海角大神

Syria was declared polio free in 1999. But with at least 10 recent confirmed cases of the paralyzing virus, international health workers are worried about a regional outbreak of the virus, particularly given the constant flow of Syrians to neighboring countries.

Before the Syrian uprising began in March 2011, the vaccination rate in Syria was above 90 percent, bolstered by a relatively strong public health system. But after almost three years of violent and destructive civil conflict, that figure has dropped to 68 percent. Most unvaccinated children are under two years old, making them particularly vulnerable to polio, which is usually spread through fecal matter.

Preliminary evidence shows that the polio virus now spreading in Syria originated in Pakistan, according to the United Nations Children's Fund (UNICEF). Similar strains have been detected in Egypt, Israel, the West Bank and Gaza Strip and some speculate it was brought by foreign fighters and jihadis who have been pouring into the country as refugees flee.

The fears have spurred a regional vaccination campaign. Doctors and nurses are giving polio vaccinations to every child registered with the United Nations in Syria's neighbors, which now host 2.2 million Syrian refugees.

The UN program is the largest immunization response ever in the Middle East and will target children in seven countries and territories: Syria, Iraq, Egypt, Turkey, Lebanon, Jordan, and the Palestinian Territories. More than 20 million children will be vaccinated.

Last week, at a UNHCR mobile clinic on the outskirts of Tripoli, Dr. Salam El-Ghamrawi squeezed pink liquid into the mouths of young Syrian children as dozens of families lined up outside.

鈥淚n Lebanon we vaccinated everyone. In Syria it was the same before聽the war. Everyone was vaccinated,鈥� says Dr. El-Ghamrawi, a Lebanese聽doctor working with the government.

Thousands of Syrians are crossing into neighboring countries聽each month, bringing with them the threat of polio and other聽diseases鈥攊ncluding measles, mumps and chicken pox. Vaccination聽stations have been set up at the borders to vaccinate upon entry. But聽reaching the thousands of children already inside these countries is聽proving a major challenge, especially because the vaccine needs to be聽administered in three doses at one-month intervals to be effective.

鈥淲e have teams that are going from home to home,鈥� says Wafaa Kanaan, a聽coordinator with Lebanon鈥檚 Ministry of Public Health, as she聽supervises vaccinations at a primary school in Beirut. In urban聽centers Lebanese children are being reached through schools and聽community organizations, but in rural areas public health workers are聽going door to door and tent to tent.

Lebanon has committed to vaccinating every child under five on聽Lebanese soil, regardless of nationality 鈥� an estimated 750,000聽children in total.
鈥淲e are a very risky country because displaced Syrians are entering聽everyday, so we are afraid the virus is coming here,鈥� says Ms. Kanaan.

Lebanon is now hosting more than 1 million Syrians in 1,600 informal聽camps and settlements across the country. While Syrians are being聽vaccinated in official refugees camps in Jordan and Turkey, the聽Lebanese government has prohibited UNHCR from setting up formal camps,聽making it difficult to locate and vaccinate all children.

鈥淚f you talk about the camps in Jordan or Turkey, it鈥檚 easier,鈥� says聽Azzeddine Zeroual, a UNICEF employee who is helping to coordinate the vaccination effort with UNICEF in Lebanon. 鈥淚n Lebanon we have hundreds of informal settlements and there is no access to health care, no access to sanitation. Here, we are using mobile clinics to reach them and minimize the risk.鈥�

Vaccinating children in Syria itself, where President Bashar al-Assad鈥檚 military continues to battle the opposition, will be especially challenging.

鈥淭his is not an easy mission,鈥� said Dr. Fouad Fouad, a Syrian epidemiologist and public health expert originally from Aleppo and currently teaching at the American University of Beirut. 鈥淭here are so many challenges 鈥� lack of transport, lack of human resources, working in heavy conflict areas.鈥�

The outbreak鈥檚 center, Deir ez-Zor province, is one of the most contested and violent regions in the country. 鈥淲hat we really need is an agreement between the fighters so we can reach every inch of Syrian soil,鈥� said Dr. Fouad.

UNICEF plans to buy 1.7 billion doses of the polio vaccine, which costs only pennies.

鈥淎t the end, it鈥檚 not the cost of the vaccine, but the logistics of how to reach every child,鈥� Dr. Fouad. 聽鈥淭his is the challenge all these authorities are facing.鈥�