Insecurity, virus sees polio cases rise in Afghanistan

Afghanistan is trying to inoculate millions of children against polio after pandemic lockdowns stalled the effort to eradicate the crippling disease. Since 2010, the country has been carrying out regular inoculation campaigns in which workers go door to door, giving the vaccine to children. Most of the workers are women, since they can get better access to mothers and children.

Authorities say nearly ten million children are now in need of vaccination against polio. Of those, authorities are unable to reach some three million children living in areas under the control of Taliban insurgents. The first round of inoculations was carried out earlier this year, and a second was launched March 29.

During the four-day second round of vaccination, more than 6 million children were vaccinated, according to Health Ministry spokesman Ghulam Dastagir Nazari. Afghanistan and Pakistan are the only two countries in the world where polio is still endemic, and both have seen a disturbing increase in cases in recent years. In Afghanistan, 56 new cases were reported in 2020, the highest number since 2011, when 80 cases were registered.

Merjan Rasekh, Head of polio public awareness of Afghan Health Ministry said, the numbers increased as anti-polio vaccination campaigns were halted in 2020 due to coronavirus pandemic and lack of security in some parts of the country. "Insecurity and coronavirus pandemic caused the increasing number of polio cases in Afghanistan, in 2020 we have registered 56 cases of polio type 1 and more than 300 cases of polio type 2 in Afghanistan," said Rasekh.

This year's polio vaccination campaign claimed lives of three female vaccinators, after they were killed in two separated attacks on March 30 as they carried out a door-to-door vaccinations in the eastern city of Jalalabad. The incident points the dangers facing the campaign as turmoil grows in the country. It was the first time that vaccination workers have been killed in a decade of door-to-door inoculations against the crippling children's disease in Afghanistan. Such attacks have been more common in neighbouring Pakistan, where at least 70 vaccinators and security personnel connected to vaccination campaigns have been killed since 2011.

Rasekh, said the killings of the three vaccinators was "painful." He also added that a continuation of such incidents can demoralize health workers, especially female vaccinators. "If this situation continues, it will definitely have negative impact on the morale of our health workers, especially the female health workers," said Rasekh. Adela Mohammadi, a vaccination worker in Kabul, said her parents didn't want her to go out to do inoculations on the day after the three women were killed in Jalalabad.

But despite, all the problems she walks door-to-door to vaccinate children. "During the campaigns we do face many problems and challenges, but still, I can't leave this job I am a volunteer, and I must serve my people. I can't do much, but this is the least I can do to serve my people," said Adela. Mohammadi has been participating in door-to-door campaigns for the past three years. She works in somewhat better educated parts of the capital, and most families she approaches allow their children to be given a dose. Public worries over the coronavirus and eagerness for treatment have made some more open to polio vaccinations, she said.

Still, she regularly faces sometimes angry resistance from some families who claim vaccines are forbidden by religion or harm children. "There are families who don't even open their gates for us, they just shout, if we don't leave, they will come out and beat us," said Adela.

The violence adds a new worry as Afghanistan struggles to stamp out a disease that has largely been eliminated around the world. But the young women at the forefront of the vaccination drive said it must continue. "If we are afraid and don't go out to vaccinate, our children and all of us will face problems," said Shabana Maani. The continued impact of polio can be seen at the International Committee of the Red Cross' Orthopedic Program in Afghanistan. It mainly provides artificial legs to the many wounded in war or by roadside bombs or mines. But it also offers services to anyone with mobility issues - including people affected by polio.

Shoaib Meskenyar, a polio victim, is working to make orthotic devices for polio patients at ICRC orthopaedic center in Kabul since 2012, he is paralyzed from right leg for the last 28 years after he was diagnosed with polio during civil war in early 90s. Meskenyar said he was happy to be able to help people with disabilities caused by polio, "I am very happy that with the job I do I can help someone like myself, or a polio victim. Because if not much can be done with my help, at least they will be able to go to their jobs and if the victim is a child, he will be able to go to school," said Meskenyar.

In Afghanistan's deeply conservative society, traumatized by decades of war, some are suspicious, viewing inoculations as a Western trick. In 2020, nearly 5,000 polio patients received treatment, including physiotherapy, medical equipment and orthopaedic devices at seven ICRC orthopaedic centres operating in Kabul, Herat, Balkh, Nangarhar, Parwan, Badakhshan and Helmand provinces.

Maiwa Gul, a polio patient from eastern Khost province, was at the center on a recent day getting repairs in the leg orthoses that he needs to walk. He urged that all children be vaccination. "Otherwise, they will eventually be in my position, needing someone to help them."

In Pakistan, officials have struggled to overcome deep public suspicion over vaccines particularly since the U.S. used a fake vaccination campaign to unearth the hideout of al-Qaida leader Osama bin Laden. Hard-line clerics and militants have stoked the fears by depicting polio vaccinations as a Western plot to sterilize Muslim children.

In Afghanistan, some have also been suspicious of vaccinations, but that rarely if ever translated into violence. The new killings appear to reflect the disturbing rise in chaos the past year, when the country has seen increasing targeted killings, sometimes of professionals or educated classes, sometimes just seemingly at random. The Islamic State group has claimed responsibility for some of the violence. But the authors of many attacks remain unknown, including the killings of the vaccination workers. 

Image Credits: AP