A new report from UNICEF, the children’s aid branch of the United Nations, says that polio vaccination coverage in Syria has dropped from 99 percent before the crisis to just 52 percent, as a large part of the country remains under siege or in the line of fire.
The organization recommends that children still inside Syria – classified as a high-risk area for polio – receive six vaccinations in a row, one per month, and that those in neighboring countries be administered three of them. It cites several major factors for the low figure: disruption of routine immunization; the damage or loss of vaccination supplies and service vehicles; ongoing mass displacement, and increasingly poor hygiene in refugee camps and other communal living centers.
We asked UNICEF’s Middle East Regional Officer Juliette Touma to explain the state of the polio outbreak.
Syria Deeply: How widespread is the problem of inadequate vaccination?
Juliette Touma: The number of vaccinated is down to 52 percent. It’s related to why polio has returned to the region. The inability to properly vaccinate is mostly due to the ongoing violence – it’s the root cause for all the problems that Syria’s children now face. With the violence came the inability to do routine vaccinations on children. We’re also dealing with damage to the health infrastructure inside Syria, where a lot of hospitals cannot be used anymore – they have been damaged or destroyed. A lot of health workers and paramedics have fled or been killed or displaced.
Syria Deeply: Why is polio returning to Syria?
Touma: A cause of the appearance of polio is in part due to a mass population movement from one place to another. Sometimes the conditions are not hygienic where the refugees live. These have been the key factors. There have been a large number of vaccinations missed, and displacement is a huge [part of that]. We are talking about more than 3 million children displaced inside Syria, and a number of routine medical services that were once provided – including vaccinations for polio – have been obstructed.
We have 765,000 children in Syria under age five, which is the key target group for polio vaccinations. These are children who haven’t been reached on a regular basis. We might have reached them once or twice, or other times not at all. It’s not enough. We need to reach them six times, one month after the other, so we make sure that they are properly vaccinated.
This is a reason why we need a commitment from all parties in the conflict to allow our teams to carry out the vaccinations in all areas of the country. The vaccine works sometimes if it hasn’t been administered six times, but it’s better to be 100 percent sure that your kid does not get infected – six times is what’s recommended inside Syria, because we consider it “primary outbreak” country. And three times for children outside Syria, which is classified as a “risk-reduction” area.
Syria Deeply: What are the hardest-to-reach areas?
Touma: Sometimes, the medical teams have to cross as many as 50 checkpoints to reach the children, and other times they have to do things like get on small boats to cross rivers because [the bridges have been blown out] and there is no way to reach the other side of the river. They’re polio warriors, really. These include areas under siege and in the line of fire, including parts of Aleppo and also Idlib, Deir Ezzor and Deira. What we hope for in the second phase is to reach these children in whatever way possible, and to reach them more than once.
Syria Deeply: How concerned is UNICEF about a widespread polio outbreak in Syria?
Touma: Polio was announced in May as a global health emergency. The risk is still there, but what we are working towards doing right now is to continue with phase two of the vaccination campaign. Starting in the coming weeks, we’ll be giving vaccinations to 25 million children [in the region] from now until the end of the year – six times inside Syria and in Iraq, and three times outside of Syria. It’s a huge undertaking. We’re reaching millions of children under age five, spread around a region going through lots of turmoil. For this, we coordinate with the World Health Organization and with local partners on the ground including ministries of health.