Polio is an entirely preventable disease that can cause paralysis, disability, and even death. It is incurable and highly contagious, but vaccination drives have meant that worldwide, cases have decreased by 99 per cent since 1988.
Until recently, the disease remained endemic in just three countries – Afghanistan, Nigeria, and Pakistan. Now, three years into the bloody conflict in Syria, the disease has re-emerged. The World Health Organisation (WHO) says there are 25 laboratory confirmed cases in the country, with another 13 confirmations pending. However, Syrian doctors place the number of children with clinical symptoms much higher, estimating that there are at least 100 cases. For every victim, at least 200 people are carrying and spreading the virus.
This is a tragic situation, particularly given that polio was stamped out in Syria in 1999. It re-emerged last year due to the destruction of health infrastructure during the war. The conflict has meant that sanitation is poor, making it more likely that the disease will spread, while the population – displaced by fighting – is highly mobile, compounding the effect. Before the war, national figures show that 91% of children were vaccinated. In 2012, this number was just 68%. In rebel-held areas, where all the polio cases so far have occurred, immunization levels are significantly lower. The Syrian government says it has continued to vaccinate during the conflict, a statement corroborated by the WHO. However, Syrian doctors and foreign observers dispute this, suggesting that the regime has withheld vaccines from the rebel-held north of the country as another means of waging war on civilians. In a conflict that has included the deliberate targeting of medical facilities, this is certainly not inconceivable.
This has implications not just for Syria but for the wider region. It was reported this week that Iraq had recorded its first case of polio in 14 years. An unvaccinated six-month-old baby near Baghdad was paralysed. According to the Irin humanitarian news agency, the strain matched that found in Syria, although it is not known how the baby contracted the virus. It is thought to be related to the displacement caused by the ongoing violence in Anbar province in Syria and Iraq. The case illustrates one of the most tragic facts about polio: it tends to affect the very young, with children under five the most likely to be unvaccinated and therefore facing the highest risk.” When you have large population movements and system breakdown, implementation of vaccinations can be patchy, and then you have a perfect picture for the re-introduction of the virus,” said Marzio Babille, UNICEF representative in Iraq, told Irin. “That was the case in Syria and now this is the case in Iraq.”
The case has added to concern that the virus could spread across the Middle East. Lebanon, with a struggling health service and a large population of refugees, many of whom are unregistered, is at particularly high risk. In the months since polio was confirmed in Syria, the largest vaccination campaign in the history of the Middle East has begun. More than 22 million children in Syria, Lebanon, Jordan, Turkey, Iraq, Egypt and Palestine have been vaccinated.
But is it enough? The UN agency responsible for dealing with the drive told the Guardian that this is perhaps “the most challenging outbreak in the history of polio eradication”. Continued conflict makes it difficult to track populations and ensure thorough coverage. The vaccine does not give a 100% guarantee, if a child’s immunity is lowered by malnourishment, contaminated water, or living in overcrowded conditions.
As the war shows no signs of slowing down, the reintroduction of the polio virus is yet another tragedy.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.