Polio in Syria: putting children above politics

By: Siddharth Chatterjee

Afterer 14 years, polio has made a comeback in Syria, courtesy of a ban on vaccination in the tribal areas of Pakistan.

One of our worst fears was recently confirmed: Polio has returned to Syria for the first time in 14 years, infecting at least 10 young children. The highly contagious virus thrives in war-torn communities where poor sanitation and conflict hasten its spread. In Syria, civil war has driven immunisation rates down to less than 70 percent, from more than 90 percent in 2010, creating exactly the sort of environment where polio tends to strike. The conflict has also had a devastating impact on Syria's health infrastructure: Across the country, it has been near impossible to deliver even the most basic of health services, with tragic results. The Syrian Arab Red Crescent Society (SARC) is the only humanitarian institution in Syria with access to nearly 90 percent of the country, but faces daunting challenges. Yet even amid the chaos of war, success against polio is possible. I witnessed first-hand the polio outbreaks in Darfur in 2004, and Somalia in 2005, while working for UNICEF. On both occasions, we overcame the chaos of armed conflict to defeat the virus. In Darfur, using humanitarian diplomacy combined with humility, we spoke to rebel leaders and government forces alike, and saw hardened commanders agree to temporarily halt their fighting and put the health of their children above all else.

Commitment by all

I learned that it is impossible to root out polio without the full commitment of all parties to a conflict, which include religious, political and tribal leaders. But I also learned that when they see the dangers to their own children, basic humanity takes control, and the necessary commitments come quickly. Health services are truly a bridge for peace. The scenario has repeated itself in more than two dozen conflict zones over the past 20 years, in places such as El Salvador, Colombia, Angola and elsewhere. The lessons from these successes are captured in the Global Polio Eradication Initiative's Strategic Plan to end polio by 2018. It includes emergency procedures to immunise high-risk areas as quickly as possible: organising days of tranquillity (ceasefires) and establishing vaccination posts around inaccessible regions to prevent polio spread from affected areas. Guided by the Strategic Plan, vaccination campaigns are scheduled across Syria and neighbouring countries in the coming weeks, and actions are underway to negotiate access to children in contested areas. But to plan is one thing, and to execute, another. These campaigns must be allowed to occur. The government and opposition forces must permit full and free access to all children for front-line health workers. The recent commitment from the Syrian Foreign Ministry to allow access is a good first step, but the international community must ensure that children in need are actually reached. Underpinned by the principles of humanity, neutrality, independence and impartiality, SARC is a versatile national humanitarian organisation to bridge political divides. The Red Crescent symbol is a unifying factor that transcends political and religious allegiance, partly because SARC volunteers often hail from the very communities that are under fire. Their networks are a permanent fixture in local communities and are critical partners in helping to depoliticise the delivery of health interventions. SARC's 84 branches and thousands of volunteers stand ready to assist.

International cooperation

Global actors have a vital role in driving polio out of Syria. Donor governments must ensure the polio program is fully funded and equipped to swiftly and efficiently curb outbreaks. Influencers like the US, UK, France, China, Russia, Iran, Qatar and Saudi Arabia, must state clearly and unequivocally to all parties the need to ensure safe access for health workers. Principles over politics must be the clarion call when it comes to children and their wellbeing, everywhere. But last week's news that the virus originated from Pakistan is a stark reminder that the most important thing the world can do is extinguish polio at its source. The underlying problem is not in Syria or in the Horn of Africa, the site of another polio outbreak this year, but in Pakistan and the other two endemic countries that have never interrupted transmission of the virus: Afghanistan and Nigeria. We must stop the virus there. Fortunately, we have a window of opportunity to do just that. Cases in these countries are down by more than one-third compared to this time last year, and the virus has retreated to just a few areas. Afghanistan, in particular, has made unbelievable progress, with no cases in its traditionally endemic Southern Region since last November. Much more concerning are Pakistan's Federally Administered Tribal Areas, where conflict, and a 2012 ban on vaccination by local leaders, have resulted in a polio outbreak that continues to worsen. The situation is a serious threat not only to Pakistan's progress, but to eradication efforts globally. Here, and everywhere else, where political struggles stand in the way of children's health, we must do everything we can to reach across divides and work together to ensure that no child goes without lifesaving vaccines. The stakes go far beyond polio. The campaigns underway in Syria and its neighbours are also bringing desperately needed measles vaccines, and vaccination campaigns can provide a platform for the delivery of vitamin A, hygiene kits and malaria bed nets. In the past 25 years, we have gone from 350,000 cases of polio in more than 125 countries to just a few hundred in a handful of countries. These last frontiers are the hardest, but the motivation and plan are there. We must push the limits to banish this disease. The children of the world are waiting for all of us to end the scourge of polio forever.