Newsgroup: it.politica.internazionale
Titolo: Syria’s Polio Epidemic: The Suppressed Truth

http://www.nybooks.com/articles/archives/2014/feb/20/syrias-polio-epidemic-suppressed-truth/?pagination=false
 
 
Syria’s Polio Epidemic: The Suppressed Truth
 
Annie Sparrow
 
The following article by Annie Sparrow will appear in the February 20 
issue of The New York Review which goes on sale next week.
 
One way to measure the horrific suffering of Syria’s increasingly 
violent war is through the experience of Syrian children. More than one 
million children are now refugees. At least 11,500 have been killed 
because of the armed conflict,1 well over half of these because of the 
direct bombing of schools, homes, and health centers, and roughly 1,500 
have been executed, shot by snipers or tortured to death. At least 128 
were killed in the chemical massacre in August.
 
In the midst of all this violence, it is easy to miss the health 
catastrophe that has also struck Syrian children, who must cope with war 
trauma, malnutrition, and stunted growth alongside collapsing sanitation 
and living conditions. Syria has become a cauldron of once-rare 
infectious diseases, with hundreds of cases of measles each month and 
outbreaks of typhoid, hepatitis, and dysentery. Tuberculosis, 
diphtheria, and whooping cough are all on the rise. Upward of 100,000 
children are stigmatized by leishmaniasis, a hideous parasitic skin 
disease that flourishes in war. Many of these diseases have already 
traveled beyond Syria’s borders, carried by millions of refugees. Five 
million more children have been forced out of their homes but are still 
living within Syria, increasingly vulnerable to early marriage, 
trafficking, and recruitment as child soldiers.
 
And now polio is back. Since May, Syrian doctors and international 
public health agencies have documented more than ninety cases of polio 
in seven of Syria’s fourteen administrative districts, or governorates: 
Deir Ezzor, Aleppo, Idlib, Hama, Damascus, al-Hasakeh, and Ar-Raqqa. At 
an average age of just under two, most victims are—or used to 
be—literally toddlers. Few were fully vaccinated. None has had treatment 
to prevent paralysis from becoming permanent. All are from areas long 
opposed to the Assad regime, which reflects the political dimension of 
the outbreak. Not a single case has occurred in territory controlled by 
the government.
 
 
Once the most feared disease of the twentieth century, polio in most 
countries had long ago passed into the history books. Syria was no 
exception. Polio was eliminated there in 1995 following mandatory (and 
free) immunization introduced in 1964 after the Baath party took power.2 
Yet wildtype 1 polio—the most vicious form of the disease—has been 
confirmed across much of Syria.
 
Ninety or so afflicted children may sound like a small number, but they 
are only a tiny manifestation of an enormous problem, since for each 
crippled child up to one thousand more are silently infected. Polio is 
so contagious that a single case is considered a public health 
emergency. Ninety cases could mean some 90,000 people infected, each a 
carrier invisibly spreading the disease to others for weeks on end.
 
This man-made outbreak is a consequence of the way that Syrian President 
Bashar al-Assad has chosen to fight the war—a war crime of truly 
epidemic proportions. Even before the uprising, in areas considered 
politically unsympathetic like Deir Ezzor, the government stopped 
maintaining sanitation and safe-water services, and began withholding 
routine immunizations for preventable childhood diseases. Once the war 
began, the government started ruthless attacks on civilians in 
opposition-held areas, forcing millions to seek refuge in filthy, 
crowded, and cold conditions. Compounding the problem are Assad’s 
ongoing attacks on doctors and the health care system, his besieging of 
cities, his obstruction of humanitarian aid, and his channeling of 
vaccines and other relief to pro-regime territory.
 
Sofie (not her real name), the first Syrian child known to have come 
down with polio, came from Spighan, a small town on the Euphrates River 
in the Mayadin district of Deir Ezzor. An unimmunized three-year-old, 
her initially unremarkable symptoms of fever and a cold were followed by 
acute flaccid paralysis, the sudden loss of muscle function, as the 
polio virus destroyed Sofie’s nerve cells. Untreated, polio has left her 
crippled, stigmatized, and shunned. Since then dozens more children in 
Deir Ezzor have succumbed. In August, cases started cropping up in other 
parts of the country: first in Aleppo, then in an opposition-held suburb 
of Damascus, Idlib, al-Hasakeh, and finally Raqqa in December.
 
Dr. Mohamed Wajih, the former head of the Aleppo Medical Council, 
described to me the government’s manipulation of the once-routine 
vaccine program:
 
Well before the revolution, the regime withheld vaccines from Deir 
Ezzor. In some liberated areas supplies to the health centers still 
existed but nurses stopped being paid, or the centers had no power to 
refrigerate the vaccines. For many nurses it was too dangerous to get to 
work.
Of the 1,919 health centers across the country before the war, 652 have 
been destroyed, shut down due to insecurity, or closed for lack of 
power, the vast majority in opposition-held areas. In the Aleppo 
governorate, vaccines stopped being delivered to rebel areas as violence 
broke out. In Aleppo city, the reach of vaccination parallels the “Death 
Path”—the few hundred yards separating government—from opposition-held 
areas. Doctors and others have told me of snipers in Aleppo deliberately 
shooting civilians in this corridor, including infants and children.
 
This politicizing of public health meant that many children born in 2010 
or later could not commence or complete the routine course of polio 
vaccination required for effective protection. Of the roughly 1.8 
million children born since the conflict began, more than half may be 
completely unvaccinated. WHO estimates that the vaccination rate has 
dropped from 83 percent of two-year-olds before the war to 52 percent in 
2012.3 The Syrian Ministry of Health states that the vaccination rate 
has dropped from 99 percent pre-war to 68 percent in 2012. More than 
three million children across Syria may now be vulnerable.
 
The main UN agencies—WHO, UNHCR, UNICEF, and the World Food Program—that 
began deploying in Syria in early 2012 to mitigate the 
government-created humanitarian crisis are all forced to stay in 
Damascus city. Their current UN mandate requires that they respect the 
regime’s sovereignty, making their operations contingent upon government 
consent. The millions of dollars of food, medical aid, and other 
humanitarian supplies provided by UN-financed convoys are all controlled 
by the regime.
 
The UN’s current polio vaccination program—sponsored by UNICEF and 
delivered in UN-financed convoys and flights—is fully orchestrated by 
the Syrian government, and in opposition-held areas, it is dependent for 
administration on volunteers from the government-dominated Syrian Arab 
Red Crescent (SARC). SARC’s president, Abdul Rahman Attar, is closely 
tied to the government, and even has his own pharmaceutical company, 
which has influenced the preference given to regime territory in the 
administration of polio vaccines during these last three years.
 
It is notable that polio first appeared in Mayadin, a Sunni-dominated 
district in eastern Syria. This same district suffered a cholera 
outbreak in 2009. Four years of drought on top of four decades of 
dictatorship led to contaminated water, lack of water treatment, and 
ineffective sanitation. Showing its reluctance to help an area seen as 
hostile to the Baath regime in Damascus, the government denied that 
cholera had broken out, despite three thousand cases and the deaths of 
three children. It still denies that such an outbreak took place. 
Doctors and pharmacists told me of colleagues imprisoned for calling the 
disease cholera and for raising public awareness of it.
 
Four years later, raw sewage in Mayadin is still pumped into the 
Euphrates River a few hundred yards above the pump that provides water 
for the village, but chlorine to decontaminate the river water has been 
lacking since 2012. Assad’s method of fighting the war has generated the 
perfect conditions for polio: the severe malnutrition we see now in many 
opposition-held areas, on top of appalling living conditions, makes 
children more vulnerable to succumbing both to polio and to the risk of 
permanent paralysis.
 
Since 1988, the Global Polio Eradication Initiative has brought together 
national governments, WHO, Rotary International, the US Centers for 
Diseases Control and Prevention (CDC), and other groups. In 2007, Bill 
Gates joined, contributing hundreds of millions of dollars in the hope 
of eliminating polio the same way that smallpox was in 1977. But 
smallpox was different. It was easy to spot: the infected have a 
glaringly obvious rash. It is a huge virus covered by a viral envelope, 
an outer layer that is easily destroyed with soap. Only one shot of 
vaccine provided immunity.
 
Polio, by contrast, is a virus so small it slips even through surgical 
masks. The lack of an envelope renders the virus immune to most 
antiviral agents including soap, acid, alcohol, and freezing. It 
survives on surfaces for hours and in raw sewage for months. Flies 
spread it with their legs. Heavy doses of chlorine are needed to kill it 
in contaminated water. Effective vaccination requires several rounds. 
And it is mostly carried invisibly by children without polio 
symptoms—who are infected not only from drinking or eating something 
contaminated by feces, but also by coughing, sneezing, and kissing, 
particularly in crowded conditions. Children who do become paralyzed 
have already had the virus for one to three weeks, and as noted, each 
infected child means up to a thousand others are also silently spreading 
the infection. It is no wonder that after twenty-five years of 
eradication efforts polio persists, and in the last two years has gained 
ground.
 
Despite the threat posed by polio to millions of Syrians, the Syrian 
government has refused to take responsibility for controlling it. For 
months the Syrian Ministry of Health denied that polio had even broken 
out. In the first week of October, after widespread reports of polio in 
Deir Ezzor, a group of Syrian doctors independent from the government 
took three samples from a “hot cluster” of twenty-two acutely paralytic 
children there. The doctors were from the Assistance Coordination Unit 
(ACU), an organization set up in 2012 by the main alliance of opposition 
groups, the Syrian National Coalition, to coordinate humanitarian 
efforts in opposition-held territory.
 
Since the Ministry of Health had already refused to investigate this 
cluster and the analysis provided by the National Polio Laboratory in 
Damascus was in doubt, the ACU was advised by the US CDC to take the 
samples to a specific hospital in Turkey where polio analysis could be 
done. Even then, WHO officials ordered the Turkish hospital not to 
accept the samples, because they had been removed from the jurisdiction 
of WHO in Syria. Turkey’s Ministry of Health immediately took the 
initiative to analyze the samples itself, with the help of the CDC. As 
international scrutiny grew, the Syrian Ministry of Health accepted 
fourteen separate samples at the national lab, but then claimed the 
samples had been contaminated and maintained that the paralyzed children 
in Deir Ezzor had a rare neurological disorder.
 
Only after October 17, when the CDC confirmed that all three samples had 
tested positive for polio, did the Syrian health ministry make a swift 
about-face, “finding” polio after all in ten of its fourteen samples, 
which it had previously declared contaminated. WHO followed suit on 
October 29, finally declaring a polio outbreak. Even then, the health 
ministry made no attempt to trace the polio’s source, and it denied WHO 
permission to visit the affected areas of Deir Ezzor. WHO was thus 
barred from stool sampling, contact tracing, source identification, and 
survey of at-risk children, as well as the decontaminating of water and 
sewage or providing treatment of the affected children. By now, it is 
impossible to trace the source of the virus in Syria.
 
Yet the Syrian government claims that the polio in Deir Ezzor was 
brought into the country by an opposition fighter from Pakistan. The 
strain of polio now spreading is indeed related to strains circulating 
in Pakistan, but also to those detected in Cairo in late 2012 and in 
Israel in early 2013. So it is at least as likely that Syrians who 
previously fled the war for Egypt have brought polio back themselves. In 
Israel, where the polio virus has now been found in 140 sewers and in 
stools from forty-two people, not a single child has been affected, due 
to excellent vaccination coverage.4
 
Despite its claims to have set up an effective early-warning system in 
September 2012, the Syrian government failed to detect the polio 
outbreak in its early stages in the spring of 2013. The opportunity to 
contain the virus within a single region and prevent its spread to other 
parts of Syria was thus lost. Yet a recent December 2013 article jointly 
published by Ministry of Health and WHO officials stated that the 
early-warning system
 
is established and functional. It has succeeded so far in mitigating the 
consequences of many outbreaks, responding to a nation-wide measles 
outbreak, a typhoid outbreak in Deir ALZour, and the present polio 
outbreak.5
In fact, the government’s warning system not only missed the first case, 
it missed the first two dozen. It’s still missing them: there have been 
at least forty-six new cases since the last “official” case was 
documented by the Syrian government and WHO in October.
 
In the spring of 2013, rising concern over the risk of diseases with 
epidemic potential led the opposition group ACU to develop its own 
parallel early-warning system. Supported by the American CDC, it trained 
doctors inside Syria to detect typhoid, polio, and other infectious 
diseases. By July it had established an effective surveillance system 
across seven opposition-held governorates, and was well positioned to 
bring the polio outbreak into sharp focus with the hot cluster it found 
in Mayadin in early October. But major discrepancies exist between the 
findings of the ACU and the official figures circulated by the Syrian 
health ministry and WHO, which insist that the epidemic has been brought 
under control.
 
According to the Ministry of Health and WHO, there are still only 
seventeen confirmed cases of polio—fifteen from Deir Ezzor, one in 
Aleppo, and one in besieged Douma, a suburb of Damascus. But the Turkish 
Ministry of Health, using samples provided by the ACU, has separately 
confirmed sixteen positive cases, at least thirteen of which are in 
addition to the official figure, the most recent on December 5 in 
Ar-Raqqa, and sixty-one additional cases—all outside 
government-controlled territory. These additional cases have not been 
laboratory-tested but meet the classical criteria for polio as defined 
by the CDC, with seven new cases reported in the first two weeks of 2014.
 
Yet the official government line—now adopted by WHO and the UN— is that 
Syria remained polio-free until October, and that no new cases of polio 
have been found since October 8. WHO has gone further, standing by its 
figures and reporting to The New York Times that polio is under control. 
These are the same WHO and Ministry of Health that have made no attempt 
to verify the cases confirmed through the Turkish Ministry of Health.
 
Meanwhile, WHO, forced to toe the government line, cannot publicly 
acknowledge the Ministry of Health data, which I have seen, showing that 
a girl in Aleppo had contracted the virus in August, that the case in 
the Douma suburb of Damascus happened in September, and that in addition 
to the acknowledged seventeen cases of polio, four more meet the 
clinical criteria.Worryingly, these same official bodies report 124 
cases of “non-polio” acute flaccid paralysis, without providing proof of 
an alternative diagnosis.
 
My careful combining of the two databases—the ACU’s and that of WHO and 
the Syrian Ministry of Health—shows an absolute minimum of at least 
ninety-three cases of polio, of which at least thirty have been 
confirmed by laboratory tests.
 
Whatever the actual number is, when the first cases were confirmed by 
the CDC in October, this signaled the widespread transmission of polio 
across many parts of Syria. Moreover, the exodus of refugees caused by 
the war and particularly by Assad’s bombardment of civilians meant that 
a certain percentage of refugees already in neighboring countries must 
be carrying the virus.
 
Ironically, Syria’s children are now at greater risk than children in 
the three countries where polio is still endemic (Afghanistan, Pakistan, 
and Nigeria) because they lack the natural immunity that comes from 
exposure and because the spread of polio by respiratory means is 
aggravated by the crowded conditions under which millions now live.
 
To avert a polio epidemic, a surveillance system is required that can 
trace affected children and contacts more rapidly than the virus 
spreads, but the government’s sloppy surveillance and months of denial 
mean that it is now impossible to contain it. The government should have 
allowed access to contested areas to reach affected children. It should 
also have mounted a widespread water decontamination effort, as well as 
monitoring sewers nationwide the way Israel is successfully doing. The 
government’s response, supported by WHO, has been to mount a belated and 
poorly designed vaccination campaign. It claims without proof that 2.2 
million children have received one dose of vaccine.
 
To reach all children, the best practice—and WHO’s and UNICEF’s 
international standard—is to conduct a door-to-door campaign. In late 
November, the Syrian government and the UN finally sent hundreds of 
thousands of vaccines to some contested areas. But while the UN claims 
that some of these vaccines have been delivered “door-to-door” in Deir 
Ezzor, doctors in the region report that the campaign has largely relied 
on people at the dwindling number of health centers, leaving it to 
parents to hear of the vaccination campaign and bring their children 
there. The UN also now acknowledges that it has missed 800,000 children 
who reside in “inaccessible areas,” including Aleppo, rural Idlib, and 
rural Damascus.
 
In some places, the government has not installed a “cold chain”—the 
linked refrigerated facilities needed to keep the oral vaccine frozen 
and viable. The oral vaccine requires multiple doses over several 
months, but according to the Qatari Red Crescent, which is monitoring 
the vaccination effort, the Syrian government is not keeping records to 
show which children have been vaccinated, where, and how many times, or 
which are still at high risk. Many Syrian government staff have been 
simply carrying vaccine around in plastic bags during the relatively 
warm fall. Some government health workers are reportedly charging $1 per 
head for what should be a free service, and vaccines have even shown up 
in private pharmacies.
 
Despite claims by both the Syrian government and WHO that the campaign 
has reached most children at risk, the government’s vaccination effort 
is focused on children in government-controlled areas, where hospitals 
are open and food, clean water, and fuel are available, while neglecting 
the children in the opposition-held areas where polio has actually 
broken out. In those areas, the government continues to attack 
civilians, hospitals, and schools.6
 
The officially reported numbers about children vaccinated have been as 
inconsistent and unreliable as the numbers about children stricken by 
polio. The joint Syrian government/WHO campaign ostensibly began on 
October 24, targeting 1.32 million Syrian children “at risk” for polio 
under age five.7 This figure has been heavily revised upward several 
times since then, as the government responds to growing evidence that 
the number of unvaccinated children is much higher, most recently on 
January 6. (There are nearly four million children under five in Syria.) 
On December 16, Syrian Minister of Health Saad al-Nayef said that “the 
biggest number of the vaccinated children was in the eastern city of 
Deir Ezzor, reaching nearly 294,000 children while 269,000 were 
vaccinated in Hama and 247,000 in al-Hasaka.”8 The UN has meanwhile 
cited even higher figures, stating, for example, that 307,105 children 
had been vaccinated in Deir Ezzor.
 
WHO has been heavily criticized for leaving Deir Ezzor out of a polio 
campaign in December 2012, apparently having been told by the government 
that the province was depopulated due to the conflict. The Syrian health 
minister denies as “baseless and untrue” a Reuters report that “Deir 
Ezzor was excluded from the vaccines,” while Elizabeth Hoff, head of WHO 
Syria, reiterated to me recently: “WHO within a sovereign country has to 
accept the government’s position.” It remains unclear whether the 
government lied to WHO, whether it informed them it had no interest in 
vaccinating Deir’s children or chlorinating its water, or whether it 
couldn’t convince SARC to deliver the vaccines after having shot several 
SARC workers in Deir city.
 
Meanwhile, the UN backs the regime’s claims with various press releases: 
“538,000 vaccines airlifted to Hassake,” reads one UNHCR report; “3.3 
million children vaccinated against polio,” states another by UNICEF and 
WHO. But even the numbers cited by WHO and the regime are inconsistent 
and regularly changed.9
 
We are told nothing about the children already infected. The acute 
flaccid paralysis described in official accounts of polio sounds 
straightforward, but in fact, as I have found during fifteen years 
working in war-torn countries, polio is hard to recognize in real time. 
Most children with polio exhibit paralysis of just one leg, which may 
have begun weeks earlier during a cold or gastroenteritis along with 
symptoms such as fever, headache, sore throat, and myalgia. Yet colds, 
diarrhea, and fever are common, particularly in the conditions now 
prevailing in Syria. Flu causes headaches and myalgia all the time.
 
In December, I tracked down one of the few pediatricians in Deir Ezzor 
governorate, who said he had recently seen
 
a one-year-old, a boy displaced from al-Hasakeh. His mother took him to 
many clinics because he wasn’t crawling or moving his right leg any 
more. It happened after a cold, she said. Three months ago. Actually his 
whole right leg became paralyzed, but he was given the wrong 
diagnosis—of hip dysplasia. He wasn’t vaccinated—there aren’t vaccines, 
she said.
Appalling as polio is, 30 percent of children who suffer acute paralysis 
will recover completely within weeks or months, and another 30 percent 
will end up with only mild paralysis—if they receive appropriate 
treatment, effective physical therapy, and good nutrition to restore 
muscle function. All of these are rare in Syria today. Support by the 
victims’ families—for rehabilitation and to correct stigmatizing myths 
of infertility and affected intelligence—is essential. Sadly, it is 
common practice in Syria to give intramuscular injections—whether of 
antibiotics or pain relievers, for example—which can exacerbate all the 
causes of permanent paralysis.
 
Infants and toddlers are more likely to suffer acute paralysis of limbs; 
older children are at greater risk of paralysis of the breathing 
muscles, so that without respiratory support the child will suffocate. 
Yet because the Syrian government has decimated the ranks of doctors, 
nurses, and physical therapists, and because it has deprived whole 
cities of food, paralyzed children have much less chance of making it 
through the acute stage, let alone of full recovery. Speaking to a 
doctor who had examined a thirteen-month-old girl from Spighan, I was 
told of weakness in her legs and chest, a weak cry, and a poor 
cough—signals of respiratory distress. When I asked what was being done 
for her, he replied: “There is no way to measure saturation, monitor 
respiration, or ventilate—no electricity for about a year now, let alone 
oxygen. Supplies stopped two years ago. All I could do was diagnose her.”
 
On October 2, the UN Security Council unanimously adopted a statement by 
the UN president urging the protection of civilians, access to besieged 
communities, and humanitarian assistance across internal lines and 
international borders. However, the Syrian government continues to 
forbid the UN and its agencies to provide cross-border aid from Turkey, 
although this is by far the easiest and most efficient way to reach many 
of the 2.5 million children in most urgent need of food, water, and 
vaccination. The UN’s humanitarian chief, Valerie Amos, says that 
cross-border aid remains “a red line for the Syrian government.”
 
Given the serious questions about the government’s response to the polio 
outbreak, several nongovernmental organizations, guided by the ACU, 
banded together in November to form the Polio Task Force to meet the 
needs of the estimated 2.7 million children most at risk. The task force 
established a cold chain across seven governorates in northern Syria, 
trained more than six thousand health care workers, and raised awareness 
in at-risk communities.
 
But the ACU effort has been stymied by a lack of vaccines—neither 
Damascus, WHO, nor UNICEF would or could provide them. Doctors Without 
Borders–Holland tried to buy polio vaccines directly from a 
manufacturer, but UNICEF, acting on the Syrian government’s behalf, was 
forced to block it. Only in the last days of December was the Turkish 
government able to facilitate the provision of 2.5 million doses of 
vaccine—enough for one round—for use in Syria. A midwinter campaign for 
Syria’s children outside government-controlled areas began in early January.
 
Turkey vaccinates children who cross its border or live in refugee camps 
on its territory, but for children inside Syria, the Syrian government 
will not let WHO or UNICEF help the ACU. The UN agencies have chosen to 
maintain good relations with the government and access to 
government-controlled areas rather than demanding access to children at 
risk, and they fear expulsion if they do so. Unofficially, they freely 
acknowledge that there are unvaccinated children in many parts of Syria.
 
Although jihadists are increasingly dominant in many 
opposition-controlled areas, when I revisited the Turkish border in late 
December they were not blocking Syrians from conducting the polio 
campaign or leading medical convoys. The recent abduction of five 
international workers for Doctors Without Borders and the execution of 
an activist Syrian doctor, apparently by the al-Qaeda-linked ISIS, raise 
valid concerns about the safety of international and national aid 
workers. But the ACU’s cross-border campaign to vaccinate 2.7 million 
children has been facilitated by the Free Syrian Army and the Islamic 
Front, a group of rebel militias that this month began attacking the 
ISIS. Hundreds of ACU employees across northeast Syria are conducting a 
door-to-door campaign, coordinated with local councils, villages, and 
municipalities, which began on January 2. The ACU negotiated permission 
from all opposition groups, including the ISIS and al-Nusra. When one 
campaign leader heading a convoy of doctors and vaccines was arrested on 
January 1 at an ISIS checkpoint in Aleppo, he was quickly released. 
“Even ISIS recognizes the radical threat of polio, getting us and 
vaccines across borders where the WHO cannot,” I was told by Khaled 
Almilaji, who is coordinating the campaign led by the Polio Task Force.
 
Parallel with the Syrian government’s efforts, the UN and WHO have 
mounted an effort in the neighboring countries to try to mitigate the 
spread of polio beyond Syria’s borders. The plan is to vaccinate 22 
million children over the next six to eight months.10
 
But by ignoring the epicenter of the epidemic, the UN facilitates 
Assad’s forced-displacement strategy, creating an incentive for 
civilians in opposition-held areas to flee abroad, where the chances of 
protecting their children from both bombs and polio are greater. As 
asylum seekers and smuggled migrants spread across the region, they put 
other Middle Eastern countries and Europe at risk of polio. The flurry 
of international humanitarian activity away from the epicenter of the 
polio outbreak diverts attention from Assad’s other ongoing atrocities.
 
What would an effective response to the outbreak of polio in Syria look 
like?
 
First, vaccination is a critical component, if the substantial 
deficiencies in the government’s program are rectified, and the ACU is 
fully supported. Starting vaccination at birth is essential.
 
Second, adequate nutrition is urgently required both for effective 
uptake of the vaccine as well as to protect vulnerable children from 
succumbing to polio. Both the ACU and the Ministry of Health report that 
40 percent of children afflicted by polio paralysis had been partially 
or completely vaccinated. This means either that the vaccine was not 
viable when administered or that vaccination cannot protect starving 
children. An effective response to polio has to include a vast increase 
in the quantity and quality of food delivered to all areas in need 
regardless of the military force controlling the local population, 
including besieged areas.
 
Third, clean water is essential. According to a UN study, 4.4 million 
Syrians lack safe and sufficient water for daily needs, and the 
situation has seriously worsened within the last month.11 Containing 
polio—not to mention preventing a comeback of cholera—requires 
decontaminating water, treating sewage, and restoring sanitation. 
(Removing the piles of trash all over the country, currently excellent 
breeding grounds for flies and other vectors of disease, would help 
considerably.) Clinical surveillance must be supplemented by 
environmental surveillance so that polio can be detected before children 
succumb to it, which requires unimpeded access by public health experts.
 
Fourth, children with polio must be treated. Syrian doctors and physical 
therapists are not familiar with polio, so they must be supported. Beds, 
splints, ventilators, oxygen, and a constant electricity supply must be 
put in place. WHO does not help when it claims on its website that “the 
only effective treatment is vaccination” or that polio causes “permanent 
paralysis within hours.” Neither is true, and the effect is to write off 
stricken children.
 
Fifth, the overcrowding of living quarters that has facilitated the 
rapid spread of contagious diseases must be addressed. Cold makes the 
effects of polio worse—tents should be replaced with solid structures.
 
Sixth, we must face reality: these vast essential needs will not be met 
by the Syrian government. And they will not be met if all international 
assistance must be channeled through Damascus. WHO, UNICEF, and other 
international agencies must be free to launch cross-border operations. 
But that will happen only if ordered by the UN Security Council. The 
current presidential statement only “urges” such cooperation—the most 
that Russia would allow, and so far not enough to convince Syria to 
cooperate. A UNSC resolution mandating cross-border aid is required.
 
Finally, the international community should stop pretending that mere 
vaccination is the answer. Nor should it accept the Syrian government’s 
efforts to pretend to be doing something to address the humanitarian 
needs of civilians in opposition-held areas while continuing its 
deliberate strategy—which amounts to a war crime—of making life as 
miserable as possible for the people living there. Rather than diverting 
attention from the regime’s war on civilians, the global threat posed by 
this polio epidemic provides the imperative for ending it.
 
—January 20, 2014
 
1
Oxford Research Group, Stolen Futures: The Hidden Toll of Child 
Casualties in Syria, November 2013. ↩
 
2
The last confirmed case was imported in 1999. VDVP (type 2) was isolated 
from one or more immundeficient persons in 2006. ↩
 
3
“Syrian Arab Republic: WHO and UNICEF Estimates of Immunization 
Coverage: 2012 Revision,” July 2, 2013. ↩
 
4
“Wild-type Poliovirus 1 Transmission in Israel—What Is the Risk to the 
EU/EEA?” European Centre for Disease Prevention and Control. ↩
 
5
Ghada Muhjazi et al., “An Early Warning and Response System for Syria,” 
The Lancet, December 21, 2013. ↩
 
6
“Draft Press Statement on Aleppo Strikes Under Silence,” UN Security 
Council “What’s in Blue” Series, January 8, 2014. ↩
 
7
Syrian Arab Republic Polio Situation Report No. 1, November 7, 2013. ↩
 
8
“Minister: 2.177 Million Children Vacciated Against Polio” and “WHO: 
Syria’s Response to Polio Virus Swift and Qualitative,” Syrian Arab News 
Agency, December 23, 2003, and January 5, 2014. ↩
 
9
“Paralysis: How Political Deadlock Is Failing to Stop Polio in Syria,” 
Médecins Sans Frontières blog, December 11, 2013. ↩
 
10
“Over 23 Million Children to Be Vaccinated in Mass Polio Immunization 
Campaign Across Middle East,” UNICEF and WHO joint press release, 
December 9, 2013. ↩
 
11
Syrian Integrated Needs Assessment, led by OCHA. ↩
-- 
Namib
.....
Sherif of Wazan: Great Raisuli, we have lost everything. All is drifting 
on the wind as you said. We have lost everything.
Raisuli: Sherif, is there not one thing in your life that is worth 
losing everything for?
[they both begin to laugh]

Presto, una manifestazione di solidarieta' per i palestinesi! Appuntamento davanti alla scuola ebraica! Chi porta le bare? 

 Presto, una manifestazione di solidarieta' per i palestinesi! Appuntamento davanti alla scuola ebraica! Chi porta le bare?
 
La poliomielite (altrui) ti mette di buon umore, vedo.


 La poliomielite (altrui) ti mette di buon umore, vedo.
 
tu vedi i tuoi cazzo di pregiudizi, Namib.
Facciamo un breve ripasso
a) medici israeliani ed ebrei della Diaspora entrano clandestinamente (protetti dall'esercito di Gerusalemme) in Siria per prestare cure.
MA Per Namib e Tondelli occorre smarcare ebraismo da sionismo. Magari ci mandiamo medici musulmani, eh?
b) questi medici vantano una enorme esperienza, dovuta (anche) alla situazione in cui si trova lo Stato ebraico, sottoposto a minacce di distruzione ed attacchi terroristici 
MA Per Namib occorre far pace con i terroristi, per Tondelli c'e' poco da piangere quando crepano bambini ebrei in Francia, per Arrigoni (che per Namib non era così cattivo) Israele va distrutto
c) quando in Siria il casino ha iniziato a farsi grave, io ho iniziato a versare 50 GBP al mese tramite il World Jewish Relief. Ho pure invitato a farlo sul mio blog (che Namib non legge) e tramite i commenti al blog di Tondelli. com 50 GBP al mese si assicurano cure mediche per 100 persone, per sei mesi.
INTANTO Namib cosa ha fatto? E chi lo sa. Pero' non una parola di autocritica, lui che -come molti altri- ha dedicato tante energie a criticare lo Stato ebraico. Il Modenese intanto e' allagato, e una altra volta i concittadini di Tondelli beneficeranno della assistenza israeliana e degli avanzamenti tecnologici di quello Stato che Tondelli e Namib vorrebbero rendere meno ebraico.
 

 tu vedi i tuoi cazzo di pregiudizi, Namib.
 
Tu vedi ebrei dappertutto, anche quando non se ne parla affatto (e nella 
fattispecie dell'art. se ne parla, sia pure en passant, molto bene). E 
continui ad attribuirmi (e non è certo una novità) cose che non ho mai 
detto. Che du' palle, francamente.


 
 
ganzo, Namib
prima decide che io voto Likud (perché' tutti i sionisti sono cattivi ed estremisti)
poi fa sapere che i contadini della Galilea non avrebbero diritto di voto (perché i sionisti sono razzisti e stabiliscono l'apartheid vedi ad esempio come Jabotinsky andava d'accordo con i boeri)
e ora ha deciso che la morte altrui sollazza il sanguinario sionista tribale ed identuitario.
 
in tutto questo, coprendo il sottoscritto di ogni possibile insulto, Giuseppe Lucchesini ala Namib si guarda bene dal criticare gli sproloqui antisemiti, i deliri razzisti, i progetti genocidi di Leonardo Tondelli o Vittorio Arrigoni. Perché' lui non aderisce ad alcun branco indennitario. 
 
Il problema e' che di gente come Namib, nella sinistra italiana, ce ne e' molta. Gente per la quale i tribali sono sempre gli altri, e i palestinesi sempre più' deboli e gli israeliani sempre troppo forti e troppo ebrei.
 
Come sono contento di essermi lasciato alle spalle quel mondo

 detto. 
 
ah, non hai mai detto che io voterei Likud?

 comica ossessione
 
Parole sante.


 Il problema e' che di gente come Namib
 
:)


 :)
 
tutto ad un tratto si diverte. Si vede che la poliomielite stavolta lo fa ridere.

 tutto ad un tratto si diverte.
 
Tutto ad un tratto (ma no: è da tempo) *mi diverti* --- o i tuoi 
commenti hanno qualcosa a che fare con i casi di poliomielite in Siria 
(una faccenda che mi sembra ben più grave delle tue oclofaide con 
Tondelli, con me, e con chiunque abbia la buffa ventura di inciampare 
nelle tue umoristiche ossessioni)?


 commenti hanno qualcosa a che fare con i casi di poliomielite in Siria 
 
che sarebbe dove io spedisco una certa somma ogni mese, che a qualcosa serve perché' c'e' personale capace, appartenente chissa' come mai a una minoranza etnico-religiosa, e che arriva in loco grazie alla presenza nei pressi, di uno Stato popolato in massima parte dalla suddetta minoranza etnico-religiosa, Stato che tu (che in loco non spedisci nulla (1)) vorresti rendere meno etnico e meno religioso.
 
(1) ma rilevi, calunniando (2) che la poliomelite fa divertire altri. 
(2) calunniando un ebreo. Quando si dice la coincidenza.

 licenziare il boia.
 
Ormai, sarebbe il caso di decidere se licenziarlo dalla realtà & amen. A 
questo punto, se Assad cadesse dalle scale e si rompesse l'osso del 
collo, immagino che riceverebbe solenni encomi dagli ambasciatori russi 
e cinesi, ma suppongo altresì che costoro sarebbero ben lieti di 
togliersi dai coglioni un macellaio dotato della peggior caratteristica 
che un macellaio possa avere: l'inutilità.


 guerra. E invece...
 
e invece siamo in Italia e la gente si mobilita molto per i morti in medio oriente solo quando serve come pretesto per attaccare Israele, fare manifestazioni davanti alle sinagoghe, gettare qualche anonima bara in quota sindacato ecc. ecc. 
Una ipocrisia denunciata persino da Al Jazeera, che e' tutto dire.

 che a qualcosa serve perché' c'e' personale capace
 
Intendi dire che sei altrove, immagino.


 sei altrove, immagino.
 
Metto mano al portafoglio perché' dubito di poter essere utile in altro modo. Piuttosto, dove sono gli aiuti che i marxisti stan porgendo alle popolazioni colpite dalla poliomielite? 
Siete impegnati nelle manifestazioni pro Palestina?

 Ormai, sarebbe il caso di decidere se licenziarlo dalla realtà & amen.
 
ma non mi dire. Poi chi resta a difendere la bandiera dell'internazionalismo? il Paciugotto nordcoreano, Fidel Castro e Slavj Zizek?

 attingendo al sempiterno repertorio
 
Vai tranqui: sei scimunito in proprio, non collettivamente. O la 
scimunitaggine fa parte di un "sempiterno repertorio"? :)
 
"ah, se solo Israele
 
...di cui nessuno ha parlato, ma che riusciresti a ficcare anche in un 
discorso vertente sui lepidotteri!".


 ...di cui nessuno ha parlato, 
 
Quindi non e' vero che risolvere la tragedia dei palestinesi (causata dalle pretese ebraiche di sovranita') porta a risolvere tutti i problemi del Medio Oriente?  No, perche' non molto tempo chi lo sosteneva (io) si prendeva da te del fascista (o dell'elettore del Likud, che poi -sempre secondo te- e' persino peggio) [1].
Fai una figura migliore se ammetti di aver sostenuto molte dogmatiche cazzate.
 
[1] coraggio, magari ce la fai pure a vedere che lo status quo tra Israele e i palestinesi potrebbe persino continuare. Con beneficio di entrambi

 Quindi non e' vero che risolvere la tragedia dei palestinesi
 
Nessuno ha parlato nemmeno dei palestinesi. Senti le voci?


 Nessuno ha parlato nemmeno dei palestinesi.
 
SENSAZIONALE! Vuol dire che, a pochi kilometri dalla Palestina, ci sono arabi che se la passano peggio di loro? No, perche' non molto tempo chi lo sosteneva (io) si prendeva da te del fascista (o dell'elettore del Likud, che poi -sempre secondo te- e' persino peggio) [1].


 SENSAZIONALE!
 
Ma no, è normale. Si parlava d'altro.


 che un macellaio possa avere: l'inutilità.
 
non direi che il garante di più che apprezzabili accordi commerciali sia 
considerato sia dalla Cina che dalla Russia come inutile, altrimenti non 
si spiegherebbe il matrimonio che dura da così tanti anni tra Mosca e 
Damasco...ultimamente rafforzato da una dote di tonnellate di armamenti 
russi per Assad, evidentemente ti sei perso tre anni di conflitto siriano...


Né Pechino né Mosca moriranno per Damasco, la cui produzione petrolifera 
è circa 4 volte quella della Basilicata, e la cui complicata 
strategicità è più un'eredità del passato che una promessa dell'avvenire.


 strategicità è più un'eredità del passato che una promessa dell'avvenire.
 
http://rt.com/business/syria-oil-gas-russia-795/
 
http://www.ilfattoquotidiano.it/2013/07/02/siria-500milioni-di-dollari-al-mese-da-cina-iran-e-russia/642559/
 


http://petrolio.blogosfere.it/2012/03/siria-export-land-model-e-motivi-di-irritazione.html
 



lo sai che la tenutaria di quel blog, che mi pare sia laureata in lettere, tipico titolo di studio di esperti di petrolio,  l'ha chiuso per andare a lavorare per Grillo, vero? :D

 lo sai che la tenutaria di quel blog, che mi pare sia laureata in lettere, tipico titolo di studio di esperti di petrolio,  l'ha chiuso per andare a lavorare per Grillo, vero? :D
 
E questo accresce o diminuisce il numero di barili di petrolio 
attribuibili alla Siria e alla Basilicata?



mi pare un po' confuso come articolo, fra l'altro si vede bene che la 
produzione supera i consumi fino al 2009, ora i russi andranno ad 
implementare ulteriormente le capacità estrattive nell'aria abbastanza 
poco esplorate...sempre che Assad non cada prima...fra l'altro il 
problema di questi anni è che le aree petrolifere sono finite sotto il 
controllo dei ribelli, non a caso Assad ha pensato bene di affidarsi ad 
Al Qaeda per recuperarne una parte vendendo parte di quel petrolio 
sottobanco e passando i proventi alla false flag qaedista


ah ecco :-)