The United Nations says tens of thousands of Afghan children could die this winter because the Allies have ignored a plea for a three-day pause in the bombing to allow a programme of immunisation.
The appeal was made by the UN secretary general, Kofi Annan, at the request of the World Health Organisation (WHO) and the UN Children's Fund (Unicef). According to sources familiar with the discussions, the question was raised with President George Bush and the US Secretary of State, Colin Powell. But with only days to go before the immunisations are due to begin, and despite the co-operation of the Taliban, the US has given no indication that there will be any suspension of the bombing.
Aid officials in Pakistan say they face a painful dilemma: whether to expose their Afghan volunteer staff to the risk of travelling across the country during the bombing campaign; or whether to abandon the vaccinations and endanger the lives of almost 50,000 children under five years old.
"There is a physical danger, of course," said Navid Sadozai of the World Health Organisation, which will carry out the vaccination programme with Unicef. "But the cost of not carrying on could be much higher. It would be a global tragedy." All over the world, Unicef and the WHO carry out national immunisation days, in which millions of children are vaccinated against mundane diseases which remain killers in the poorest countries. In war zones, the organisations habitually make an appeal for "days of tranquility", when warring parties observe a ceasefire to allow the vaccinations to go ahead.
For the past six years, the Taliban and the opposition Northern Alliance have silenced their guns during immunisation days. This year, the Taliban is understood to have given assurances that it will once again co-operate. But, despite lobbying by Mr Annan, there has been no response from Washington. Yesterday, he reiterated an appeal for the bombing to end "as quickly as possible" so humanitarian efforts could be stepped up.
Dr Sadozai said: "We have still not given up hope. We hope for the best, but we are prepared for the worst."
As well as vaccinating against polio, the WHO and Unicef's 40,000 Afghan volunteers are due to dose children with vitamin A drops, which drastically reduce rates of one of the biggest winter killers, measles. Health workers describe it as one of the few truly successful public health programmes in Afghanistan, but if it does not go ahead as planned next week, the onset of the bitter Afghan winter will make it impossible before the spring.
Every year in Afghanistan, 300,000 children under the age of five die from preventable causes such as malnutrition, exposure and diarrhoea. Unicef estimates that an extra 100,000 will die this winter unless adequate food aid reaches them. One-quarter of such deaths are caused by measles, but vitamin A can reduce them by half. In theory, a comprehensive programme could save 48,000 lives.
The WHO and Unicef have already sent trains of donkeys carrying refrigerated boxes with 400,000 vials of the vaccine over the 4,000m Shah Saleem Pass between Pakistan and Afghanistan. By yesterday evening enough vaccine was stockpiled within the country to vaccinate five million children. But, according to aid workers, it will be impossible to reach the neediest areas if the bombing continues.
Since 1996, polio has been almost eradicated in Afghanistan, one of the few positive achievements of the past few years. But as people flee the bombing within Afghanistan and across the border, doctors fear the disease could make a comeback. "With these people getting displaced, there's a danger of redistributing the virus all over again," said Dr Sadozai.Reuse content