The World Health Organization, or WHO, has long advised that increasing conflict in the world is a harbinger of epidemics. A few years after the warning was issued, the reality of a polio epidemic, which is spreading like wildfire in war torn zones, is here to stay.  

One of the biggest problems with polio is that mass vaccinations must be sustained and constant.  If there is even a small hole in the temporal schedule of vaccinations, the opportunity for widespread disease skyrockets. 

Pakistan is one of the world's most dangerous places, when it comes to polio.  Since tribal warlords and constant strife in the mountainous regions of Pakistan has made almost impossible to carry out mass vaccinations, the resurgence of the crippling disease was only a matter of time.  In some areas, the vaccinations are stopped by the Taliban, with the reasoning that the West is trying to sterilize their women. 

Now, Pakistan is ground zero when it comes to polio.  New waves of the disease keep washing over the younger population each year, with more and more casualties reported in the more remote and poorer villages.  

But the disease has made a vicious comeback in many other places too.  One of the worst hit is Syria, where the 3 year long civil war has left a large number of every child younger than 3 helpless against the disease, and even some of the 4 and 5 year old.  

Incredibly, even in Cameroon, where unrest and civil strife has broken out, the deadly virus is spreading unabated.  

The WHO is asking the world community, and especially the countries most affected to do everything possible to stem the disease before it envelopes the world whole.  Mosquitoes are not the only carrier of the disease.  An infected child itself becomes a carrier, who can then transmit it to his siblings and family, or shed the virus in his bodily fluids and infect water sources. 

The WHO is also asking that the countries most affected, Syria, Pakistan and Cameroon vaccinate anyone who intends to travel abroad and carry a certificate to certify their vaccinated status.  In fact, the WHO has deemed adult passengers just as dangerous for the spread of the disease as children, who are the most affected, and think that it was adult passengers who carried the disease with them to Afghanistan to Syria this year.  Likewise, travelers from Cameroon have apparently carried the disease to Equatorial Guinea. 


Although those three countries have the most cases, and there the disease is spreading uncontrolled, many other countries are now seeing cases, especially in Africa, and in Israel who had not seen cases for decades.
New global cases doubled in 2013 compared to the year before, with 3/5 of all new cases in countries that did not have a history of the disease.  Because there is no cure, the only way to prevent the crippling effects and deaths that occur is through vaccination. 

Just recently, the WHO also reported that the disease had spread to Iraq, for the first time in a generation, most probably due to the Syrian diaspora.

Although Pakistani health authorities are trying very hard to kick-start the vaccination program again, the reality is that the killing of Osama bin Laden after a doctor became an informant caused a backlash against health worker that has not yet abated.   For this reason world health authorities have urged all of Pakistan's neighboring countries to vaccinate in the border regions.  Pakistani health authorities are also trying to also install their own vaccination station on the Pakistani side, to try and catch anyone who may be traveling sick, or infected. 

The worst case scenario however, is that of Syrian refugees. More than 100 children have certified symptoms of the disease with almost as many more suspected, even though neighboring countries have undertaken border to border vaccinations en masse.  Some of the victims of the new epidemic are barely old enough to walk, and are now permanently paralyzed.  15 years after Syria was declared a polio free zone, young refugees are succumbing to the disease or permanently scarred by it. The other problem that could amplify the epidemic is under-reporting.  With the Syrians constantly on the move fleeing a war theatre that is ever changing, the number of cases is believed to be as high as 1,000.  If that turns out to be true, there could be a whole generation of Syrian children maimed, crippled or killed by the resurgent epidemic. 

Polio lives in water, and human waste.  In some Syrian refugee camps there are open sewers where human refuse runs freely throughout the camps, and mosquitoes lay their eggs in the rivulets of waste.  With Syria's health system all but destroyed, there is no telling who is getting vaccinated within its borders, even as Al Assad maintains that everyone is still getting vaccinated.  

Turkish health authorities are scrambling to vaccinate those refugees that are living in camps on both sides of the border with Syria, at great risk.  Already some workers have been killed.  There are almost 1,000,000 people in camps who are completely severed from aid agencies or government and health authorities.  Those numbers are staggering in the face of a possible spread of the polio virus through the refugee camps.  

Foreign agencies are now also pushing for the vaccination of what could be as many as 23 million children both refugees and from Syria's neighboring states, who lives in the cross border areas and could be exposed to the virus either from refugees or the mosquitoes that thrive in the camps' fetid water pools. 

Without any drinking water in the camps, most of the refugees must make do with shallow wells, which are woefully contaminated with the camps' runoff.  Without clean water, the efforts to bring vaccinations might be too late.  Other diseases too, lurk in the dirty pools and wells.  Even if they vaccinate against polio, other lethal disease could soon spread, the most likely and dangerous of them is cholera.

With the summer fast approaching, and the mosquito population set to explode, the aid agencies and other health operators on the ground are scrambling to keep ahead of the disease.  The WHO has already predicted that the disease will spread to Lebanon, Iraq, Jordan and all the other places where the refugees are migrating to.  Turkey is most at risk, but there, the government is organizing massive efforts to vaccinate its camps and bring them under better conditions. 

Source: WHO/BBC: 4.5.14 

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