Polio wars

February 4, 2018

Since 2012, an estimated 80 workers in Pakistan have lost their lives in the battle against polio. But the End Polio Pakistan website that registers the country’s efforts at polio elimination does not even mention the polio workers who died in the line of duty

Polio wars

Mehwish, eyes flashing behind her niqab, narrates with quiet confidence the tale of how she escaped sexual harassment during a routine vaccination campaign in her area. "At a home in one of the posh localities, a man asked us to come inside to give polio drops to the two children in his house. Once we entered he asked me to come into the bedroom, attempting to grab my hand with the intention of pulling me further in, but thankfully I managed to escape".

Sitting with her colleagues inside the rickety union council office in Lahore from where the anti-polio campaign is conducted in that area, this young polio worker brings to mind the spectre of Sakina Bibi and her daughter Rizwana, two women who weren’t lucky enough to escape, and got killed in the outskirts of Quetta on January 18, 2018 as they were going about their job.

Mehwish, like many of her counterparts across the country, is a young woman who has done her Matric and is employed by the government as a Lady Sentry Patrol, earning a monthly salary of Rs18,500. Her job is to go door-to-door during both Dengue and Polio campaigns, administering information and vaccine. Cases of attempted sexual harassment are reported mostly around posh localities, she tells me, where the houses are bigger and neighbours cannot keep a watch out. Her male colleague and in-charge of the union council tells me Mehwish’s harasser followed her for a while till she called the office and a team was dispatched to help her. An FIR was registered against the harasser who spent the night in the police station where he was given ‘due treatment’, he adds with some satisfaction.

Given that the logistics of the polio-eradication operation are sprawling, providing security to every single staff member becomes a near impossibility. In Punjab, it is also not strictly required, since there has never been an attack on a polio worker’s life in this province.

Of the 260,000 health workers and support staff employed for anti-polio campaigns in the country, a majority are women, dozens of whom have been shot dead while on duty. More than 84 per cent of the health workers trying to eradicate the polio virus in Quetta are women.

In a job where getting killed is an imminent possibility, sexual harassment seems to be a concern relatively lower down the rung, especially if the women bearing the brunt of it manage to escape relatively unscathed. Anika, a Social Mobiliser in the same union council as Mehwish’s says she sometimes has to face catcalls and lewd remarks on the street when she goes door-to-door to recheck the work that her colleagues conducted earlier, "But that is to be expected. I have now become confident enough to ignore such harassment, and then there are always two or three girls with me. We manage," she says.

Anika who has an FA receives a monthly salary of Rs20,500, an amount greater than what many school teachers get with an MA degree. These pay scales were revised a few years ago when concerns over polio eradication reached their peak with 198 cases of polio registered in 2011 (a decade-long high), and after workers’ lives were endangered.

Given that the logistics of the polio-eradication operation are complex and sprawling, providing security to every single staff member becomes a near impossibility. In Punjab, it is also not strictly required, since there has never been an attack on a polio worker’s life in this province.


The rest of the country poses a different story, though. Since 2012, an estimated 80 people in Pakistan have lost their lives in the battle against polio. These systematic attacks gained legitimacy in the minds of many Pakistanis after 2011 when certain reports claimed that a local doctor, Shakil Afridi posed as a Hepatitis B vaccinator while working for the CIA to locate and kill Osama Bin Laden. Polio campaigns had been a target even prior to that with clerics like Sufi Mohammad spreading false information that the vaccine caused infertility. There was also a grenade attack aimed at the Red Crescent compound in Peshawar in 2007 damaging vehicles but not resulting in any casualties. Fatal attacks on workers by militant groups, however, gained currency only around 2012. (See ‘A partial timeline of violence against polio workers’).

After each polio worker killing, the public clamours for greater security for individuals conducting this vital national task, but the police itself has faced a substantial loss of life during polio campaigns, having borne the brunt of suicide attacks and drive-by killings in Karachi, Khyber Pakhtunkhwa and Balochistan. Police personnel are installed in every area that is monitored under the polio plan but an excess of crime and the lack of personnel means they can’t accompany every single polio worker. They sometimes arrive too late to be able to do anything, as was the case in the recent killings in Quetta.

There is also the issue that security personnel are said to create suspicion among certain locals who see polio vaccination as a governmental conspiracy conducted on the behest of western powers. A conspicuous uniform and weaponry is said to attract too much unwanted attention towards polio workers, a reason offered by police officers for hanging back.

Pakistan is one of the last two countries in the world where the polio virus is still endemic. However, an improvement in the overall security situation in the country is tied to the success of the polio campaign - which has seen far fewer reported cases this year as compared to the past. Pakistan has outperformed Afghanistan for the first time since both countries whittled down to the last three among the list of polio carriers (Nigeria is the third, which did not report a case last year, but is still not considered completely in the clear).


Although it’s still too early to celebrate, this move towards eradication was helped by three crucial factors: making sure that polio workers belong to the community and area they work in so they can establish an essential trust with the households in that vicinity; by bringing the country’s overall security situation under control, particularly in Karachi which saw both sustained polio cases as well as militant violence against polio workers; and by involving the country’s clergy who have come together to give fatwas in favour of the polio campaign, assuring people that there are no haraam substances in the vaccine, nor is it a conspiracy against Muslims.

Polio eradication efforts in Pakistan are supported financially by the Bill and Melinda Gates Foundation, the UAE government and Rotary International, and implemented with the support of UNICEF and WHO. There is a slick and friendly website End Polio Pakistan that registers the country’s efforts at polio elimination, narrating the efforts of many a polio worker in urban centres and remote areas of the country. Oddly it does not even mention, let alone have a separate section, on the polio workers who died in the line of duty.

This also means there is no trace of the investigations that are regularly ordered into the murders of polio workers but only one of whom has been noticeably recorded by the media, i.e the sentencing of a TTP militant Afsar Khan who killed polio vaccinator Umer Farooq in Sohrab Goth, Karachi when he was returning from his anti-polio campaign duties.

Munir Ahmed, Coordinator Emergency Operation Centre Punjab, says one of the reasons polio hasn’t been eliminated from Pakistan yet is that polio workers get paid very little for the immense effort they put into their work: Rs250 per day. This money is solely for their engagement as polio campaigners, in addition to their regular salaries as government health workers. "Although the Rs250 is on top of their regular salaries, even then the work they do requires great physical labour, vigilance and danger. It needs to be acknowledged financially and through praise." Another reason he suggests is the free movement of people at the Afghan-Pakistan border, "Unluckily we found a positive environmental sample in December in Lahore which was linked to Kabul, Afghanistan. The virus tells you the travel history."


In Icchra, a densely populated area of Lahore, there is a smaller neighbourhood known as Chaudhry Colony, an enclave of largely Christian domestic workers. Their houses sit on either side of an open-air sewage canal lined with garbage and filth. This nullah is one of the places in Lahore which has tested positive for polio samples in the environment. A special campaign is being run here to counter the effects of this result. The day’s proceedings have gone well, all the children who needed to be immunised have cooperated. The residents of the area seem happy with their polio team.

When I ask if they have any reservations, one man running a small corner shop says, "None. They are doing great work. People who don’t let them do their work are just uneducated. They don’t realise this is for our own good". The lady workers’ team who has been going door-to-door has a friendly rapport with the community. A young girl who is assisting tells me she has just sat for her FSc exam and is hoping to become a doctor.

A large band of energetic young boys of school-going age play beside this nullah at 11 o’clock in the morning.  One of them tosses a tennis ball into the air, another boy jumps to catch it, precariously perched at the edge of the canal as he just about manages to grab onto the ball before it splashes into the foul water. They are playing chuk danda, my guide informs me, a cross between cricket and gulli danda. Their energy is infectious.

As is that of most workers I have come across throughout my reporting. I have been impressed by the detailed planning that has gone into reaching every single child in this union council and the hard work being carried out by people from top to bottom. I wonder what it is that is going right here: the donor money, the implementation, or the involvement of the community. If we can reach nearly every single child in the country and map them from neighbourhood-to-neighbourhood, overcome parental concerns and religious propaganda, what is preventing us from making it compulsory to send these children to school or to provide them with a better life in general. It just seems like a matter of will.

The Pakistan chapter of the End Polio Now campaign is called End Polio Pakistan, the name has been updated in the story to refer to their activities in Pakistan.

Polio wars