TIME polio

The Battle to Eradicate Polio in Pakistan

A Pakistani health worker vaccinates a child in Islamabad
A Pakistani health worker vaccinates a child in Islamabad Anadolu Agency/Getty Images

Political unrest in Pakistan has been a gift to the poliovirus, with 99 cases reported there so far this year. But Rotary International, which has already vaccinated 2 billion children in 122 countries, is hitting back hard

Epidemiology can be all about geography—and that’s especially true when it comes to polio. If you live in the U.S., where polio was eradicated in 1979, the specter of the disease has faded almost entirely, though pockets of infections can occur among the unvaccinated. In Pakistan, however, things are moving in precisely the opposite direction, and have been for a while now.

One of only three countries in the world where polio remains endemic (the other two are Nigeria and Afghanistan), Pakistan had been close to joining the world’s polio-free nations, with only 58 infections in 2012. But thanks to bans on vaccinating—and deadly attacks on polio fieldworkers—by the Pakistani Taliban, the caseload rose to 93 in 2013. In 2014, the total reached 99 by July 18—a figure all the more alarming compared to this point last year, when there had been just 21 cases.

“It’s a scary number,” says Aziz Memon, Pakistani chairman of Rotary International’s polio eradication campaign. “Children in North Waziristan have been trapped for three and a half years without a drop of polio vaccine, and that’s what’s causing this.”

The folks at Rotary know what they’re talking about. Since launching their polio eradication effort in 1985, they have been responsible for the vaccination of 2 billion children in 122 countries. Along with the World Health Organization, UNICEF, The Gates Foundation and others, they have helped slash the global infection rate from 350,000 cases per year in 1988 to 416 in 2013.

That’s indisputably good news, but polio is an exceedingly sneaky virus, with 200 symptom-free carriers for every one case of the disease. That fact, combined with the anti-vaccine forces in Pakistan, not to mention the porous borders cause by war and unrest in the overall region, has caused the disease to leak out from the three endemic countries, with stray cases turning up in Equatorial Guinea, Iraq, Cameroon, Syria, Ethiopia, Somalia and Kenya. In a handful of other countries, the virus has been detected in sewage, but it has not led to any cases of the disease—yet.

It’s Pakistan though that’s considered ground zero, and Rotary has announced that it’s now deploying some very simple weapons in what has always been a village-to-village, door-to-door battle. To improve surveillance and tracking—a maddeningly difficult job in a country in which so many people live off the communications grid—Rotary has distributed hundreds of cell phones to midwives who circulate through communities, canvassing residents to find out who has received the vaccine and who has been overlooked. Information on the unvaccinated kids—the “missing children” in the fieldworkers argot—is entered into the phones and uploaded to a central spreadsheet, allowing later vaccinators to target their efforts more precisely.

“The midwives also track pregnant mothers,” says Memon. “And when their children are born they can continue to maintain complete health records, not just for polio but for other vaccines and basic health care as well.”

Rotary has also worked with The Coca-Cola Company to build what’s known as a reverse osmosis water plant—essentially a sophisticated filtration facility—in the town of Malin, within the city of Karachi. Polio is a disease spread almost entirely by human waste, and once it leeches into the water system it can spread nearly anywhere. The Malir plant, which was constructed near a school to give polio-age kids the first access to the newly filtered water, is a relatively modest one, with just 20,000 gal. (76,000 liters) of clean water on hand at any one moment, and cost only $40,000 to build. But as a pilot project it represents a very good start. “We can’t build a massive plant like the government can,” says Memon. “This is a small plant for a small community.”

One thing, paradoxically, that’s working in the vaccinators’ favor is the increased number of displaced people in Pakistan. A recent push by the Pakistani military to flush the Taliban from its safe havens has broken the vaccination blockade, and already 350,000 children have received at least one dose of the polio vaccine. But 1.5 million refugees are scattered around the country. Rotary has dispatched field workers to refugee camps and transit points to identify the children and few adults who need the polio vaccine and administer it on the spot.

“The government did not have any idea about what the numbers of displaced people would be,” says Memon. In the refugee camps, he adds, there are at least 40,000 pregnant women, whose babies will have to be vaccinated shortly after birth.

The diabolical thing about polio—and indeed any disease science hopes to eradicate—is that even one case is too many. As long as any wild poliovirus is out there, everyone needs to be protected. It is only when the last scrap of virus has been found and snuffed, that the protective push can stop. That has happened once before in medical history—with smallpox. In the case of polio, it’s tantalizingly close to happening again.

TIME Military

Afghanistan: Awash in Guns, as Well as Narcotics

U.S.-supplied weapons like these M-16s in Kandahar, Afghanistan, often lack proper accounting by both U.S. and Afghan authorities, according to a new investigation SIGAR

Contrary to law, U.S. military lacks data on nearly half the weapons delivered

The bad news out of Afghanistan this week is that the U.S. military’s accounting for the arsenals the Pentagon is giving to Afghan security forces is plagued by “incompatible inventory systems” that generate “missing serial numbers, inaccurate shipping and receiving dates, and duplicate records,” according to a new report from the top U.S. government investigator inside Afghanistan.

The worse news? The problems become “far more severe” once the weapons are in the hands of the Afghan forces. “Given the Afghan government’s limited ability to account for or properly dispose of these weapons, there is a real potential for these weapons to fall into the hands of insurgents, which will pose additional risks to U.S. personnel, the Afghan National Security Forces, and Afghan civilians,” according to John Sopko, the special inspector general for Afghanistan reconstruction.

Sopko and the U.N. have made clear in recent years that the production of opium in Afghanistan is growing with every passing year. Sopko’s latest report, released Monday, makes clear that Afghanistan is also awash in undocumented American-supplied arms.

As the U.S. pulls its combat troops out of Afghanistan by the end of this year, proper accounting and tracking of the arms become critical for Afghan forces to battle the Taliban — and to keep those weapons out of enemy hands. “Taliban fighters are scoring early gains in several strategic areas near the capital this summer, inflicting heavy casualties and casting new doubt on the ability of Afghan forces to contain the insurgency as the United States moves to complete its withdrawal of combat troops,” the New York Times reported Sunday.

“We’re not talking just handguns and M-16s and AK-47s,” Sopko told TIME correspondents over lunch on Friday. “We’re talking some high-powered stuff — grenade launchers, RPGs, machine guns — anything that one person could use.” His new report says the U.S. recorded improperly, or simply failed to record, the serial numbers of 43% of the nearly half-million small arms the U.S. has supplied Afghanistan over the past decade.

Sloppy U.S. record keeping is compounded by Afghanistan’s indifference to the congressionally mandated U.S. oversight of the weapons’ whereabouts. “When we went there and said, ‘We want to see how the Afghans handle this,’ the Afghans refused to let us in to check the weapons” at one facility in Kabul, Sopko said. U.S. military officials told Sopko’s auditors they’d get them in. “We showed up and guess what — everybody was attending a funeral,” Sopko said. “We could not get in. When our guys tried to take pictures, all of a sudden, whoa, the Afghans kicked us out — and our U.S. military couldn’t get us in.”

The problem of untracked weapons, according to excerpts from the 28-page report, is likely to get worse:

As of November 2013, more than 112,000 weapons provided to the Afghan National Army and Afghan National Police exceed requirements in the current [Afghan government requirement] …

excess weapons

The Afghan National Army has 83,184 more AK-47s than needed because, prior to 2010, DOD issued both NATO-standard weapons, such as M-16s, and non-standard weapons, such as AK-47s. After 2010, DOD and the Afghan Ministry of Defense determined that interoperability and logistics would be enhanced if the Afghan National Army used only NATO standard weapons. Subsequently, the requirement was changed. However, no provision was made to return or destroy non-standard weapons, such as AK-47s, that were no longer needed …

This problem of the Afghan National Security Forces having more weapons than needed is likely to be exacerbated as the number of ANSF personnel decreases to lower levels in the coming years. Specifically, the current requirements in the [Afghan government requirement] are based on supporting the ANSF at a surge strength of 352,000 personnel. At the Chicago Summit held in May 2012, the international community and Afghan government approved a preliminary model for a reduction of the ANSF force strength by 123,500 personnel to a total of 228,500 by 2017. [U.S. military commanders in Afghanistan] told us they are still planning on providing weapons at the 352,000 personnel level because that is the number stated in the current [Afghan government requirement].

Part of the accountability problem, the report notes, stems from imposing rules that require schooling in a country without much of it. “Efforts to develop the capabilities of Afghan National Security Forces personnel to manage the central depots,” it says, “have been hindered by the lack of basic education or skills among ANSF personnel.”

TIME Military

Navy Nurse Refuses Gitmo Force Feed Order

Guantanamo Hunger Strike
In this photo Nov. 20, 2013 file photo reviewed by the U.S. military, a U.S. Navy nurse stands next to a chair with restraints, used for force-feeding, and a tray displaying nutritional shakes, a tube for feeding through the nose, and lubricants, including a jar of olive oil, during a tour of the detainee hospital at Guantanamo Bay Naval Base in Cuba. Charles Dharapak—AP

A detainee described the act as a conscientious objection

A Navy medical officer at the U.S. military prison at Guantánamo Bay, Cuba has refused an order to continue force-feeding hunger-striking prisoners in what one detainee lawyer described as an act of conscientious objection.

“There was a recent instance of a medical provider not willing to carry-out the enteral feeding of a detainee. The matter is in the hands of the individual’s leadership,” a Pentagon spokesperson said in an email. “The service member has been temporarily assigned to alternate duties with no impact to medical support operations.”

It is the first known instance of a U.S. service member rebelling against the Pentagon’s force-feeding policy. An unknown number of the 149 detainees at Guantánamo’s Camp Delta have been on hunger strike for the past year and a half to protest their indefinite detention.

News of the refusal comes to the public by way of an attorney for one of the detainees, who, according to The Miami Herald, says his client described how some time before the Fourth of July a Navy medical nurse suddenly shifted course and refused to continue force-feeding prisoners. The nurse, he said, was abruptly removed from duty at the detention center. The attorney said his client described the nurse’s action as a conscientious objection.

The Herald reports that the prisoner who provided news of the incident described the nurse as a roughly 40-year-old Latino man most likely with the rank of lieutenant in the Navy.

Last year, civilian doctors writing for the New England Journal of Medicine declared that medical professionals taking part in force-feeding was unethical and called the Guantánamo medical staff to refuse to participate.

TIME Nigeria

All Malala Wants for Her Birthday Is Safe Return for Boko Haram Girls

Calls kidnapped girls her "sisters" during visit to Nigeria

+ READ ARTICLE

Girls’ education activist Malala Yousafzai met Sunday with parents of the Nigerian schoolgirls kidnapped by the militant group Boko Haram and pledged again to fight for their safe release.

“I can see those girls as my sisters… and I’m going to speak up for them until they are released,” she told a crowd of parents, Reuters reports. “I can feel… the circumstances under which you are suffering. It’s quite difficult for a parent to know that their daughter is in great danger.

“My birthday wish this year is… bring back our girls now, and alive,” she added.

More than 200 schoolgirls have been missing since they were abducted by Islamist terror group Boko Haram on April 14 as they were preparing to take exams near Chibok, in the northeast region of the country. In the months since the abduction, Nigerian President Goodluck Jonathan has been unable to secure their release amid widespread international focus, even as Boko Haram leaders threatened to “sell them in the market.”

Malala, who became renowned as an international advocate for girls’ education after she survived a Taliban assassination attempt, is scheduled to meet with the Nigerian leader on Monday. She turned 17 on Saturday.

TIME justice

Dutch Supreme Court Blocks Extradition of Al-Qaeda Suspect to U.S.

NETHERLANDS-PAKISTAN-USA-JUSTICE
The lawyer of Dutch-Pakistani national Sabir Khan, Andre Seebregts (L), arrives in the courtroom of The Hague, on February 12, 2013. Robin Utrecht—AFP/Getty Images

The U.S. wanted to put Sabir Khan on trial in New York for supporting terrorist attacks against Americans in Afghanistan

In a setback for the Obama administration’s use of law enforcement to fight al-Qaeda, the Supreme Court of the Netherlands on Friday blocked the extradition to the U.S. of Sabir Ali Khan, a Dutch-Pakistani man wanted in New York for conspiracy to commit murder and support of al-Qaeda.

The U.S. believes Khan was involved in Taliban and al-Qaeda attacks against Americans in Afghanistan’s Kunar Province in 2010, according to U.S. court documents obtained by TIME. Khan was arrested by Pakistani forces in Sept. 2010, allegedly at the request of the U.S., and held at a secret prison where he says he was tortured.

Khan, whose mother was Dutch, has citizenship in the Netherlands and was eventually released to Dutch authorities and flown to Holland, where he was arrested. His Dutch lawyer argued that the government should determine whether Khan was arrested at the U.S. behest, and whether he would face a threat of further torture if he were extradited.

The Dutch Supreme Court Friday ruled that the extradition could not proceed because the Dutch Government had declined to look into the alleged U.S. role in Khan’s arrest. The Court, which did not address the threat of torture by the U.S., concluded “the Dutch State should have done some research in this matter,” says Dutch Supreme Court Spokeperson Mireille Beentjes. In blocking the extradition, the court stressed “the large interest of combatting torture worldwide,” Beentjes said, quoting from the court’s opinion.

Robert Nardoza, spokesman for the Eastern District of New York, where Khan was indicted on five counts in 2010, said, “We’re going to review the ruling by the Dutch Supreme Court and consider our options.”

Khan, who is in his late 20s, declined to comment when reached by telephone Friday. He remains free and living in the Netherlands. In January, he told TIME that while he suspects he is under constant surveillance, “Officially I have no restrictions on me.”

The case shows how the U.S. must increasingly rely on other states’ legal systems in countering terrorism as Washington attempts to wind down extraordinary powers granted to the president after 9/11. Those states are sometimes more or less aggressive than the U.S. would like, and counterterrorism officials are having to adjust as a result.

 

TIME Afghan civilian casualties

U.N.: Civilians Feel Toll of Afghan War as U.S. Withdrawal Nears

A victim's body lies on the road as Afghan security forces inspect the site of a suicide attack in Kabul on June 21, 2014.
A victim's body lies on the road as Afghan security forces inspect the site of a suicide attack in Kabul on June 21, 2014. Shah Marai—AFP/Getty Images

1,564 deaths recorded in the first half of this year, up 17 percent compared with 2013

A United Nations report released on Wednesday finds that civilian casualties in Afghanistan rose sharply in the first half of this year as they increasingly feel the brunt of war.

The report by the U.N. Assistance Mission in Afghanistan (UNAMA), compiled as U.S.-led forces withdraw from a 12-year battle with the Taliban and amid a steep decline in security, finds that ground combat—now more than improvised explosive devices—is the leading cause of death and injury to civilians.

More than 4,800 civilian casualties were recorded in the first six months of this year. That figure includes 1,564 deaths, up 17 percent compared to the same period the year before. Child casualties associated with ground combat more than doubled—rising 34 percent to 1,071—while two-thirds more women were killed and wounded by ground engagements.

“The fight is increasingly taking place in communities, public places and near the homes of ordinary Afghans, with death and injury to women and children in a continued disturbing upward spiral,” said Georgette Gagnon, UNAMA’s Director of Human Rights.

Afghanistan’s unrest is increasing amidst the ongoing political crisis, as a disputed presidential election has created a tense stand-off between the two leading candidates, Ashraf Ghani and Abdullah Abdullah. Early results on Monday showed Ghani net 56.44% of the run-off vote on June 14, but Abdullah was quick to reject the outcome and claim it was marred by fraud.

Abdullah’s supporters protested in the capital, Kabul, on Tuesday and called on him to form a parallel government. Washington responded by saying it would pull both financial aid and security support if power was seized illegally.

 

TIME Education

Malala Day Video Tells the #StrongerThan Story Through Children’s Voices

“Once there was a girl who wanted to go to school….”

+ READ ARTICLE

Correction appended, July 9

In preparation for worldwide Malala Day on July 14, 2014, the Malala Fund released this video of children telling the inspiring story of the Pakistani girl who dared to learn.

“This is a story of strength,” begins the clip. One child after another then picks up the narrative, telling the story of Malala Yousafzai, the Pakistani girl who narrowly survived a Taliban assassination attempt while still a young teenager, after gaining attention as an advocate for girls’ education. Since then, Malala has become an international envoy for education and women’s rights.

“Malala Day is not my day,” she said in a statement. “It is the day of every girl and every boy. It is a day when we come together to raise our voices, so that those without a voice can be heard.”

The Malala Fund calls on people to use the #StrongerThan hashtag on social medial to tell their own story of overcoming oppression.

Correction: The original version of this story misstated Malala Yousafzai’s nationality.

TIME Pakistan

Pakistan’s New Antiterror Law Gives Security Forces Unprecedented Power

Pakistan
Pakistan army troops arrive at Karachi airport following an attack by unknown gunmen, disguised as police, who stormed a terminal used for VIPs and cargo, Sunday night, June 8, 2014. Fareed Khan—ASSOCIATED PRESS

The law permits the arrest of terror suspects without warrants and their detention for 60 days without trial. Officials will also be able to issue shoot-on-sight orders

In an effort to curb the increasing audacity of Islamist militant groups in the country, Pakistan’s parliament passed a comprehensive counterterrorism bill on Wednesday that gives unprecedented powers to domestic security forces.

The legislation, called the Protection of Pakistan Bill 2014, has drawn the ire of human-rights groups for its rigor and breadth. Under the new law, the national government can not only arrest suspected terrorists without warrants but also detain them for 60 days without any discussion of trial.

More controversially, it permits police and other security officials to issue shoot-on-sight orders.

“This is perhaps the strongest of the laws that Pakistan has come up with to deal with militancy and terrorism,” Irfan Shahzad, a researcher at the Institute for Policy Studies in Islamabad, tells TIME. “I would not say that outright it is a violation [of human rights], but it certainly raises questions over what rights we Pakistanis have as citizens of this country.”

Thousands have died since the Pakistan Taliban began its present insurgency in 2007, and Islamabad has frequently struggled to contain the bloodshed. It is currently taking the fight to the insurgents in the mountainous region of North Waziristan, but the offensive has sparked a humanitarian crisis, displacing nearly half a million people.

Shahzad says the new legislation has been born out of increasing frustration. “If a government fails to deliver,” he says, “they resort to certain actions that they believe will increase their command over certain groups.”

Among the provisions of the new law are the granting to security forces the power to search premises without warrants, the allowing of tapped phone calls as court evidence and a steep increase in prison sentences for terrorist offenses. While the bill has vocal critics, Shahzad believes that it will be accepted by a population exhausted by years of conflict.

“We’re talking about a country where the literacy rate is just over 50%,” he says. “Even among those who are literate and who read the news, they are very much hard-pressed by the matter of their own survival. [This law] may not necessarily be a major issue to them.”

TIME Military

Sergeant Bowe Bergdahl Is Venturing Off Base as Part of Reintegration

Bowe Bergdahl
This undated photo provided by the U.S. Army shows Sergeant Bowe Bergdahl AP

Held captive by the Taliban for five years, he's now being reintegrated with society

Sergeant Bowe Bergdahl, the prisoner of war in Afghanistan who recently returned to the U.S. after five years of captivity, is regularly going off post to dine, shop and do other chores, according to Lieut. Colonel Carol McClelland.

“He’s been doing it for at least a week,” the Army spokeswoman tells TIME, adding that it was a normal component of his reintegration into society. On visits to San Antonio, he has been accompanied by members of his reintegration team, including a psychologist, according to the Associated Press.

Bergdahl, 28, was shifted last week to outpatient care at Fort Sam Houston in San Antonio. He was freed by the Taliban on May 31 in a prisoner exchange for five senior Taliban officials held at Guantánamo Bay, and arrived in the U.S. on June 13. He was initially being treated in the U.S. at Brooke Army Medical Center.

As part of the reintegration process, the Army is increasing his exposure to people and social settings incrementally. It’s still unknown if his parents, who has asked for privacy since Bergdahl’s return, has visited their son.

The Army is still investigating circumstances surrounding Bergdahl’s departure from his outpost in June 2009 before his capture.

With reporting by Mark Thompson

TIME Pakistan

Unbelievably, There Are Now Refugees Fleeing to Afghanistan

The Pakistani military’s offensive against insurgents in North Waziristan has sparked a humanitarian crisis, with thousands of Pakistanis concluding that Afghanistan is just a far safer place to be right now.

+ READ ARTICLE

The Pakistani military has begun operations against Islamic insurgents in the North Waziristan region, delivering the offensive that Washington has been requesting for a decade, and sparking a massive exodus of refugees — some of whom are fleeing to neighboring Afghanistan to escape the fighting.

Militants, who have long inhabited the mountainous tribal area, have found themselves the target of heavy artillery bombardment and airstrikes for the past fortnight, in what the military’s PR chief Major-General Asim Bajwa termed “the beginning of the end of terrorism in Pakistan.”

Reports began to surface on Thursday in the Pakistani press that ground troops had started moving into North Waziristan to clear out the insurgent forces.

Washington says militants have been using North Waziristan for years as a base from which to attack NATO forces in Afghanistan and to wage a terrorist insurgency against the Pakistani state.

Senior members of the Pakistani Taliban (the Tehreek-i-Taliban Pakistan), the Haqqani Network and Al Qaeda’s central command — along with a smattering of militants from as far away as western China’s Xinjiang province and Chechnya — are believed to be holed up in the area. All are on Islamabad’s kill list.

“For the military, there’ll be no discrimination among Tehreek-i-Taliban Pakistan, Haqqani network or any other militant group,” Major-General Bajwa told reporters during a press conference in Rawalpindi on Thursday.

The mountainous border dividing Pakistan and Afghanistan has been home to martial tribes for centuries. However, the presence of heavily armed insurgents and foreign jihadis is the notorious legacy of American and Saudi intelligence agencies, who used the fighters as proxy forces during the clandestine war with Soviet troops occupying Afghanistan in the 1980s.

“This is famously the powder keg, which has led to everything going wrong in the region and the beginning of heavily armed militant Islam,” William Dalrymple, the historian and author of nine books on South Asia, tells TIME. “Obviously in retrospect [it’s] one of the great mistakes of American foreign policy.”

The Pakistani secret service (ISI) is alleged to have helped insurgent elements fleeing the U.S. invasion of Afghanistan in 2001, using those militant groups to maintain pressure on the newly formed government in Kabul, which they believed harbored pro-Indian sensibilities.

“The Pakistan Army, or elements within ISI, always continued to support the Taliban as a way of getting rid of the Karzai government and a way of installing a pro-Pakistani Taliban regime in Kabul,” says Dalrymple.

That policy appears to have backfired. In 2007, the Pakistani Taliban launched a fresh insurgency against Islamabad that to date has been responsible for the deaths of tens of thousands of Pakistanis and at least 15,000 security personnel.

Prime Minister Nawaz Sharif campaigned last year on the promise of peace talks with the Taliban, but any hope of negotiations has been extinguished by a recent string of humiliating attacks, including a brazen assault on Karachi airport, deep in the country’s commercial hub.

The perennially stretched Pakistani state is now attempting to deal with the massive humanitarian fallout from the new offensive. In the less than two weeks of fighting, more than 450,000 people have been internally displaced. Officials estimate that the number will surpass 500,000 soon.

In a bizarre reversal of the norm, tens of thousands of Pakistanis have reportedly flooded into war-torn eastern Afghanistan to escape the fighting on the Pakistan side of the border.

“The [Afghan] government estimates there are over 60,000 thousand for now,” says Babar Baloch from U.N.’s High Commissioner for Refugees.

The exodus has also ignited fears that the polio epidemic rampant in North Waziristan for two years could spread to other parts of the region.

Meanwhile, analysts have already begun to criticize the new military campaign for not being part of a broader vision of Pakistan’s future.

“There isn’t yet a clear national strategy,” says Shuja Nawaz, director of the South Asia Center at the Atlantic Council. That means “operations are going to be tactical at best.” He adds: “The civilians were not brought in at the planning stage. And they’re not prepared in any way to take over from the military once the clearing has taken place.”

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser
Follow

Get every new post delivered to your Inbox.

Join 45,130 other followers