GAZIANTEP, Turkey — Despite grave danger, a campaign to combat the spread of polio in rebel-held Syria has been surprisingly successful, with volunteers inoculating about 1.4 million children since the beginning of the year.
The reemergence of polio in Syria in October alarmed health organizations, which feared that factors such as tainted water, dysfunctional sanitation systems and a mobile population could contribute to a broader, region-wide epidemic.
In response, a coalition of nonprofit organizations quickly recruited and deployed thousands of volunteers in the country’s embattled north, where they won the cooperation of rebel fighters and braved shelling and airstrikes to administer the vaccine to children under age 5. Four volunteers have been killed in the process, but there has not been a confirmed case of polio in Syria in nearly five months.
“Implementing the campaign is not hard from a medical standpoint. It’s two drops in the mouth,” said Abd al-Rizzaq Darweesh, a doctor working in the northern city of Aleppo. “The difficulty is primarily the war.”
Since the identification of the first case in the northeastern province of Deir al-Zour, 35 more cases of the highly contagious disease were confirmed in Syria, according to the Global Polio Eradication Initiative. The infection had not been seen in the country since 1999, and Pakistan, Afghanistan and Nigeria were thought to be among the last bastions of the infamous disease.
“Everyone was shocked,” said Tamer Hassan, the Turkey country director for the Syrian American Medical Society (SAMS), one of a handful of organizations involved in the campaign. And, Tamer said, the urgent question became: “What to do?”
The answer, many of those involved in the response said, was clear: As many children as possible needed to be vaccinated. After the first Syria case was discovered, UNICEF and its partners launched what they call the biggest immunization campaign in Middle Eastern history — one that they say has reached 25 million children in seven countries.
But the U.N. agency had limited access to northern Syria. So last fall, a group of small, Syria-oriented organizations formed the ad-hoc Polio Control Task Force.
Headquartered in southern Turkey, the coalition includes SAMS, the opposition-linked Assistance Coordination Unit (ACU) and about half a dozen other groups. It is supported by a patchwork of local organizations, international aid groups and foreign governments.
Task force officials said they started by recruiting and training low-paid volunteers, many drawn from a network of opposition doctors and activists that had been built over more than three years of uprising and war in Syria. The group rapidly grew to more than 8,000 strong, almost all based inside Syria or traveling there regularly.
“They are the heroes of this campaign,” said Bashir Taj al-Din, a technical coordinator at the ACU and the current head of the polio task force. About half of the training — mostly for supervisors and administrators — was done in next-door Turkey, while shorter sessions for less-experienced vaccinators were held at the local level in Syria.
After receiving vaccines from the Turkish Red Crescent at the Syrian border, the task force transports them to a web of storage hubs, health clinics and, ultimately, volunteers in the seven accessible northern provinces where they work.
The volunteers have faced shells, barrel bombs and snipers. Four were killed, including Mohammed Kalaaji, 19, a vaccinator in a particularly restive district of Aleppo.
The vaccination teams work in pairs: one vaccinator, like Kalaaji, and one record-keeper. Donning official task force jackets or armbands and carrying ice-filled coolers packed with vials of the vaccine, they go house to house, often on foot. Then they go back at later dates — each child needs at least three doses of the vaccine for it to be effective.
During the second round of vaccination, which started in late January, the use of barrel bombs increased markedly in Aleppo, Darweesh said as he recounted Kalaaji’s story. After administering a dose, Kalaaji left his partner to mark the child’s finger and the door of the house — a standard practice meant to keep track of vaccinated children. When he walked into the street, a barrel bomb exploded at his feet, fatally wounding him.
“Of course I’m scared. All of us are scared,” Darweesh said in an interview in Gaziantep, Turkey. “But there’s a job that needs to be done.”
This month, the task force completed the sixth of eight scheduled rounds of vaccination meant to maximize coverage across northern Syria. The task force says it has reached about 1.4 million of the estimated 1.5 million children targeted for inoculation in the areas it covers.
The Syria campaign has proceeded very differently from similar efforts in Pakistan, where polio vaccination has come up against intense social, religious and political backlash. Doctors running the campaign in Syria said that although rumors that the vaccine causes AIDS, impotence or other maladies initially circulated, those appear to have subsided.
The doctors also said the opposition factions fighting in northern Syria have been generally cooperative. The use of local staffers has helped the task force navigate among armed actors, from the moderate Free Syrian Army to the al-Qaeda-inspired Islamic State of Iraq and Syria (ISIS), which has launched a violent sweep across Iraq in recent days.
Darweesh said ISIS fighters have, for the most part, not interfered in the effort. Though there have been a few instances in which task force members have been kidnapped or detained, Darweesh added that many fighters have had their own children vaccinated. Moreover, some armed groups, though not ISIS, go out of their way to help task force members find safe passage or, in areas where rebels are more trusted than doctors, convince reluctant citizens that the vaccine is safe.
“Even fighters have children,” Taj al-Din said.
But the battle against polio in Syria and the region is far from over. Last month, a second case of polio was confirmed in Iraq, where the ISIS advance has created hundreds of thousands of refugees. The World Health Organization declared the spread of polio a “Public Health Emergency of International Concern.”
Complicating the effort in Syria is the fact that a majority of children live in regime-controlled areas and so are dependent on the government or the Syrian Arab Red Crescent for vaccinations. A UNICEF spokesman said a Damascus-led anti-polio campaign has reached 2.9 million children, though the agency notes that independent monitoring has been limited because of the conflict.
Both UNICEF and the task force estimate that as many as 400,000 children in besieged and hard-to-reach areas of Syria are still in need of vaccination.
“Was [the task force’s campaign] successful in reaching a great deal of kids? Yes, for sure,” said Annie Sparrow, a public health specialist at Mount Sinai Hospital in New York and the author of a New York Review of Books article about the polio outbreak in Syria. “Has it stopped the transmission of polio? You can’t say that.”