Polio attacks — Pakistan’s future under threat

It is difficult to see how health work and politics can be decoupled after the damaging incidents of the last decade.

The murder of nine health workers this past week was shocking even by Pakistan’s standards. Six women and three men were shot dead by militants as they tried to administer polio drops to children. Four women were shot in Karachi on December 17 by gunmen on motorbikes. At almost the same time, a teenage volunteer was killed in a coordinated attack in Peshawar. On December 19, a woman and her driver were killed in Charsadda. On the same day, a man was shot in Peshawar, dying of his injuries a day later. All were taking part in a three-day vaccination drive. Run by the UN, it was aimed at eliminating polio from Pakistan, which along with Nigeria and Afghanistan, is one of the last countries in the world where the disease still exists.

The World Health Organisation has temporarily suspended the vaccination programme because the government is unable to provide security to the tens of thousands of health workers involved. It is unclear when it will resume. This is a particular tragedy given the fact that such a huge progress has been made towards eliminating polio in the last 12 months. Pakistan had 20,000 polio cases in 1994, a number which has been reduced to just 56 in 2012, after years of vigorous vaccination efforts. Health experts say that the disease, which can paralyse or kill within minutes, could be eradicated from Pakistan altogether with a final push.

Although the Taliban have denied responsibility for these attacks, they have been responsible for spreading misinformation about the polio programme, saying that it is a Western plot to sterilise Muslim children. This toxic message has been spread on the radio across the tribal areas — where about 69 per cent of Pakistan’s polio cases are reported — and Khyber-Pakhtunkwa, home to a further 24 per cent. These are the areas which most urgently need the vaccinations.

It is easy to see why people believe what the Taliban say, given the fake hepatitis drive in Abbottabad last year. With the help of a Pakistani doctor, the US used the cover of a vaccination programme to obtain DNA from members of Osama bin Laden’s family in the run-up to his assassination. The incident, which has led to a distrust of the very concept of vaccinations, is evidence that politicising medical work is an incredibly dangerous game.

Aid work and healthcare have to be neutral and apolitical or they cannot function effectively. This is a fundamental, universal principle. Militants, state, military, and foreign governments share culpability for the way in which this neutrality has eroded in Pakistan.

Even in the aftermath of the deaths, the politicisation of the polio drive has not stopped. Interviewed by the BBC about the attacks, the Jamaat-e-Islami’s secretary general, Liaquat Baloch, asked why so much attention was being given to this when drone attacks were killing people every day. Mentioning drone strikes to justify an ever-expanding range of atrocities surely qualifies as the Pakistani equivalent of Godwin’s law (which states that any internet discussion will always end with someone mentioning Hitler). On a serious note, it echoes the Taliban’s own statement that they would allow the polio programme to continue only when US drone strikes ended. The deaths of children and other civilians at the hands of unmanned aircraft is certainly a grave tragedy, but is it really helped by allowing other children to be paralysed or killed by a preventable disease?

The politicisation of medicine goes far beyond these latest attacks. “There has been a series of events where aid and medical action in particular has been manipulated for political or military reasons,” says Médecins Sans Frontières operations coordinator Chris Lockyar. “That creates a distrust of that action of delivering aid which is provided on a neutral basis.”

Indeed, for many years, much needed humanitarian aid in Pakistan has been manipulated or restricted by internal and external military and political objectives. On the one hand, the Pakistani military has, at times, controlled humanitarian assistance and, on the other, donor countries such as the US or Europe have deliberately used aid as a way of  ‘stabilising’ areas that they see as strategically important. During the devastating floods in 2010, I remember being shocked at the ad campaigns in the UK, which focused not on the humanitarian crisis, but on the need to secure the area so that terrorists could not take hold. US Secretary of State Hillary Clinton made the link between development work and security concerns explicit when she said that it was “central to advancing American interests”. These obvious alternative agendas understandably foster suspicion towards foreign assistance among many Pakistanis, creating a situation where militants are easily able to exploit existing sentiments among the population. It also means that even apolitical and much-needed medical programmes are tarred with the same brush. The attacks on the polio drive — aimed only at preventing children from being paralysed — are evidence of just that.

So, what comes next? Targeting misinformation is the first step. Yet, a government campaign encouraging people to get vaccinated, backed by celebrities like Shahid Afridi, apparently did not have the desired effect. Trusted people within communities — religious leaders and village elders — must step up and speak out against militant propaganda on a wider scale than they already have. As the World Health Organisation pointed out, much of this programme was actually funded by the Islamic world, not the West.

More widely, it is difficult to see how health work and politics can be decoupled after the incredibly damaging incidents and rhetoric of the last decade — dating back to the Iraq War, when the US disastrously described humanitarian groups as ‘soft power’, undermining their independent, neutral role. It would take a serious and concerted effort from national and international governments, the military and local communities to change the public perception. But if this were done, it would prevent essential medicine from being a political football and undermine the potency of Taliban propaganda. If the bloodshed of last week is to mean anything, let it be steps towards that end.

Published in The Express Tribune, December 24^th, 2012.