Kandahar - the polio capital

Eliminated in the relatively secure northern and central provinces, polio persists in the insecure southern and eastern provinces, according to the Ministry of Public Health (MoPH) and the UN World Health Organization (WHO).

The southern province of Kandahar is the worst affected: Of the 25 polio cases confirmed in Afghanistan in 2010, 11 were in Kandahar. In 2009, 38 cases were reported - 21 in Kandahar; and in 2008, 31 cases, with 12 in Kandahar, according to WHO.

In the past three years polio cases have been reported in fewer than 12 of the country’s 34 provinces - and there has been only one confirmed polio case reported in Afghanistan so far this year - a two-year-old boy, now permanently disabled - in Damaan District, Kandahar Province.

Canada, which has stationed over 2,000 soldiers in the province since 2006 and is committed to major humanitarian and development projects there, had vowed it would support aid agencies in eradicating polio in Kandahar by the end of 2009.

“It’s mostly due to a lack of access to children that we have been unable to curb polio in Kandahar,” Abdul Qayum Pokhla, provincial director of public health, told IRIN, adding that rampant insecurity had denied immunizers access to tens of thousands of children.

“There are also gaps in the polio programme as we’re unable to supervise its actual delivery to the populace and monitor the programme’s effectiveness,” he said.

In 2009, with support from the International Committee of the Red Cross, a major breakthrough was achieved when Taliban leaders issued “support letters” for the polio campaigns.

“The Taliban may not attack us but too often we cannot corroborate the lists the immunizers give us,” said Pokhla, adding that lack of awareness among rural communities about polio immunization was also a key challenge.

Conflict-related internal displacements and cross-border movements to and from neighbouring Pakistan (where polio is endemic) have also been cited as causes of the spread of polio. Most of the returning Afghan refugees from Pakistan have come through the eastern province of Nangarhar, according to the UN Refugee Agency.

Access denied in Zabul

In Zabul Province, next door to Kandahar, local Taliban insurgents allegedly opposed the March 2011 anti-polio drive, meaning that tens of thousands of under-five children missed out on immunization.

Arshad Quddus, a WHO polio officer in Kabul, said WHO was aware of the situation in Zabul and was working with local health workers to explore a “window of opportunity” and implement a localized anti-polio campaign in the near future.

“WHO is extremely concerned about almost 70,000 children in Zabul who must be immunized against polio,” said Arshad, adding that the disease was persistent in the province.

MoPH officials said about 7.8 million children are due to be immunized this year but the coverage ratio hitherto in Kandahar, Zabul and Helmand provinces was under 50 percent.

“In every immunization round we miss a small percentage of children and that’s why polio has remained endemic in Afghanistan,” said MoPH spokesman Kargar Nooroghli.