Less than a week after the World Health Organization (WHO) confirmed that 10 Syrian children had been paralyzed by polio, the Syrian regime capitalized on their suffering for propaganda purposes.
“The virus originates in Pakistan and has been brought to Syria by the jihadists who come from Pakistan,” Minister of Social Affairs Kindah al-Shammat told the Associated Press on Sunday. While the Pakistan-origin theory was floated by international health officials last week, the WHO has yet to complete the genetic sequencing of the Syrian virus that would prove it came from Pakistan, one of three countries where the virus is endemic. Even if the virus did originate in Pakistan, there would still be no way to tell how it came to Syria. In fact, says the WHO’s polio-eradication spokesman Oliver Rosenbauer, an adult fighter is the least likely of carriers. The virus tends to travel with children who have not yet been vaccinated.
The possibility that a strain from Pakistan may have taken root in war-ravaged Syria is the nightmare of epidemiologists who have long warned that failure to eradicate the disease in its last holdouts threatens to undermine hard-fought progress in the rest of the world. Polio was eradicated in 1999 in Syria, the first Arab state to implement mass immunization. But late last month, health officials reported that 22 children from the contested province of Deir ez-Zor suffered from sudden-onset paralysis, a symptom of polio. The other 12 cases are awaiting confirmation.
In pointing fingers at foreign fighters, the government is attempting to shift blame to the rebels, part of a regime narrative that the armed opposition is funded by outsiders and controlled by foreign terrorists. But where the virus originated is of less importance than how it was able to take root, says Dr. Fouad Fouad, a Syrian epidemiologist currently teaching at the American University of Beirut. And for that, he holds the Syrian Ministry of Health responsible. “It is possible that polio was brought in by Pakistani fighters, but the blame should start earlier,” he says.
Before Syria’s civil war began in 2011, an estimated 95% of children under the age of 5 were vaccinated, enough to stop the disease in its tracks. But since the war started, says Fouad, “Many parts of the country were left out of the immunization process. The WHO and the Ministry of Health couldn’t reach the conflict areas, leaving a big hole in the safety net, but they didn’t raise the alarm and they didn’t change their approach.” It is telling that of Syria’s 10 confirmed victims and 12 suspected cases, almost all are under the age of 2.
Despite efforts in Syria over the past year, the declining rate of immunization “was on the radar for a lot of people,” says the WHO’s Rosenbauer. “Clearly those immunization campaigns were not good enough. That’s the problem with areas of [conflict]. Health systems deteriorate, immunizations go down, and vulnerability goes up.” Information is another casualty of war. Rosenbauer admits that the WHO has very little information about what kind of immunization coverage is being implemented on the ground. Deir ez-Zor is split between regime and rebel forces, and access for the humanitarian organizations that would be running vaccination campaigns is nearly impossible.
For every child stricken with paralysis from polio, another 199 infected children show few or no symptoms. That means the disease can prey on a community for several weeks before it is detected, says Rosenbauer. So for Deir ez-Zor’s 10 confirmed victims, there could be nearly 2,000 carriers spreading the virus through the region’s compromised water supply, or taking it with them as they flee the fighting for shelter in bigger cities and take refuge across Syria’s borders. It’s a crisis that not only affects Syria, but also all of its neighbors.
Syria has some 3 million children under the age of 5, all of whom the WHO says will need to be vaccinated, but it’s not yet clear that all of them can be reached. The regime has repeatedly blocked delivery of other kinds of humanitarian assistance, including medicine, to rebel-controlled areas, and tales of mass starvation are rife. Fouad believes that Syria’s children will require an international resolution on par with the chemical-weapons accord that forced Assad to give up his arsenal: “Syrians are dying of starvation and communicable diseases. If the U.N. Security Council can issue a resolution on chemical weapons, they should do the same for health.” If not, Syria could join Pakistan, Afghanistan and Nigeria as a potential exporter of a disease that should be on its way to extinction.