Health experts are urgently trying to vaccinate 2.4m children in Syria against polio after the war-ravaged country reported its first suspected cases of the debilitating disease for 14 years.
Last week, the World Health Organisation (WHO) revealed it was investigating 22 children with suspected polio in the Deir Al Zour province of Syria, where two-and-half years of civil war have severely undermined health services and disrupted immunisation programmes. At least 500,000 children are estimated to have missed out on vaccinations because of the situation.
On Thursday, staff from Syrian Ministry of Health, the WHO, Unicef and several local organisations began a project to vaccinate 2.4m children against polio, measles, mumps and rubella.
“Originally this was due to start on November 10 but it has been brought forward because of the cases that have been reported in Deir Al Zour,” said Unicef’s Simon Ingram, speaking from neighbouring Jordan. “It’s one of the things we are trying to do in the region to try and prepare for the eventuality that these cases are confirmed.”
The suspected outbreak has deeply concerned health workers and has underscored the very real danger polio still poses, even though the crippling disease is now considered endemic in just three countries – Pakistan, Nigeria and Afghanistan.
The global battle against the polio virus has largely been a success story, with the total number of cases being reduced from 350,000 in 1988 to 223 last year. India, which once accounted for half of the world’s cases of polio, was taken off the endemic list in 2012 after a massive public health campaign.
But with a sizeable number of cases confirmed in Somalia and Kenya, and now probably Syria, the number of cases will this year represent an increase rather than a fall – the first upward trend since 2008. There were also a handful of cases reported in Cameroon, South Sudan and Ethiopia and this year’s total already stands at 301, before the cases in Syria are added.
Experts say the new outbreaks highlight the need to completely eradicate polio in those counties where it is still endemic and from where it can spread to other countries, especially those considered high risk.
Oliver Rosenbauer, a WHO spokesman, said every time a polio case is detected, DNA tests are conducted to trace the source of the virus. He said the polio outbreak in Somalia had come from a virus originally from Nigeria. From Somalia it had then spread into Kenya and Ethiopia.
Meanwhile, Pakistan remains one of the toughest challenges for polio workers. Many communities in the remote tribal areas bordering Afghanistan have historically been suspicious of vaccination programmes.
But after it emerged in 2011 that the CIA had recruited a Pakistani doctor to launch a fake vaccination programme in the city of Abbottabad in an attempt to secure a DNA sample from the children in Osama bin Laden’s compound, so suspicion has grown.
Last year, the Taliban prevented health workers doing vaccinations in North and South Waziristan, a decision that meant 240,000 children under the age of five missed out. Dozens of health workers and police guards have been attacked and a number killed.
It is not yet known where the Syrian virus originated, something that will only be identified by the tests being conducted in laboratories in Tunisia. But earlier this year polio virus from Pakistan was detected in the sewers in both Egypt and Israel.
Some reports have raised the prospect that the polio virus in Syria may have been introduced by a foreign fighter joining the hostilities against President Bashar al-Assad. The city of Deir Al Zour is partly controlled by Syrian government forces while the surrounding countryside is held by rebel forces. Asked about this possibility, Mr Rosenbauer said: “That would be just speculation.”
Regardless of whether the polio in Syria is traced to Pakistan, according to the Dawn newspaper officials there have already expressed fears that Pakistanis could face travel bans if the country is unable to tackle the disease.
“If the situation is not handled on a war footing, there could be a ban on Pakistanis wanting to travel to Saudi Arabia for Haj... as well as workers,” said Shaukatullah Khan, the governor of Khyber Pakhtunkhwa, speaking during an event on World Polio Day.
The polio virus invades the nervous system and can cause irreversible paralysis within hours. There is no cure and the disease can only be prevented by a programme of vaccination, something that usually requires three doses. The spread of the disease is hastened by poor hygiene.
The UN estimates more than 100,000 people have been killed in the Syrian conflict and that 2m Syrians have fled the country. Internally, there has been massive movement, something that has helped disrupt health programmes.
As a result, children are now at far higher risk of diseases such as polio and measles. Most of the 22 children with suspected cases reported in Deir Al Zour are believed to be aged less than two years.
In addition to the vaccination programme, Unicef has flown in extra supplies of fortified food for children; the conflict is also undermining the ability of children to access sufficient to eat.
In a statement, Unicef said: “Hospitals visited by [our] staff are reporting an upward trend in the number of children being admitted with moderate and severe acute malnutrition compared to two years ago.”