The World Health Organization has declared a polio emergency in Syria.
After being free of the crippling disease for more than a decade, Syria recorded 10 confirmed cases of polio in October. Now the outbreak has grown to 17 confirmed cases, the WHO said last week. And the virus has spread to four cities, including a war-torn suburb near the capital of Damascus.
The Syrian government has pledged to immunize all Syrian children under age 5. But wartime politics is getting in the way. And the outbreak is expected to grow.
"Actually, it is spreading quickly," says Dr. Mohammed Al Saad in Gaziantep, Turkey, near the northern border of Syria. There are now more than 60 suspected cases, he says, with new ones reported each day.
Most cases have occurred in children less than 2 years old, who were born in Syria after the war started and missed their routine vaccinations, he says.
Saad is part of an early-warning medical team with the Syrian opposition that monitors rebel-held areas. The group, called the EWARN team, is working with the U.S. Centers for Disease Control and Prevention in Atlanta. It was the team that first raised the alarm after discovering polio cases in the province of Dier ez-Zor.
Now the medical group is gearing up for a mass vaccination campaign in northern Syria a short drive across the Turkish border.
The goal of this polio task force is to immunize children in rebel areas. The communities there have been decimated by shelling and bombs. They have no electricity, clean water or functioning sewage treatment.
These are places where children are at greatest risk, says the leader of the task force, Dr. Bashir. (He asked us not to use his last name for security reasons.) "Our target is to train about 8,000 people for the door-to-door polio campaign," he says.
Mass immunization is the only way to contain the outbreak. The fastest way to reach kids is to cross the border from Turkey. But that raises a political problem for United Nations agencies in charge of the vaccinations.
Requests to the U.N. for vaccines have been in vain, Bashir says. "Until now they didn't promise they could provide us with vaccine for our children."
Delivery from any U.N. agency is not likely. That's because the U.N. is only authorized to operate through sovereign states, meaning it delivers all humanitarian aid through the central government in Damascus. And last month, the Syrian regime said no to a U.N. Security Council statement urging cross-border aid.
UNICEF's vaccination program is based in Damascus. Reaching children in rebel areas is a challenge, says UNICEF spokeswoman Juliette Touma. "In the past couple of years, we were not able to reach more than half a million children because of access restrictions," she says. "And this could explain why we have polio inside Syria."
Only after the outbreak was confirmed did the Syrian regime pledge to vaccinate all Syrian children. Now some vaccines are getting to rebel areas. After negotiations with the regime and the rebels, about 180,000 doses arrived in Dier ez-Zor, where the first cases were reported, Touma says.
There is no other way to deliver humanitarian assistance than to deal with all parties of the conflict. Touma says that UNICEF has been able to do that.
But doctors on the opposition's Polio Task Force charge that the Damascus based program is not reaching all the vulnerable children in rebel areas. Dr. Khaled Almilaji says the virus is spreading faster in rebel areas, where millions of people are displaced and living in dire conditions, he says. Families are drinking directly from the rivers, dependent on contaminated water, which can carry the virus.
"We are sure that the people in Dier ez-Zor [and] some villages don't know about the polio, actually," Almilaji says. "Do they know they have to take the vaccines?"
A door-to-door campaign is now key to families with children at risk, he says. "This is a disease. This is not politics."
International aid workers are calling for great pressure on the Syrian regime to allow a route from Turkey to northern Syria for vaccinators.
The polio cases are alarming, says Mary Ana McGlasson, a registered nurse who is now working on humanitarian efforts in Syria. "Humanitarian aid, in general, throughout large parts of Syria is not functioning," she says. "And I think that the polio epidemic and the vaccination campaign is one symptom of many."
The return of this crippling disease and the response, she says, are a sign that the international aid system is failing Syria's children. "My anger is directed at all parties to the conflict that are slowing down humanitarian aid even by a fraction," McGlasson says. "It's children caught in the middle of that who are suffering, and that's tragic to me."
Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.
Update at 10:32 p.m. ET. Vaccine Airlifted Into Syria:
The U.N. said Monday that it had airlifted polio vaccines for 538,000 children in hard-to-reach areas of northern Syria, including Dier ez-Zor. The airlift also brought blankets and other winter supplies to families.
Cross-border aid from Turkey the easier way to reach these children is still not an option.