The conflict in Syria makes it impossible for health workers to carry out immunisations for polio as an outbreak hits the country.
Syria’s civil war unleashes new polio threat
Istanbul // Millions of children have been vaccinated in the Middle East since polio was detected in Syria last year, but health officials say millions more immunisations must be given to contain the outbreak.
The World Health Organisation (WHO) declared a regional emergency in response to the confirmation of polio cases in Syria last October. Since then international agencies and governments have been rushing to immunise 22 million children in Syria and neighbouring countries.
The Syrian civil war has severely damaged Syria’s health service infrastructure and displaced millions of people.
In the resulting chaos, international health agencies admit they have no clear idea of the vaccination programme’s coverage.
To be successful, 80 to 90 per cent of people must be immunised, doctors said, something aid officials acknowledged was a difficult task in Syria.
“Because of population displacements and the difficulty in verifying numbers, reliable coverage data for some areas is not available, though we do know that the first campaign in Syria reached more than two million children,” said Oliver Rosenbauer, a spokesperson for WHO’s polio eradication initiative.
Among the two million vaccinations in Syria were 60,000 children in Deir Ezzor, the province in which the outbreak was first confirmed. Of the 17 polio cases in Syria, 15 have been in the eastern desert province, where fighting between rebels and the regime has been intense.
The other two cases in Syria were in Aleppo and Douma, on the northern edge of Damascus, Syria’s most populous areas.
Areas in and around the Syrian capital are among those where vaccinations have not been universally carried out, including Moadamiya, just 8 kilometres from the heart of Damascus. It has been unreachable by aid groups for almost a year, with UN agencies saying the regime has repeatedly denied requests for humanitarian supplies to be allowed in.
“We have reached almost two million children last month, but we are still far from reaching every child because of the war,” said Juliette Touma, a regional spokesperson for Unicef.
“How do we coordinate with the different parties to the conflict to ensure that our staff, the Syrian Arab Red Crescent volunteers and medical workers have access, are safe and are capable of crossing the check points and reaching children?
“We were not able to reach some parts of rural Damascus – the city Moadamiya, in almost a year.”
Some parts of Aleppo, the old city of Homs and areas in the northeastern province of Raqqa are inaccessible to aid workers, health agencies said.
WHO said this week that they are unable to reach 100,000 children in Raqqa because of heavy fighting.
Aid workers have given conflicting accounts of how much cooperation they are getting from the Syrian regime and rebels groups. WHO said neither deliberately blocked the vaccination effort, but that insecurity was a major issue.
In Damascus, however, people on the ground said efforts by medical teams with vaccines to enter Douma – where one polio case has been confirmed – and the eastern Ghouta – scene of last summer’s massive chemical weapons attack – were blocked last week by regime checkpoints.
There have been successes, however, with Unicef saying it reached Bludan, once a popular tourist destination west of Damascus and vaccinated another 60,000 people.
A complex maze of front lines controlled by different factions means that areas with easy access to vaccinations can be a few kilometres from areas health staff cannot reach.
In Masakin Barzeh, a Damascus neighbourhood, “there are different vaccination centres with plentiful supplies of polio vaccines but just two kilometres from the vaccination centre, it is hard to take vaccinations to Qaboun or the old town of Barzeh where there are hundreds of children who cannot get any vaccinations – this is our dilemma”, said a Syrian doctor working with the health ministry.
Throughout almost three years of revolution and war, Syrians have learnt to be suspicious of government health clinics where wounded activists and protesters have been arrested seeking medical care.
As part of the vaccination drive, clinics now have a no-questions-asked policy to ensure everyone who can get to a clinic will, regardless of their political affiliation.
“It was easy to get the children vaccinated – just ten minutes without any waiting or queues,” said Um Faisal, who took her two grandchildren to the clinic in Barzeh, Damascus, for polio vaccinations after hearing about the campaign on state television.
“It is very dangerous to see polio is spreading among our children, we have enough death in Syria so, we don’t need more reasons of death, that is why I came,” she said.
As millions of Syrians have fled the fighting and are now refugees, the immunisation programme has also focused on neighbouring countries such as Jordan, which hosts more than half a million Syrians.
“One single case of polio in any country is considered an outbreak,” said Najwa Khuri Bulos, chairperson of the National Immunisation Technical Advisory Group, which assists the Jordanian health ministry with vaccinations.
“This means a hundred others are infected and are already spreading the disease,” she said.
Jordan has not had confirmed polio cases and Dr Bulos said the response in the kingdom had hit the 90 per cent coverage requirement.
In Jordan’s Zaatari camp, the largest refugee centre for Syrians, more than 18,000 children under the age of five were immunised in three vaccination rounds between October and December.
However, even if the emergency response – vaccinations in Syria are to continue until April – does contain this latest outbreak, the danger of a recurrence remains unless the virus is eradicated worldwide.
Polio remains endemic in three countries – Nigeria, Pakistan and Afghanistan.
“It is from here that polio will continue to spread to reinfect polio-free areas, as we have seen time and again,” said Mr Rosenbauer, of WHO.
The strain of the virus found in Syria was of Pakistani origin, according to WHO, the same as a strain also found in sewage in Egypt, Israel and the Palestinian territories during the last year.
Deir Ezzor was left out of a joint WHO and Syrian government immunisation campaign in December 2012 because of fighting and logistical problems, according to WHO. The programme resumed the following month but that did not stop the outbreak.
“The only way to truly minimise the risk of an outbreak is to maintain very high levels of routine vaccination coverage across the population,” said Mr Rosenbauer.
“And in Deir Ezzor, which is one of the most contested areas with declining infrastructure, populations are unfortunately particularly vulnerable to diseases such as polio.”
* Suha Maayeh reported from Amman