This article was originally posted by theÂ New York Times.
LONDON â€” Pakistanâ€™s polio crisis has reached new depths this year, health officials say, intensified by a deadly mix of ruthless militant violence, large-scale refugee displacement and political chaos that has cemented the countryâ€™s role as the central global incubator of a disease that other conflict-torn countries have managed to hold in check.
The number of new Pakistani polio cases this year hit 260 this week, four times as many as at the same point last year, making a mockery of promises by Prime Minister Nawaz Sharif and other politicians from across the spectrum to halt the galloping progress of the disease.
Even as domestic vaccination drives and extensive international aid have put huge numbers of anti-polio workers in the field, Pakistanâ€™s militants have seen it as an opportunity to strike at symbols of authority, portraying the workers as agents in a sinister Western plot. On Wednesday, four more health workers were gunned down, bringing the death toll among anti-polio workers to 65 since the first targeted attack in December 2012.
The attackers, who struck in Quetta, the capital of Baluchistan Province, opened fire on the workersâ€™ vehicle after demanding to know if they were involved in the anti-polio campaign. Television footage showed emergency workers carrying three other wounded workers from a van that contained abandoned slippers and blood-smeared iceboxes with polio vaccines.
The wounded, and three of the dead, were women, whose greater access to private households in conservative rural areas of Pakistan have put them in high demand as health workers.
The attackers escaped, and there was no claim of responsibility, although a Taliban splinter group said it had carried out a gun attack near Peshawar on Monday that wounded a polio worker and a student. Polio vaccinations are â€œdangerous to health and against Islam,â€ a spokesman for that group, Jamaat-e-Ahrar, said after the attack, echoing longstanding claims that Western countries are using immunization to sterilize Muslim children.
But the power of such conspiracy theories has been diminished by hundreds of millions of dollars in donations from Gulf countries and Islamic organizations toward the immunization campaign. Many here believe the militants simply see the attacks as another way to challenge authority. â€œItâ€™s not just polio â€” they want to disrupt all government activities,â€ said Aziz Memon, who leads Rotary Internationalâ€™s immunization efforts in Pakistan.
War and politics accelerated the surge in polio infections this year.
A sweeping military offensive against the Pakistani Taliban and other militant groups in the North Waziristan tribal district caused at least a million civilians to flee into neighboring areas and across the border into Afghanistan.
But few of the children in that outpouring of refugees had been immunized for polio, because vaccinators had been unable to reach the area, which for years has been the main target of American drone strikes. â€œIt wasnâ€™t even an underimmunized area; it was nonimmunized,â€ said Dr. Elias Durry, the World Health Organizationâ€™s polio coordinator in Pakistan.
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As fleeing families reached refugee camps and then often moved beyond, polio infection rates soared, and the virus spread to new areas, including the countryâ€™s largest city, Karachi. The number of districts infected by polio increased to 22 this year, from 10 before, and almost three quarters of the new cases came from the tribal districts of North Waziristan, South Waziristan and Khyber.
As the disease has spread, Pakistanâ€™s political leadership has been consumed by security crises and power games.
Much of the political chaos has centered on a high-stakes confrontation between Mr. Sharif and his political nemesis, Imran Khan, who since August has helped lead a protest rally in Islamabad that has demanded the prime ministerâ€™s resignation and brought the government to a standstill.
Mr. Khan and another protest leader, the cleric Muhammad Tahir-ul Qadri, have accused Mr. Sharif of corruption and ineptitude, even as they, in turn, have been accused of exploiting chaos for political gain. Mr. Khan intends to hold another rally in Islamabad on Sunday, offering the prospect of fresh political drama.
Meanwhile, political and sectarian violence has heightened in Karachi, in the Pakistani heartland of Punjab, and in war-torn Baluchistan Province.
The interlocking crises surrounding Pakistanâ€™s polio emergency have had another effect: acute embarrassment among many Pakistanis who, after years of seeking to shake off Western perceptions of their country as an incubator of global terrorism, now also find it painted as a global disease hub. Regulations introduced this year require air travelers from Pakistan of all ages to produce a certificate proving that they have been vaccinated for polio. One newspaper called the epidemic Pakistanâ€™s â€œbadge of shame.â€
In contrast, the other two countries where polio is endemic have recorded more modest infection rates. So far this year, Afghanistan has registered 21 new cases, many of which are a result of refugees fleeing Pakistan. And Nigeria, which is battling the Boko Haram insurgency and, more recently, a small outbreak of Ebola, has had just six cases.
Meanwhile, officials say Pakistan has exported the polio virus to China, Egypt and Syria â€” in some cases, experts believe, via militant families traveling to the battlefields of the Middle East.
In a bid to address the problem, Mr. Sharif last month constituted an emergency response committee and administered polio drops to children at a ceremony in Islamabad on Oct. 24. Immunization was an issue of â€œutmost importanceâ€ and the right of every Pakistani child, he said.
Mr. Sharif said he hoped that the health authorities and international donors could use the coming six months, considered to be the low season for polio transmission, to reverse the tide of infections. Experts say that, even if militant violence continues, immunization is still possible provided there are adequate security precautions. Since the first death of a polio worker two years ago, health workers have delivered 450 million doses of vaccine, said Dr. Durry of the W.H.O.
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In an interview, Mazhar Nisar Sheikh, a spokesman for the Health Ministry, said the virus was mostly being contained. â€œNinety percent of cases are limited to parts of the country where security has been compromised,â€ he said.
Still, Baluchistan Province offers a stark illustration of polioâ€™s resurgence. Baluchistan had been polio-free for two years until July, when it recorded a case in Kila Abdullah, a remote district on a route to South Waziristan.
Since then health officials have recorded another nine polio cases in the province â€” more than in Somalia, which has also suffered an outbreak this year. That caused health experts to start a targeted vaccination drive in 11 districts of Baluchistan this week, including the effort in Quetta, where the health workers were killed Wednesday.
Despite the dispiriting numbers and the violence, those at the forefront of immunization efforts in Pakistan say this is one battle the country cannot afford to lose.
â€œWe are committed,â€ said Mr. Memon, of Rotary International. â€œThe children of this country should walk, not crawl. We promised to end this, and we will.â€