Endgame for an Enduring Disease? Pakistan’s Fight Against Polio

4 minute read

Twenty-three years after it was eradicated in the United States, polio still stalks Pakistan, one of three countries left in the world where the devastating disease remains endemic. Prevention should be easy – all it takes is two drops of the vaccine, administered three different times, for a child to become immune. For years, polio has hovered on the brink of extinction in Pakistan, thanks in part to a 25-year effort by UNICEF, WHO, the CDC and Rotary International that has established a system of nationwide vaccinations that take place every six weeks. In 1988 there were 350,000 cases of polio in 125 different countries; today, that number is down to 176 cases in Pakistan, Afghanistan and Nigeria.

Hopes that polio could be knocked out for good in Pakistan faltered this summer when a pair of militant commanders in the ungoverned tribal areas along the border with Afghanistan banned the program, saying no vaccination teams should come to the area until the drone campaign against militants came to a halt — essentially holding the nation’s children hostage. The militant ban has spread amongst Pakistan’s Pashtun population, reaching as far as Karachi, in the country’s south.

There were 48 cases of paralytic polio last year in Pakistan, down from 154 in 2011. And while the cases are concentrated in the Pashtun speaking populations of Khyber Pakhhtunwa Province and the tribal areas, many of them have direct links to Gadap Town, Karachi’s biggest slum. Home to more than 400,000 people, of which 60,000 are children under the age of five, the tightly packed warren of concrete-block low-rise apartment buildings and small family compounds has become something of a black hole for government services. There is only one basic health clinic to serve the entire population, no sanitation services, no water treatment and a high likelihood that waste water is mixed with drinking water. For polio, it is the perfect storm, combining limited access, bad hygiene, low education levels and severe malnutrition: the polio virus has recently been found in water samples collected from the fetid stream that runs through the slum, a popular playground for area children. One polio worker recounts watching young children play tea party there, sipping stream water from the lids of water bottles scavenged among the heaps of rotting refuse lining the banks.

Pashtun-speaking migrants from the tribal areas dominate the area, and militant networks have made inroads among the population. Local officials call Gadap town “mini Waziristan,” in reference to an area near the Afghan border that is home to both the Pakistani Taliban and al-Qaeda linked militants. It’s not much of an exaggeration. In Gadap town, women, if they are seen at all, wear the trademark shuttlecock burqa of the Pashtun heartland. A recent survey conducted in Karachi by the World Health Organization noted that Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Pakistan will never be free of polio, concluded the report, until a way is found to persuade poor Pashtuns to vaccinate their children. The Pakistani government is working with local communities on an education campaign, and making sure that every child on a public bus coming into or out of Karachi gets the drops. Still, some families have had to learn about the value of the vaccine the hard way.

Not so long ago, every child in Muhib Banda, a Pashtun village not far from the provincial capital of Peshawar, was vaccinated each time the polio teams came through. Local shopkeeper Saiful Islam says that he made sure his sons were first in line. But in late May, rumors swept through the town, as vicious and quick as a virus. “Some people were saying that the polio vaccine was made of pig urine, or monkey urine,” says Islam. “They said that it was a conspiracy to make Muslim children infertile. I believed them.” When the vaccinators came through a few days later, he refused to answer their knock. He refused again in July. And then his six month-old daughter Sulaim came down with a fever. When she recovered, she could no longer move her legs. It’s likely that she will never be able to walk. “Our ignorance made her paralyzed,” says Islam. He has pledged to join the fight against the disease, praying that Sulaim will be its last victim.


Diego Ibarra Sánchez is a Spanish documentary photography based in Pakistan.

Aryn Baker is the Middle-East bureau chief for TIME.


Image: Latif, son of Jam Pumhoom, got polio when he was 8 years old
The following photographs were shot in October 2012. Portrait of Latif, son of Jam Pumhoom, at the depressed fishermen area outskirt of Karachi. He got polio when he was 8 years old. Pakistan has come a long way on its struggle to eradicate poliomyelitis.Diego Ibarra Sánchez for TIME
Image: A garbage dump located at the Baluch colony in Karachi
A garbage dump located at the Baluch colony in Karachi. The inadequate sanitation and a polluted environment could make the threat of the virus persists in Pakistan. Besides, Polio can be spread when food or drink is contaminated by feces.Diego Ibarra Sánchez for TIME
Image: A child getting a polio vaccine at Toll Plaza, outskirts of Karachi
A child getting a polio vaccine at Toll Plaza, outskirts of Karachi. Polio is a highly infectious disease caused by a virus that can provoke permanent paralysis in a matter of hours. There is no cure, but there are safe and effective vaccines.Diego Ibarra Sánchez for TIME
Image: A vaccination team at Karachi Toll Plaza stopping a bus to make sure the riders get vaccines
A vaccination team at Karachi Toll Plaza stopping a bus to make sure the riders get vaccines on their efforts to stop this disease.Diego Ibarra Sánchez for TIME
Image: The polio vaccination team at Karachi Toll Plaza has vaccinated more than 500 children traveling on buses
The polio vaccination team at Karachi Toll Plaza has vaccinated more than 500 children traveling on buses.Diego Ibarra Sánchez for TIME
Image: Reflections of a driver in a bus at the Toll Plaza, near Gadap Town
Reflections of a driver in a bus at the Toll Plaza, near Gadap Town. The flux of travelers make easier to spread the polio virus all over the country. Gadap Town is "one of the polio virus reservoirs" in Pakistan, where a lot of efforts have been made over the past six months to vaccine children against polio, according to a UN report.Diego Ibarra Sánchez for TIME
Image: A child getting a polio vaccine at Toll Plaza outskirts of Karachi
A child getting a polio vaccine at Toll Plaza outskirts of Karachi. Polio is a highly infectious disease caused by a virus that can cause permanent paralysis in a matter of hours. There is no cure, but there are safe and effective vaccines.Diego Ibarra Sánchez for TIME
Image: The inside of a warfare trench in Sango next to Barra agency
The inside of a warfare trench in Sango next to Barra agency. Security forces and local citizens have to deal frequently with attacks from the Taliban.Diego Ibarra Sánchez for TIME
Image: A man who suffers the consequences of polio begging on the Karachi streets
A man who suffers the consequences of polio begging on the Karachi streets. The Taliban have banned vaccination campaigns in some areas, condemning the initiative as a cover for espionage since a Pakistani doctor was jailed after helping the CIA track down al-Qaeda chief Osama bin Laden using a hepatitis vaccination program.Diego Ibarra Sánchez for TIME
Image: Goats passing away a waste pipe at Union Council 4 in Karachi.
Goats passing away a waste pipe at Union Council 4 in Karachi. This Karachi´s sector is not only a high-risk area for polio, but also an area that houses some of the most vulnerable and disadvantaged children and for whom the right to health, clean water, and education are significantly challenged.Diego Ibarra Sánchez for TIME
Image: A Pakistani woman crossing an improvised bridge at the volatile area of Union Council 4 in Gadap
A Pakistani woman crossing an improvised bridge at the volatile area of Union Council 4 in Gadap. According to a WHO´s report in September 2012, its sewage water tested positive for the virus.Diego Ibarra Sánchez for TIME
Image: A portrait of Saiful Islam holding his 8-month-daughter, Sulaim, at his home in Mardan
A portrait of Saiful Islam holding his 8-month-daughter, Sulaim, at his home in Mardan (Khyber Pakhtunkhwa). He made the decision of refusing vaccinations for his daughter because of rumors vaccines could contain animal urine. She was struck by polio two months ago. Both of her legs are paralyzed now.Diego Ibarra Sánchez for TIME

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