Palestinian health authorities and United Nations agencies on Sunday began a vaccination drive against polio in the Gaza Strip, hoping to prevent an outbreak in the territory ravaged by nearly 11 months of Israeli bombardment.

Authorities plan to vaccinate children in central Gaza until Wednesday before moving to the more devastated northern and southern parts of the Strip, aiming to inoculate about 640,000 children. On Saturday, a few children were vaccinated before the formal start of the campaign.

“This is the first few hours of the first phase of a massive campaign, one of the most complex in the world,” said Juliette Touma, communications director of UNRWA, the United Nations Palestinian refugee agency.

“Today is test time for parties to the conflict to respect these area pauses to allow the UNRWA teams and other medical workers to reach children with these very precious two drops. It’s a race against time,” Touma told the Reuters news agency.

Israel and Hamas, which have so far failed to conclude a deal to end the war, said they would cooperate to allow the campaign to succeed.

The World Health Organization said on Thursday that Israel has agreed to limited pauses in its military operations to facilitate the campaign. There were initial reports of Israeli strikes in central Gaza early on Sunday, but it was not immediately known if anyone was killed or wounded.

Hospitals in Deir el-Balah and Nuseirat confirmed that the campaign had begun on Sunday. Israel said on Saturday that the vaccination programme would continue through September 9 and last eight hours a day.

The vaccinations will be held at some 160 sites across the territory, including medical centres and schools. Children below 10 years of age will receive two drops of oral polio vaccine in two rounds, the second to be administered four weeks after the first.

Gaza recently reported its first polio case in 25 years – a 10-month-old boy, now paralysed in the leg. The WHO says the presence of a paralysis case indicates there could be hundreds more who have been infected but are not showing symptoms.

Most affected children do not experience symptoms and those who do usually recover in a week or so, the UN health agency said. There is no cure for polio, it can only be prevented. When polio causes paralysis, it is usually permanent. The disease can be fatal if the paralysis affects breathing muscles.

The vaccination campaign faces a host of challenges, from ongoing war to devastated roads and hospitals shut down by the war. About 90 percent of Gaza’s population of 2.3 million people have been displaced within the besieged territory, with hundreds of thousands crammed into squalid tent camps.

Health officials have expressed alarm about disease outbreaks as rubbish piles up and the bombing of critical infrastructure has sent putrid water flowing through the streets. Widespread hunger has left people even more vulnerable to illness.

“We escaped death with our children and fled from place to place for the sake of our children, and now we have these diseases,” said Wafaa Obaid, who brought her three children to Al-Aqsa Martyrs Hospital in Deir el-Balah for vaccination.

U.S. forces have destroyed two Houthi drones and an unmanned surface vessel in the Red Sea, the U.S. military announced. 

The U.S. Central Command (CENTCOM) posted on X Saturday that in the past 24 hours, forces destroyed one Iranian-backed Houthi uncrewed aerial vehicle (UAV) and one uncrewed surface vessel (USV) in Houthi-controlled areas of Yemen.

The U.S. military noted that they determined that the UAV and USV presented a “clear and imminent threat” to U.S. and coalition forces as well as merchant vessels in the Middle Eastern region.

“This action was taken to protect freedom of navigation and make international waters safer and more secure for U.S., coalition, and merchant vessels,” CENTCOM said.

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The escalation of the ongoing Israel and Hamas war has escalated further since the Hezbollah attack in Israel that targeted a children’s soccer field. 

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The attack, in July, killed 12 children and wounded dozens more.