olio has resurfaced in Gaza for the first time in 25 years, thriving in the same conditions in which people are dying. The first was confirmed Friday in a 10-month-old unvaccinated child in Deir al-Balah, the enclave’s health authorities have said; the World Health Organization announced last month that the virus had been initially detected in wastewater in the city. Now, in Gaza, the medical safety of thousands of children depends on the safe delivery of vaccines to the region.

“Just when it seems the situation could not get worse for Palestinians in , the suffering grows—and the world watches,” said U.N. Secretary General António Guterres in a Friday.

“In recent weeks, the poliovirus has been detected in wastewater samples in Khan Younis and Deir al-Balah,” he said. The reemergence of polio in Gaza did not come as a complete shock, given the situation in the region since the Hamas attacks on Israel last October, during which roughly 1,200 people were killed. More than 40,000 people have been killed in Gaza in the ensuing conflict, according to figures from the Hamas-led Gaza health ministry, which are considered reliable by the U.

S. government and the U.N.

—and, unsurprisingly, immunization coverage for cVDPV2, or circulating vaccine-derived poliovirus type 2, has dropped at a staggering rate. “Any disease that [can] spread that way will eventually spread,” says Dr. Majed Jaber, a physician from Gaza who spoke to TIME from Al-Mawasi, a town in Khan Younis.