Written by Dr. Ghassan Kderany for Tahrir Souri
With the escalation of the war in Syria and all the chaos growing in areas beyond regime control, the health sector has been exposed to massive destruction that has caused many of the health centers to be out of service either for destruction in whole or in part, or due to the lack of qualified staff to manage these centers. This greatly affected the health care provided to citizens in general and children in particular, including vaccines that were provided to children within the program supervised by the Syrian Ministry of Health in collaboration with the UNICEF.
Vaccination rates in Syria fell from 91% of children before the war to an estimated 68% in 2012, but those are national figures. In rebel-held territory where all the polio cases have so far occurred In October 2013, Syrian government and the World Health Organization (WHO) have officially announced the isolation of polio virus wild-type samples taken from 15 children in the city of Deir ez-Zor in the east, where the infrastructure needed to provide electricity and clean water has been largely destroyed. Later, two more cases were discovered in Aleppo and Damascus.
In its latest report on the outbreak of polio in Syria issued in March 2014 , the World Health Organization officially confirmed 25 cases registered during the year 2013 divided as follows: 18 in Deir ez-Zor, 2 in Hasakah, 3 in Aleppo, 2 in Idlib, while the report doesn’t mention the case registered in Damascus. The report also noted recording 12 cases compatible with polio without laboratory confirmation of the presence of the official laboratories distributed as follows: 8 in Deir ez-Zor, 3 in Aleppo,1 in Hasakah and they were all contracted during the same year.
The report also documents 166 cases of acute flaccid paralysis not caused by polio in 2013 compared to 38 cases during the first three months of the year 2014. It should be noted that all polio-confirmed cases were diagnosed among children under the age of five years who live in areas outside regime control, as a result, many have been denied the right to vaccination through campaigns organized by the Syrian Ministry of Health.
This large number of cases, pushed the World Health Organization (WHO) and UNICEF in particular – to organize a campaign to vaccinate 22 million children, including children at risk of contracting the disease in Syria and neighboring countries. The Syrian Ministry of Health oversaw the campaign in the areas controlled by the regime while civil organizations relied on volunteers in areas under the control of the opposition. The six-phase vaccination campaign started on the month of October and ended on May (phase 6). The turnout was favorable as 2.17 million children received the vaccine in the first round, and rose to 2.7 million children in the fourth round.
Implementing the campaign was not a simple task, with the regime denying UN organizations access inside the country through border-crossings that are outside Syrian government control, those NGOs would correspondingly face the risk of being banned from exercising any activity inside the war-torn country. All those restrictions have urged the Turkish Red Crescent and the Turkish Ministry of Health to provide the additional batch of vaccines which were delivered to opposition-held areas, while the Syrian Arab Red Crescent handled the distribution process across the border.
Doctors admit the WHO’s “hands are tied in terms of direct cross-border support”. As a UN agency, it must work with governments and is not allowed to deliver vaccine directly to rebel-held territory across the Turkish border. The polio virus lives in water, contaminated food and sewage. The infection increases during the hot season where the sewage systems and drinking water purification are absent. Polio is considered endemic in only three countries: Afghanistan, Pakistan and Nigeria. Another case of authentic polio was recorded in Syria in 1995 and was attributed vaccination coverage 92% in 2010 decreased to 68% in 2012.
95% of people who make up the reservoir for the spread of the virus do not show any symptoms, while symptoms such as nausea and vomiting fever and most of the remaining 5%, except for a small percentage of cases where the virus affects the motor neurons of the parties lower limbs, leading to paralysis fast FD falls partly with aging without full recovery.
There are two types of polio vaccine: trivalent oral polio vaccine (tOPV), given by mouth, and inactivated polio vaccine (IPV), given as an injection January 2000, tOPV is no longer recommended for immunization. The recommended schedule for childhood immunization is for IPV to be given at two, four, and six to 18 months of age and between four to six years of age. Adults traveling to countries where polio cases are occurring should review their immunization status to make sure they are immune.