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Mon December 2, 2013

As Polio Spreads In Syria, Politics Thwarts Vaccination Efforts

Originally published on Thu December 5, 2013 8:31 am

The World Health Organization has declared a polio emergency in Syria.

After being free of the crippling disease for more than a decade, Syria recorded 10 confirmed cases of polio in October. Now the outbreak has grown to 17 confirmed cases, the WHO said last week. And the virus has spread to four cities, including a war-torn suburb near the capital of Damascus.

The Syrian government has pledged to immunize all Syrian children under age 5. But wartime politics is getting in the way. And the outbreak is expected to grow.

"Actually, it is spreading quickly," says Dr. Mohammed Al Saad in Gaziantep, Turkey, near the northern border of Syria. There are now more than 60 suspected cases, he says, with new ones reported each day.

Most cases have occurred in children less than 2 years old, who were born in Syria after the war started and missed their routine vaccinations, he says.

Saad is part of an early-warning medical team with the Syrian opposition that monitors rebel-held areas. The group, called the EWARN team, is working with the U.S. Centers for Disease Control and Prevention in Atlanta. It was the team that first raised the alarm after discovering polio cases in the province of Dier ez-Zor.

Now the medical group is gearing up for a mass vaccination campaign in northern Syria — a short drive across the Turkish border.

The goal of this polio task force is to immunize children in rebel areas. The communities there have been decimated by shelling and bombs. They have no electricity, clean water or functioning sewage treatment.

These are places where children are at greatest risk, says the leader of the task force, Dr. Bashir. (He asked us not to use his last name for security reasons.) "Our target is to train about 8,000 people for the door-to-door polio campaign," he says.

Mass immunization is the only way to contain the outbreak. The fastest way to reach kids is to cross the border from Turkey. But that raises a political problem for United Nations agencies in charge of the vaccinations.

Requests to the U.N. for vaccines have been in vain, Bashir says. "Until now they didn't promise they could provide us with vaccine for our children."

Delivery from any U.N. agency is not likely. That's because the U.N. is only authorized to operate through sovereign states, meaning it delivers all humanitarian aid through the central government in Damascus. And last month, the Syrian regime said no to a U.N. Security Council statement urging cross-border aid.

UNICEF's vaccination program is based in Damascus. Reaching children in rebel areas is a challenge, says UNICEF spokeswoman Juliette Touma. "In the past couple of years, we were not able to reach more than half a million children because of access restrictions," she says. "And this could explain why we have polio inside Syria."

Only after the outbreak was confirmed did the Syrian regime pledge to vaccinate all Syrian children. Now some vaccines are getting to rebel areas. After negotiations with the regime and the rebels, about 180,000 doses arrived in Dier ez-Zor, where the first cases were reported, Touma says.

There is no other way to deliver humanitarian assistance than to deal with all parties of the conflict. Touma says that UNICEF has been able to do that.

But doctors on the opposition's Polio Task Force charge that the Damascus based program is not reaching all the vulnerable children in rebel areas. Dr. Khaled Almilaji says the virus is spreading faster in rebel areas, where millions of people are displaced and living in dire conditions, he says. Families are drinking directly from the rivers, dependent on contaminated water, which can carry the virus.

"We are sure that the people in Dier ez-Zor [and] some villages don't know about the polio, actually," Almilaji says. "Do they know they have to take the vaccines?"

A door-to-door campaign is now key to families with children at risk, he says. "This is a disease. This is not politics."

International aid workers are calling for great pressure on the Syrian regime to allow a route from Turkey to northern Syria for vaccinators.

The polio cases are alarming, says Mary Ana McGlasson, a registered nurse who is now working on humanitarian efforts in Syria. "Humanitarian aid, in general, throughout large parts of Syria is not functioning," she says. "And I think that the polio epidemic and the vaccination campaign is one symptom of many."

The return of this crippling disease and the response, she says, are a sign that the international aid system is failing Syria's children. "My anger is directed at all parties to the conflict that are slowing down humanitarian aid even by a fraction," McGlasson says. "It's children caught in the middle of that who are suffering, and that's tragic to me."

Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.

Update at 10:32 p.m. ET. Vaccine Airlifted Into Syria:

The U.N. said Monday that it had airlifted polio vaccines for 538,000 children in hard-to-reach areas of northern Syria, including Dier ez-Zor. The airlift also brought blankets and other winter supplies to families.

Cross-border aid from Turkey — the easier way to reach these children — is still not an option.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

The World Health Organization has declared a polio emergency in Syria. The outbreak has spread to four cities there, including a war-torn suburb of the capital. The Syrian government has pledged to immunize all children under five, but wartime politics is getting in the way and the outbreak is expected to spread.

NPR's Deborah Amos reports from Gaziantep, on Turkey's southern border with Syria.

(SOUNDBITE OF CROWD)

DEBORAH AMOS, BYLINE: A polio task force gears up for a mass immunization campaign in Northern Syria, just a short drive away. The doctors are part of the Syrian opposition, a medical early warning team that monitors rebel-held areas. They raised the first alarm after discovering polio cases in the province of Deir ez-Zor. Dr. Mohammed al-Saad says there are now more than 60 suspected cases, with new ones reported every day.

Is this spreading quickly?

DR. MOHAMMED AL-SAAD: It is spreading quickly when you are looking to the age group; most of them less than two years old who didn't receive the routine vaccination in Syria.

AMOS: This workshop prepares volunteers to immunize children in rebel areas, communities decimated by shelling and bombs with no electricity, no clean water or functioning sewage treatment, where children under five are at greatest risk, says Dr. Bashir, head of the polio task force.

DR. BASHIR: Our target is to train about 8,000 people for the door-to-door polio campaign.

AMOS: Mass immunization is the only way to contain the outbreak. The fastest way to reach kid is to cross the border from Turkey. But that raises a political problem for U.N. agencies in charge of immunization. Dr. Bashir says a request for vaccines has been in vain.

BASHIR: Till now they didn't promise they can provide us with vaccine for our children.

AMOS: Delivery from any U.N. agency is not likely. The U.N. is only authorized to operate through sovereign states. That means it delivers all humanitarian aid through the central government in Damascus. And last month, the Syrian regime said no to a U.N. Security Council statement urging cross-border aid. UNICEF's vaccination program is based in Damascus. Reaching children in rebel areas is a challenge, says spokeswoman, Juliette Touma.

JULIETTE TOUMA: In the past couple of years, we were not able to reach more than half a million children because of access restrictions. And this could explain why we have polio cases inside Syria.

AMOS: Only after the outbreak was confirmed did the Syrian regime pledged to vaccinate all Syrian children. And some vaccines are getting to rebel areas. One hundred-eighty thousand doses have arrived in Deir ez-Zor where the outbreak began, says Touma, after negotiations with the regime and the rebels.

TOUMA: There is no other way to deliver humanitarian assistance than to deal with all parties of the conflict.

AMOS: And you've been able to do that in Deir ez-Zor?

TOUMA: Yes, we have.

AMOS: But it's not enough for all vulnerable children, says Dr. Khaled Almilaji, with the polio task force. The virus is spreading in rebel areas, he says, where there are millions of displaced living in dire conditions. Families are drinking directly from the rivers, he says, dependent on contaminated water, a carrier for the virus.

DR. KHALED ALMILAJI: We are sure that the people in Deir ez-Zor, some villages, they don't know about the polio actually.

AMOS: He says a door-to-door campaign is now key for families with children at risk.

ALMILAJI: This is a disease. This is not politics. So they can't pretend that they are - we are doing what is needed. And this is more important.

AMOS: International aid workers call for greater pressure on the Syrian regime, to allow a route from Turkey to northern Syria.

The polio cases are alarming, says Mary Ana McGlasson, a registered nurse who now works on aid to Syria.

MARY ANA MCGLASSON: Humanitarian aid in general, throughout large parts of Syria is not functioning. And I think that the polio epidemic and the vaccination campaign is one symptom of many.

AMOS: She says the return of this crippling disease and the response is a sign the international aid system is failing Syria's children.

MCGLASSON: My anger is directed at all parties to the conflict that are slowing down humanitarian aid, even by a fraction. And its children caught in the middle of that that are suffering and that's tragic to me.

SIEGEL: Polio does not stop at borders or military checkpoints. Without a comprehensive response, say aid workers, the outbreak could become a public health catastrophe. Deborah Amos, NPR News.

(SOUNDBITE OF BELL)

SIEGEL: You're listening to ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.

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