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International law hinders Syrian aid

March 29, 2014 at 3:08 pm

Before the war in Syria broke out in 2011, the country had been polio-free for almost two decades. However, the World Health Organisation (WHO) publicly reported the first cases of polio on October 29 last year.


Polio is a highly contagious disease transmitted via contaminated food and water and also through kissing, coughing and sneezing causing paralysis and even death. It had been almost eradicated worldwide.

Since the October outbreak, the WHO has helped the Syrian government set up a surveillance system and has launched a massive vaccination campaign not only in Syria, but its neighbouring countries and beyond.

Every case of polio found in Syria has been in opposition areas.

But amid the escalating death toll due to barrel bombs and the use of other crude weapons, the issue of polio, like many other diseases that have been a ramification of the war, has somewhat been forgotten.

The WHO recently responded to allegations it had blocked a vaccination campaign in Syria and had obstructed the testing of polio samples. The organisation’s response also triggered criticism as to why it was interested in defending its own reputation rather than dealing with the issue at hand.

In a commentary in the Lancet, WHO assistant director-general for polio and emergencies, Bruce Aylward, and WHO regional director for the Eastern Mediterranean, Ala Alwan, said that those involved in the vaccination campaign faced “immense hurdles”.

“It is essential that the complexities of the environment in which they are working are properly understood and that where information is incomplete, or is not shared for security reasons, it is not replaced with speculation or accusation,” they wrote.

Their comments came amid an article by deputy director of the Human Rights Programme at Icahn School of Medicine at Mount Sinai in New York City, Dr Annie Sparrow, in The New York Review of Books that claimed WHO had misled the international community on the number of polio cases in Syria.

Sparrow estimated that at least 90 children had been infected with polio compared with WHO figures of less than 30 confirmed cases.

While both numbers may seem insignificant, for every case of paralysis from polio, there are between 200 and 1,000 children infected without symptoms.

Sparrow claimed the WHO had ignored dozens of other reported cases of polio from other sources including the Turkish Ministry of Health, preferring to take the Syrian government’s line that polio was under control.

The WHO has staunchly refuted such claims.

Whatever the figure, it is no doubt polio remains a grave risk in Syria and beyond as refugees continue to flee the war-ravaged country.

According to the organisation, the most recent vaccination round last month was carried out in all governorates in Syria, with preliminary results suggesting that coverage was greater than 85 per cent in all but three of Syria’s governorates.

However, Sparrow wrote that the WHO’s vaccination programme was “fully orchestrated by the Syrian government and, in opposition-held areas, it is dependent for administration on volunteers from the government-dominated Syrian Arab Red Crescent (SARC)”.

As such, the polio vaccination campaign has become a deeply politicised issue in regards to access to territory held by opposing sides.

The WHO has always maintained it has been, and continues to be, impartial in Syria, in accordance with international humanitarian principles.

“WHO is impartial in aiding communities on all sides of this crisis, despite the restraints placed on all humanitarian actors whether they operate from within Syria or from neighbouring countries,” the commentary piece in the Lancet further stated.

The delivery of humanitarian aid in Syria is restricted by the nature of the legal and institutional framework regulating humanitarian support, which requires the consent of the host government.

WHO is therefore constrained by its current mandate with the Syrian government –and such a situation would only change with a UN Security Council resolution mandating that cross-border aid be provided impartially to all those in need.

But, given the significant regional and international support for the Syrian government, this has meant there has been a lack of unanimity at the United Nations to take stronger action for civilians in dire need.

If humanitarian aid is allowed in a country, it must be impartial – administered in accordance with an objective standard, which is applied equally to all parties – and not supporting the opposing party.

Consequently, humanitarian needs remain unmet in Syria by the agencies authorised to work there because securing cross-line access from all parties is not only problematic, but too often, impossible.

There are no neutral spaces left to occupy in Syria and WHO should be cognisant of the fact its delivery and execution of polio vaccinations was inevitably going to be restricted within the realms of international humanitarian law.

As Sparrow points out: “Despite claims by both the Syrian government and WHO that the campaign has reached most children at risk, the government’s vaccination effort is focused on children in government-controlled areas, where hospitals are open and food, clean water and fuel are available, while neglecting the children in the opposition-held areas where polio has actually broken out.”

But as the conflict continues unabated, focus must be shifted towards ensuring all parties involved with the arduous task of trying to contain polio are transparent to minimise the impact of the outbreak.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.