16 March 2007
Gulalai, 45, a resident of Madabat village, 15 km east of Tarinkot, provincial capital of Afghanistan's central Oruzgan province would like to vaccinate her children against polio, but insecurity in the restive province has prevented health officials and volunteers from visiting her. Polio is endemic in Afghanistan (© Ali Mohammad Khoshal/IRIN)Tarinkot, Afghanistan:
Gulalai, 45, has always viewed the health of her children as a top priority and is not afraid to speak up about it. "It's been two years and still no one has come to vaccinate my children against polio," the mother-of-five told IRIN.
But living in the heartland of Afghanistan's Uruzgan province - where a growing anti-government insurgency has made vaccinations all but impossible - Gulalai has no illusions as to why.
"The vaccinators don't feel safe. They won't come and our children will suffer," she said from the town of Madabot, a dust-ridden community of 15,000 people just 15km from the provincial capital of Tarinkot.
Four other women in the area that IRIN interviewed echoed her view.
"People say the children in Tarinkot have been vaccinated, but unfortunately our children haven't," Moahboba, 28, said from the doorway of her simple mud brick home in Dorafshan, 20km northwest of Tarinkot. "The vaccinators do not come here because the security situation doesn't allow it."
Polio is a debilitating disease that mainly strikes children.
For polio vaccinators working on the frontlines of an emerging Taliban resurgence and earning just US $50 per month, the 15 or 20km trip from the provincial capital to outlying towns and villages is too much of a risk to take.
"While I was traveling to Tarinkot, the Taliban stopped my bus and forced me outside," said Hamdullah, a government polio vaccinator who was beaten and harassed on 16 February while on duty.
"They slapped my face. They held me for eight hours before releasing me," the 35-year-old said. "They made me promise that I would not vaccinate any more children – threatening to kill me if I did."Aid workers threatened
The Taliban have long eyed aid workers with suspicion, suspecting them to be collaborating with Western military forces. Aid workers have repeatedly been warned and threatened to leave the country or face the consequences. "If they won't stop their work, we will target them, like we've targeted them in the past," said Qari Yousef Ahmadi, purportedly a Taliban spokesman, to the Associated Press late last year.
Threats of violence are having a serious impact on Afghanistan's overall polio eradication efforts.
According to the World Health Organization (WHO), Afghanistan had a severe polio outbreak in 2006, largely because of conflict in the south severely impeding access to children during immunisation rounds.
Health specialists agree that eradicating the polio virus is no longer a technical issue only. Polio eradication hinges on vaccine supply, the outlook of the local community, funding and, most of all, support from political leaders at all levels.
While the first three points are essentially in place in Afghanistan, getting support from political leaders will prove key to the success of a polio eradication campaign, specialists say.
Afghanistan, India, Pakistan and Nigeria are the four countries worldwide where polio remains endemic, according to the WHO.
Impact of insecurity
Specialists say the transmission of the virus continues to take place in areas where insecurity is high as large immunity gaps among young children exist.
To control outbreaks and interrupt transmission, vaccinators need to reach all children everywhere through high-quality vaccination campaigns, with a particular focus on children in border areas and in mobile populations.
Of the 31 confirmed cases of polio in Afghanistan in 2006, 29 occurred in rural areas of the south – designated by UN security officials as "very high risk areas".
The WHO estimates that in 2006 alone, vaccinators were unable to access an estimated 125,000 children in the south and south-eastern regions of the country due to insecurity.
Of this number, about 75,000 were in the southern provinces of Helmand, Kandahar, Uruzgan, Zabul and Nimruz, and 50,000 in the south-eastern provinces of Paktia, Paktika, Khost and Ghazni.
"Security is the primary challenge we face in successfully eradicating polio from Afghanistan today," Dr Tahir Pervaiz Mir, head of WHO's polio eradication drive in Afghanistan, told IRIN in Kabul.
Each year, WHO, in collaboration with the UN children's agency, UNICEF, and the Afghan health ministry, initiates four national immunisation drives (NIDs) and has additional sub-national immunisation drives in the areas deemed to be at particularly high risk.
Supplementary rounds generally carried out in January and February annually in the south – 10 in 2006 alone - have proven especially difficult for vaccinators. "During the February vaccination rounds, our teams were not able to access around 100,000 children in the southern region because of insecurity," Mir noted.
Echoing Mir's concern on the impact insecurity was having, Saifudin Khan, a health officer for Urozgan's provincial health department, said, "We have not been able to carry out any vaccinations in areas like Dorafshan, Madabot and Charmestan because of the security situation. When any of our volunteers go to these areas, the Taliban destroy their tools and threaten to kill them."