On October 2, the UN Security Council unanimously adopted a statement by the UN president urging the protection of civilians, access to besieged communities, and humanitarian assistance across internal lines and international borders. However, the Syrian government continues to forbid the UN and its agencies to provide cross-border aid from Turkey, although this is by far the easiest and most efficient way to reach many of the 2.5 million children in most urgent need of food, water, and vaccination. The UN’s humanitarian chief, Valerie Amos, says that cross-border aid remains “a red line for the Syrian government.”
Given the serious questions about the government’s response to the polio outbreak, several nongovernmental organizations, guided by the ACU, banded together in November to form the Polio Task Force to meet the needs of the estimated 2.7 million children most at risk. The task force established a cold chain across seven governorates in northern Syria, trained more than six thousand health care workers, and raised awareness in at-risk communities.
But the ACU effort has been stymied by a lack of vaccines—neither Damascus, WHO, nor UNICEF would or could provide them. Doctors Without Borders–Holland tried to buy polio vaccines directly from a manufacturer, but UNICEF, acting on the Syrian government’s behalf, was forced to block it. Only in the last days of December was the Turkish government able to facilitate the provision of 2.5 million doses of vaccine—enough for one round—for use in Syria. A midwinter campaign for Syria’s children outside government-controlled areas began in early January.
Turkey vaccinates children who cross its border or live in refugee camps on its territory, but for children inside Syria, the Syrian government will not let WHO or UNICEF help the ACU. The UN agencies have chosen to maintain good relations with the government and access to government-controlled areas rather than demanding access to children at risk, and they fear expulsion if they do so. Unofficially, they freely acknowledge that there are unvaccinated children in many parts of Syria.
Although jihadists are increasingly dominant in many opposition-controlled areas, when I revisited the Turkish border in late December they were not blocking Syrians from conducting the polio campaign or leading medical convoys. The recent abduction of five international workers for Doctors Without Borders and the execution of an activist Syrian doctor, apparently by the al-Qaeda-linked ISIS, raise valid concerns about the safety of international and national aid workers. But the ACU’s cross-border campaign to vaccinate 2.7 million children has been facilitated by the Free Syrian Army and the Islamic Front, a group of rebel militias that this month began attacking the ISIS. Hundreds of ACU employees across northeast Syria are conducting a door-to-door campaign, coordinated with local councils, villages, and municipalities, which began on January 2. The ACU negotiated permission from all opposition groups, including the ISIS and al-Nusra. When one campaign leader heading a convoy of doctors and vaccines was arrested on January 1 at an ISIS checkpoint in Aleppo, he was quickly released. “Even ISIS recognizes the radical threat of polio, getting us and vaccines across borders where the WHO cannot,” I was told by Khaled Almilaji, who is coordinating the campaign led by the Polio Task Force.
Parallel with the Syrian government’s efforts, the UN and WHO have mounted an effort in the neighboring countries to try to mitigate the spread of polio beyond Syria’s borders. The plan is to vaccinate 22 million children over the next six to eight months.10
But by ignoring the epicenter of the epidemic, the UN facilitates Assad’s forced-displacement strategy, creating an incentive for civilians in opposition-held areas to flee abroad, where the chances of protecting their children from both bombs and polio are greater. As asylum seekers and smuggled migrants spread across the region, they put other Middle Eastern countries and Europe at risk of polio. The flurry of international humanitarian activity away from the epicenter of the polio outbreak diverts attention from Assad’s other ongoing atrocities.
What would an effective response to the outbreak of polio in Syria look like?
First, vaccination is a critical component, if the substantial deficiencies in the government’s program are rectified, and the ACU is fully supported. Starting vaccination at birth is essential.
Second, adequate nutrition is urgently required both for effective uptake of the vaccine as well as to protect vulnerable children from succumbing to polio. Both the ACU and the Ministry of Health report that 40 percent of children afflicted by polio paralysis had been partially or completely vaccinated. This means either that the vaccine was not viable when administered or that vaccination cannot protect starving children. An effective response to polio has to include a vast increase in the quantity and quality of food delivered to all areas in need regardless of the military force controlling the local population, including besieged areas.
Third, clean water is essential. According to a UN study, 4.4 million Syrians lack safe and sufficient water for daily needs, and the situation has seriously worsened within the last month.11 Containing polio—not to mention preventing a comeback of cholera—requires decontaminating water, treating sewage, and restoring sanitation. (Removing the piles of trash all over the country, currently excellent breeding grounds for flies and other vectors of disease, would help considerably.) Clinical surveillance must be supplemented by environmental surveillance so that polio can be detected before children succumb to it, which requires unimpeded access by public health experts.
Fourth, children with polio must be treated. Syrian doctors and physical therapists are not familiar with polio, so they must be supported. Beds, splints, ventilators, oxygen, and a constant electricity supply must be put in place. WHO does not help when it claims on its website that “the only effective treatment is vaccination” or that polio causes “permanent paralysis within hours.” Neither is true, and the effect is to write off stricken children.
Fifth, the overcrowding of living quarters that has facilitated the rapid spread of contagious diseases must be addressed. Cold makes the effects of polio worse—tents should be replaced with solid structures.
Sixth, we must face reality: these vast essential needs will not be met by the Syrian government. And they will not be met if all international assistance must be channeled through Damascus. WHO, UNICEF, and other international agencies must be free to launch cross-border operations. But that will happen only if ordered by the UN Security Council. The current presidential statement only “urges” such cooperation—the most that Russia would allow, and so far not enough to convince Syria to cooperate. A UNSC resolution mandating cross-border aid is required.
Finally, the international community should stop pretending that mere vaccination is the answer. Nor should it accept the Syrian government’s efforts to pretend to be doing something to address the humanitarian needs of civilians in opposition-held areas while continuing its deliberate strategy—which amounts to a war crime—of making life as miserable as possible for the people living there. Rather than diverting attention from the regime’s war on civilians, the global threat posed by this polio epidemic provides the imperative for ending it.
—January 20, 2014
10 “Over 23 Million Children to Be Vaccinated in Mass Polio Immunization Campaign Across Middle East,” UNICEF and WHO joint press release, December 9, 2013. ↩
11 Syrian Integrated Needs Assessment, led by OCHA. ↩
The Truth About Polio in Syria March 6, 2014
“Over 23 Million Children to Be Vaccinated in Mass Polio Immunization Campaign Across Middle East,” UNICEF and WHO joint press release, December 9, 2013. ↩
Syrian Integrated Needs Assessment, led by OCHA. ↩