In Syria outbreak, polio exploits conflict once more

Reuters

* Polio virus often comes back in areas of poverty, unrest

* Refugee, nomadic populations hard to reach with vaccines

* Experts say focussed campaigns are crucial

By Kate Kelland, Health and Science Correspondent

LONDON, Oct 29 (Reuters) - With the world tantalisinglyclose to wiping out polio, conflict in Syria has allowed thecrippling disease to take hold again, putting at risk the restof the region as well as plans for global eradication.

War, unrest and poverty have often hindered the long fightagainst polio, but experts say these obstacles can be overcome,even in Syria where the highly contagious virus has takenadvantage of a fall in vaccination rates due to the fighting.

The key, according to Siddharth Chatterjee, a poliospecialist who has fought back the disease many times inconflict zones, is to banish politics from public health andfocus on saving children's lives. Polio can spread rapidly amongthose under the age of five.

"This is about the neutral, impartial, independent nature ofhealthcare," said Chatterjee, who is head of strategicpartnerships at the International Federation of Red Cross andRed Crescent Societies.

"You need to be talking to all the bad guys, all the goodguys, all the religious leaders, all the people who have anyform of influence on the community. It's about ensuring youdelineate politics from the child."

The polio outbreak in Syria, confirmed on Tuesday by theWorld Health Organisation (WHO), is depressingly similar toprevious resurgences in countries such as Sudan and Colombia,where the once eliminated virus exploited opportunities offeredby conflict and poverty to find its way back in.

HIGHLY CONTAGIOUS

Polio spreads easily from person to person. The WHO'sominous warning is that as long as any child remains infected,children everywhere are at risk.

Caused by a virus transmitted via contaminated food andwater, it can spread rapidly among children, especially in thekind of unsanitary conditions endured by displaced people inSyria or in crowded refugee camps in neighbouring countries.

But repeated and comprehensive immunisation programmes canand do beat the disease completely, as shown by the dramaticsuccess of the worldwide campaign to eradicate polio which hascut the global number of cases by 99.9 percent since 1985, from350,000 then to 223 last year.

Health groups said in April that a $5.5 billion vaccinationand monitoring plan could entirely rid the world of polio by2018, but recent outbreaks in Pakistan and Somalia, as well asthis latest reappearance in Syria, threaten that timetable.

Syria had not seen polio since 1999, according to the WHO,but its 2-1/2-year-old conflict, which began with popularprotests against President Bashar al-Assad before degeneratinginto civil war, has brought poverty, violence and displacementto many millions of people there.

And polio was not far behind. Syria's health ministry saidon Oct. 19 that 22 children in the country's north eastern Deiral-Zor province had become paralysed with polio-like symptoms.The WHO's Tunis laboratory has now isolated the polio virus insamples taken from 10 victims.

VACCINATION CAMPAIGNS

In Somalia, which had not had a case of polio for almost sixyears, the virus has also come back, exploiting conflict andpolitical unrest in areas that cannot be reached by governmentvaccination campaigns.

"It's very hard to reach nomadic populations ... even innormal circumstances," said John Rhodes, a vaccines andimmunology expert and the author of a book entitled The End ofPlagues.

"So when there is a conflict and certain areas become no-gozones for vaccination teams, it becomes very difficult indeed."

Chatterjee, a former Indian special forces officer whosurvived polio as a child, urged global public health officialsand donors to the fight against polio not to be defeatist,despite the disease's re-emergence.

"Even in a place like Syria, where we can see things havebecome very internecine, it is not impossible," he told Reuters."We've done it Darfur, we've done it in other parts of Sudan.Conflict certainly brings an additional challenge, but it's notimpossible to overcome."

To succeed, he said, engaging with health workers andcommunity volunteers on all sides of any political, ethnic orreligious divide is crucial.

"Ultimately you need to appeal to a person who may be aterrorist by others' estimations, and recognise that he islikely also to be a father, a brother, or have nieces or nephewswho may be under five and need health interventions," he said.

Bruce Aylward, the WHO's assistant director general forpolio emergencies, agreed that while a setback, the virus're-emergence in Syria was likely to be overcome by a determinedand well-equipped eradication campaign.

"These problems are always there in one form or another, inone place or another," he said. "Too often there is a sense 'wewill wait til the war ends, we will deal with it later' (butthis outbreak) forces you today to go in and deal with thedifficulties and challenges of reaching them."

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