A child receives a polio vaccine in Yemen.
Credit: Mohammed Huwais

Ten million young children in the Middle East will get a polio vaccine over the next several weeks in response to an outbreak in Syria, which had been free of the highly infectious, incurable disease for more than a dozen years. 

The United Nations announced the campaign last week after 22 children in Syria’s Deir al-Zor province became paralyzed. Ten cases have been confirmed as polio, which cripples and sometimes kills. Test results for the remaining 12 are expected within days. 

Under any circumstances, vaccinating 10 million people would require a lot of coordination and manpower. But in a country like Syria where civil war has mangled the health care system and driven millions from their homes, it’s a particularly tricky proposition.

GlobalPost spoke with Siddharth Chatterjee, head of strategic partnerships at the International Federation of Red Cross and Red Crescent Societies, about how such a campaign might work. Chatterjee, who is a polio survivor himself, has coordinated immunization campaigns in a number of unstable countries, including Somalia and Sudan.

“We have to push, push, push in order to get kids taken care of during periods of violence,” Chatterjee said. “But it can be done; I’ve seen it happen.”


Step 1: Rally local volunteers 

In times of turmoil, doctors flee and international aid organizations pull back. One solution, Chatterjee said, is investing in national organizations that use local volunteers.

The polio vaccine is given orally, rather than by shot, so it doesn’t require much medical expertise to administer, he said. Because they speak the language and are well connected in the community, local volunteers can get access to parts of the country where international health workers would be barred.

“Twenty-two of our volunteers have been killed since the conflict began two years ago, but that does not stop the work of the Syrian Arab Red Crescent,” Chatterjee said. “They are continuing to work because it's their country and they have nowhere else to go. It's their community. It's their children.”


Step 2: Negotiate a cease-fire 

Often, health workers are attacked because opposition forces see them as a symbol of the government, Chatterjee said. By targeting health workers, militants send the message, “Look, the government can’t protect you. You have to put your trust in us.”

NGO’s must work with all sides to establish “days of tranquility” where health workers can safely move through the community to administer vaccines. That could mean negotiating with politicians, religious leaders or warlords. 

“When it comes to children’s health,” Chatterjee said, “you have to get the politics out of the way.”


Step 3: Build a distribution network 

Two years ago, Syria had one of the world’s most advanced health systems, but war wreaks havoc on infrastructure. Production at Syria’s pharmaceutical factories, which once supplied more than 90 percent of the country’s drugs, had fallen by more than two-thirds by 2012, the World Health Organization reported. More than 300 of the country’s 520 ambulances have been damaged.

Health workers will have to get creative to distribute vaccines, Chatterjee said.

“In Somalia, we had to use helicopters to get the vaccines in,” he said. In Sudan, they loaded boxes of vaccines onto donkeys and camels and trotted them from village to village.


Step 4: Quarantine high-risk areas 

Before the war began in 2011, 95 percent of Syrian children were vaccinated against polio. National NGO’s like the Syrian Arab Red Crescent never stopped routine immunization campaigns, Chatterjee said. But pockets of extreme violence kept health workers from reaching an estimated 500,000 children.

“In these situations, people are mobile so it’s a little more tricky,” he said.

One strategy is to set up vaccination posts around the periphery of inaccessible areas so health workers can catch families as they move in and out.

“In some cases, the children may get immunized repeatedly, but so be it,” Chatterjee said.


Step 5: Work quickly

Polio, which spreads from person to person via contaminated food and water, is highly contagious — especially in the kind of unsanitary conditions common in crowded refugee camps. As such, in conflict areas, Chatterjee said, “It’s important to complete the campaign as quickly as possible so we can create a herd immunity.”

The World Health Organization ominously warns that as long as one child is infected, nobody is safe.

“Polio knows no boundaries,” Chatterjee said. “The virus in Syria traveled from Pakistan. The virus in Somalia came from Nigeria. The virus could even come to the United States.”


More from GlobalPost: Opinion: Poliovirus makes a comeback, and Israel is prepared

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