarian crises, effective, community-centred vaccination strategies are possible. It also highlights how access and availability, not parental reluctance (or vaccine hesitancy), were the primary constraints on coverage. Parents showed strong willingness to vaccinate when services were accessible. Sustained advocacy and diplomacy remain essential to secure access, deliver equitable immunisation and create an enabling environment for humanitarian public health responses in conflict settings. However, the gains achieved through this campaign cannot meaningfully be sustained without a lasting ceasefire, the restoration of essential services and ongoing humanitarian access, particularly for infants born after the vaccination campaign who remain at heightened risk.