Wild polio is now confirmed to have returned to war-torn Syria, raising questions about whether it arrived through foreign fighters who joined the insurgency against the government of President Bashar al-Assad.
The World Health Organization said on Tuesday that the wild poliovirus type 1 has been identified in 10 patients, mostly children, in northeastern Syria.
The 10 confirmations came from a cluster of 22 people showing paralysis in one or more limbs who were detected in Deir el-Zour, an eastern province partly held by rebel forces and heavily affected by fighting.
The news comes after the WHO confirmed in February that the polio virus that had been found in sewage samples in two areas of greater Cairo was closely related to a strain from northern Sindh province in Pakistan.
The virus was also isolated this year in sewage samples collected in Israel, the West Bank and the Gaza Strip.
Since a massive worldwide eradication campaign began in 1988, the crippling illness remains endemic in only three countries: Afghanistan, Nigeria and Pakistan.
Final genetic sequencing lab tests are being done to determine the source of the virus found in Syria.
“The exact source would need to be looked at, but originally it would have come from one of those three countries,” Oliver Rosenbauer, a spokesman of the WHO polio eradication programmem, said in an interview from Geneva.
Polio is a highly infectious disease that is spread from person to person and through contaminated food and water.
The illness, which can cause permanent paralysis, had not been detected in Syria since 1999.
The confirmed cases in Syria involved mostly children under two years of age who had not been vaccinated properly because of the two-year uprising, the WHO said, noting that estimated immunization rates in the country declined to 68 per cent last year from 91 per cent in 2010.
“Diseases, including those easily preventable by basic hygiene and vaccination, are spreading at an alarming rate,” United Nations humanitarian chief Valerie Amos told the Security Council on Friday in a briefing about the Syrian crisis.
She said 2.5 million people in Syria remain beyond the reach of relief workers because of the fighting, the threat of kidnappings and bureaucratic hurdles from the Assad government. “Words, despite their ability to shock, cannot really paint a picture of the grim and gruesome reality of Syria today,” she said.
The latest setback occurred at a time when progress was being recorded in endemic areas, Mr. Rosenbauer noted. “In all three endemic countries, there’s been a lot of progress that’s being made and more children are being reached.”
In Pakistan, some previously affected areas, such as Karachi, the capital of Sindh province, and some districts of Balochistan province, now seem to be polio-free, Mr. Rosenbauer said.
However, the challenge remains in the Federally Administered Tribal Areas, a Taliban stronghold in the northwest of the country. “That’s really the engine of polio virus transmission at the moment,” Mr. Rosenbauer said. “The challenge is access. … There’s a ban on immunization by local leaders. The children are not being able to be vaccinated.”
Taliban bans against immunization have portrayed vaccination drives as foreign-funded endeavours and health workers as foreign spies.
A senior Taliban leader, Hafiz Gul Bahadur, issued a decree in June, 2012, banning anti-polio drives until U.S. drone strikes stopped. The decree also mentioned Shakil Afridi, a Pakistani doctor whom the Central Intelligence Agency paid to run a hepatitis vaccination project that was actually a front for the hunt for al-Qaeda leader Osama bin Laden.
Last December, six health workers involved in polio vaccination were killed in various locations in Pakistan.
However, Mr. Rosenbauer said Dr. Afridi’s case had had a limited impact. “We do get asked a lot of tough questions by parents, but it tends not to be about that issue.”
He alluded to a study showing that less than 2 per cent of parents in most high-risk Pakistani areas consistently refuse vaccination. “In Germany, where I am from, resistance is about 6 or 7 per cent.”
Poor sanitation and logistical challenges are bigger factors that explain the resiliency of polio in Pakistan, he said.