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PESHAWAR, Pakistan—When Salma Iqbal developed a high fever in July, her family didn’t think it was anything to worry about. Within two days, however, the alert, playful 9-month-old’s legs had gone limp.
The family rushed her to a clinic in the Bakhshu Pul area, a dusty suburb of Peshawar in northwestern Pakistan, where a doctor told them the little girl had been paralyzed by polio.
“We couldn’t believe it,” said Aqa Khan, her uncle. “We kept taking her to different doctors hoping for a different assessment until reality hit us.”
Salma is one of 202 children paralyzed by the polio virus in Pakistan this year, the most since the 199 recorded in 2000. There are nearly four times as many cases than during the same period last year, a jump that has prompted the government and its partners to formulate a new emergency plan for polio eradication, Pakistani government and United Nations officials said on Sunday.
“The stakes are now much higher,” said Elias Durry, the World Health Organization’s senior coordinator for polio eradication in Pakistan. “What we are looking for is not just a public-health effort but a national emergency in which everybody, once and for all, puts in everything the country can afford to get rid of the virus.”
In May, Pakistan put in place restrictions for people traveling to and from the country, making polio vaccinations mandatory after WHO termed the spread of polio an international emergency. The organization identified Pakistan, Cameroon and Syria as the countries from which the virus could spread.
“We are very cognizant of this issue, and are taking it very, very seriously,” said Ayesha Farooq, who leads Pakistani Prime Minister Nawaz Sharif ’s special polio-eradication cell. “We’re making efforts at all levels to ensure that the eradication efforts are successful.”
Pakistan, Afghanistan and Nigeria are the only countries where polio is considered endemic, but Pakistan accounts for 83% of all polio cases in the world, according to data from Sept. 25.
Nearly 90% of Pakistan’s cases are from the loosely governed, conflict-prone tribal areas that border Afghanistan, and the adjacent Khyber-Pakhtunkhwa province. The number of districts with polio has also increased this year to 23, compared with 16 last year.
Officials said the jump in the number of cases this year was driven by the displacement of hundreds of thousands of people by fighting the North Waziristan tribal region, after the government launched an offensive against militant groups based there.
The Pakistani Taliban and other powerful militant groups banned polio vaccinations in 2012, accusing health workers of spying for the U.S.
“There has been no vaccination campaign in North Waziristan since June 2012,” said Bilal Ahmed, who leads polio eradication efforts in the tribal areas and Khyber-Pakhtunkhwa province for Unicef.“So when a high-risk group like that moves, the risk of spread increases.”
Salma Iqbal, now a year old, had traveled to North Waziristan three times before the onset of paralysis in her legs in June. Her father, Iqbal Khan, runs a transport business with his brother Aqa Khan, and their families divide time between North Waziristan and Peshawar, the capital of Khyber-Pakhtunkhwa. Salma was never vaccinated for polio, the family said.“The situation in our area is very bad, because of all the fighting,” said Salma’s uncle Aqa Khan, as she sat near him at their house in Peshawar. “The last I remember any health teams coming to our native village in [North] Waziristan was over six years ago.”
The sudden influx of people from North Waziristan, however, is only one issue, officials and health workers say.
Many families continue to refuse vaccinations, citing religious, medical or security concerns.
In addition, polio vaccinators and their security escorts continue to be attacked. More than 60 vaccinators and security personnel have been killed during polio-eradication drives since 2011..
“There are some people who will not let us vaccinate their child because the cleric at the local mosque told them it is unlawful, or that it is designed to harm Muslims,” said a polio vaccinator in Peshawar. “We then bring the fatwas of the top scholars who have explained that it isn’t true, and try to convince them. We succeed around 50% of the time.”
High-risk communities in the Khyber-Pakhtunkhwa province and the tribal areas are mostly conservative, and men from outside the family aren’t allowed to meet women. Officials say the vaccination teams in these areas often lack a female member, and therefore can’t access many children.
Salma Iqbal’s family, however, has decided to help. Her 19-year-old cousin Shahid Khan signed up with the local polio vaccination team.
“When your own family suffers something like this, you look at things differently,” he said. “I don’t want other families to suffer this.”
http://online.wsj.com/articles/pakistan-reports-record-polio-cases-this-year-1412425596
