Pakistani Taliban’s Deadly Cocktail –Terror and Polio

Monish Gulati

A police escort was killed and another wounded when militants attacked a team of polio vaccinators on the outskirts of Peshawar on 30 November.¹ Earlier on 23 November, militants in Pakistan kidnapped eleven teachers involved in a polio vaccination campaign for school children at a private school in the Bara area of the Khyber tribal agency. The militants took the teachers to an area controlled by Taliban-affiliated Lashkar-e-Islam group.² These incidents are amongst a string of senseless attacks carried out over the last few years by the Pakistani Taliban (or the Tehrik-i-Taliban Pakistan-TTP) on health workers working under Pakistan’s polio immunisation programme. This article looks at the impact of these actions of the TTP on Pakistan’s efforts to rid itself of polio, particularly after medical evidence has indicated that Pakistan may have contributed to the spread of the disease to Syria, and implications this holds for India.

A strain of the virus that originated in Pakistan has caused polio and crippled at least 13 children in Deir al-Zor, Syria, where an outbreak was detected in October. Genetic sequencing has confirmed the origin of the virus strain found in Syrian children. According to the Assistant Director-General for Polio, Emergencies and Country Collaboration at the World Health Organisation (WHO), the virus has travelled over land to Syria³ and is spreading across the Middle East. Emergency plans are being implemented to vaccinate more than 20 million children in the region.⁴ Closely related strains of the wild polio virus of Pakistani origin have also been detected in sewage samples in Israel, the West Bank and Gaza Strip since February 2013. The vaccinations are to be carried out in Egypt, Iraq, Jordan, Lebanon, the Gaza Strip, West Bank, Syria, and Turkey.⁵

Pakistan

Pakistan is one of three nations in the world (others being Afghanistan and Nigeria) where polio remains endemic. Efforts to stamp out polio in Pakistan through an oral immunisation programme have been on since 1994. The programme had begun to yield results; in 2011 there were 198 new recorded cases of polio in Pakistan, while in 2012, there were just 58. However, the official number of polio cases detected so far this year, have risen to 72. Most of the polio cases have been detected in Pakistan's tribal regions; 19 cases from North Waziristan, 17 from Khyber, 9 from Khyber Pakhtunkhwa province, 6 each from Bannu and Punjab, and 4 from Sindh have been reported so far this year.⁶

The Pakistani polio programme was initially targeted by the clergy and the Taliban who declared the vaccination as a Western ploy to render Muslims sterile by alluding to the fact that it was receiving foreign financial assistance. However, there was little improvement in the situation even after the funding of the programme was taken over by the Pakistani government with the assistance of the Bill and Melinda Gates Foundation (B&MGF), which had pledged to pay the seven per cent annual interest on the $227 million loan the Islamic Development Bank had provided to Pakistan for polio immunisation.

Another misconception is that the polio vaccine contains materials forbidden by Islam, such as alcohol and pig’s blood.⁷ The misconceptions are worse among the Pashtun population. Officials associated with the programme, however, blame it on the country’s failure to ensure quality polio vaccination, preventing immunisation refusal and the inability to reach all children under five years of age.⁸

Since July last year, 24 health workers and policemen providing protection to these health workers have been killed and 14 others injured in 24 targeted attacks on vaccinators in different parts of the country by the Taliban.⁹ The most recent attack having taken place on the outskirts of Peshawar when two people were killed and 13 wounded in a bombing that targeted polio workers.¹⁰ Attacks on health workers have not been restricted to the north of the country; in December 2012, gunmen killed four women working on a government polio vaccination campaign in Karachi.

Other Factors

Besides vaccination refusal, denial of access to certain restive areas is a major cause for the rise in polio cases. According to reports, the authorities in FATA were unable to vaccinate around 900,000 targeted children either due to the TTP’s ban on vaccination in North and South Waziristan agencies last year or due to military action against militants in other agencies.

Many Pakistanis have viewed polio vaccination campaigns with suspicion after the CIA's use of a fake vaccination program in 2011 to collect DNA samples from residents of Osama bin Laden's compound to verify his location. The policy gave credence to the conspiracy theories in circulation. Last year, a Taliban commander in northwest Pakistan announced a ban on polio vaccines for children in the region as long as the US continues its campaign of drone strikes in the region. The TTP also believes that western powers are using polio vaccination programmes as a cover for espionage. ¹¹

However, many experts believe TTP’s strategy goes deeper. “It’s another way of trying to control the population through fear”. The difference in perception between the Afghan Taliban and the TTP on such issues gives credence to this notion. Mullah Omar had issued a statement that called for a change in the Taliban attitude, particularly towards women’s rights and education. In May 2013, the Afghan Taliban endorsed polio vaccination saying, “According to the latest international medicine science, the polio disease can only be cured by preventive measures i.e. the anti-polio drops and the vaccination of children against this disease. The Islamic Emirate of Afghanistan supports and lends a hand to all those programs which works for the health care of the helpless people of our country.”¹² Mullah Omar has allowed polio immunisation in Taliban dominated areas of Afghanistan since 2007.¹³

The Afghan Taliban proceeded to warn organisations not to attack polio immunisation teams. The Taliban ‘advisory’ was applicable to all its affiliates including the TTP. However the TTP continued with its targeting of Pakistani health workers carrying out polio-immunisation; drawing international condemnation. These acts, amongst others including kidnapping and extortion, were reported to have deeply strained the relations between the TTP and Mullah Omar.

Gender Aspect

It has been suggested that there is a gendered aspect to TTP’s actions based on the recent history of militant violence being directed against “lady health workers”, a body of more than 100,000 women who deliver door-to-door healthcare.¹⁴ The lady health worker programme was initiated by Benazir Bhutto in 1994, and for many women and girls in remote areas, they provide the only direct access to healthcare. A 2012 study published in the British Medical Journal looked at how the Taliban threatened and attacked female health workers in Swat during their brief period of control of the area. Lady health workers were socially ostracised after public vilification by the TTP. The study also found that many Lady health workers stopped working or left the area due to the threat to their lives.

Afghanistan

According to the Global Polio Eradication Initiative, Afghanistan is one of three countries in the world where polio remains endemic. There have been 8 confirmed cases of polio in 2013 (as of October) and 37 reported cases in 2012, which were confined to the southern provinces, specifically within thirteen districts in the provinces of Helmand, Kandahar, and Uruzgan. However, the eight cases of polio confirmed in 2013 are located in the eastern provinces of Nangarhar and Kunar. Same has been confirmed by WHO, which said that polio has been eradicated across the country except Kunar and Nangarhar provinces (which are adjoining FATA).¹⁵

India

WHO removed India from the list of polio-endemic countries in March 2012 after India successfully completed an entire year without an incidence of polio. However, India will have to remain polio free for two more years before it is declared polio-free by the WHO.¹⁶ India is alive to the possibility of the polio virus entering the country through transnational movement of people, particularly from Pakistan and Afghanistan. The Central government has alerted all the States bordering the neighbouring countries to strengthen surveillance. Special booths have been established on the Wagah border and Attari and Munabao train stations to ensure that all children under the age of 5 coming from across the border are given polio drops.

In 2012, after WHO removed India from the list of polio-endemic countries, Dr. Zulfiqar A. Bhutta, a vaccine expert at Aga Khan University’s medical school in Karachi, stated “[n]othing wounded our pride as much as that”. Following the WHO announcement, Pakistan’s government went on an emergency footing. A cabinet-level “polio cell” ¹⁷ was created and various mullahs were drafted to endorse the vaccination campaign in order to dispel persistent rumours and to give moral legitimacy to the program. The mullahs subsequently issued 24 fatwas in favour of vaccination and the same was disseminated to the public through the health care workers.

Impact

Given the current situation where Syrians refugees in neighboring countries have topped two million and that the immunization level in these areas is not reassuring, the risk of further spread of the wild poliovirus across the region is considered to be high. A surveillance alert has been issued to actively search for additional potential cases. Lebanon, which hosts more than 800,000 Syrian refugees, is vaccinating all children under five. In Europe, experts have warned that the Syrian refugees could inadvertently bring polio virus to Europe.¹⁸ The issue has further complicated the humanitarian crisis arising out of the Syrian conflict.

Back in Pakistan, the government has included polio vaccination programme on the agenda for the proposed dialogue with the Taliban groups. Imran Khan’s new provincial government in KPK is planning to give polio workers weapons licenses to carry their own guns.¹⁹ However, the issue remains complex not only because of the TTP and insurgency in FATA but because of the fact that the polio virus is also endemic to Afghanistan and that Pakistan hosts large number Afghan refugees. This worsening situation in Pakistan has the capability to negate the positive gains seen in Afghanistan as cross-border movements in the region could see a resurge of polio in the region.

India on the other hand, besides escalation of terrorism post-2014, would also be mindful of the polio virus as a destabilized region could see refugee movements into the country at a time it would be celebrating the success of its decades-long ‘Pulse-polio’ programme.

(The author is an independent analyst based in New Delhi)

Endnotes

1. Polio cop, 3 soldiers killed in attacks, The Nation, December 01, 2013. http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/na...
2. Jibran Ahmad. Pakistan militants kidnap 11 teachers in polio vaccination campaign, Reuters, November 23, 2013. http://news.yahoo.com/pakistan-militants-kidnap-11-teachers-polio-vaccin...
3. Syed Fazl-e-Haider. The virus of extremism fuels the spread of polio in Pakistan, The National, November 2, 2013. http://www.thenational.ae/thenationalconversation/comment/the-virus-of-e...
4. Stephanie Nebehay Polio strain in Syria originated in Pakistan, WHO confirms, Reuters, Nov. 11, 2013. http://www.nbcnews.com/health/polio-strain-syria-originated-pakistan-who...
5. WHO: Pakistan Polio Strain In Syria, RFE/RL, November 12, 2013.
   http://www.rferl.org/content/pakistan-polio-syria/25165286.html
6. Ashfaq Yusufzai. Polio incidence higher than last year, Dawn, November 13, 2013.
   http://dawn.com/news/1056082/polio-incidence-higher-than-last-year
7. Samira Shackle. The struggle for a Polio-free Pakistan, NewStatesman, June 252013. http://www.newstatesman.com/politics/2013/06/struggle-polio-free-pakistan
8. Ser 6.
9. Ser 3.
10. 2 killed in blast targeting Pakistani polio workers, CNN, October 8, 2013. http://edition.cnn.com/2013/10/07/world/asia/pakistan-polio-workers-attack/
11. Ser 3.
12. Zubair Babakarkhail and Dean Nelson. Taliban renounces war on anti-polio workers, The Telegraph, May 13 2013. http://www.telegraph.co.uk/news/worldnews/asia/afghanistan/10053981/Tali...
13. Yaroslav Trofimov. ‘Risky Ally in War on Polio: the Taliban,’ WSJ, January 15, 2010. http://online.wsj.com/news/articles/SB126298998237022117
14. Ser 7.
15. BBC Pashto, November 19, 2013.
16. Aarti Dhar. India no more a polio-endemic country: WHO, The Hindu, February 25, 2012. http://www.thehindu.com/sci-tech/health/india-no-more-a-polioendemic-cou...
17. Khoso directs revival of Polio Cell, Dawn, June 02, 2013.
    http://dawn.com/2013/06/02/khoso-directs-revival-of-polio-cell/
18. Owen Bennett. Europe at risk of polio outbreak as refugees flee Syria, Express, November 8, 2013. http://www.express.co.uk/news/world/441872/Europe-at-risk-of-polio-outbr...
19. Ser 7.  

Test of democracy in Pakistan

Amb Satish Chandra, 

Dean, Centre for National Security and Strategic Studies

Apart from being the first elections to be conducted by a legitimately constituted civilian set-up on completion of a full term by a democratically elected government, Pakistan’s upcoming elections scheduled for May 11, 2013, are notable in more than one way.

Firstly, this will be the bloodiest election in Pakistan’s history. From April 21 to 28 alone, there were as many as 20 attacks on political parties, resulting in 40 deaths and 190 wounded.

Secondly, there is no single overwhelming factor to influence voting like the sympathy wave that brought the Pakistan People’s Party (PPP) to power in 1988 and 2008.

Thirdly, a relatively unknown factor will influence the outcome, in terms of the youth vote with 31 per cent of the voters aged between 18 and 29.

These elections, like the ones held earlier, will not be free and fair as the heavy hand of the Tehrik-i-Taliban Pakistan (TTP) has been evident right from the scrutiny of candidates to election rallies. Electoral officers have been influenced by it, with a wink and a nod from the army and the judiciary, to rigidly interpret Articles 62 and 63 of the Constitution to disqualify “undesirables” from the elections. For instance, doubts about the absence of anyone’s Islamic credentials have been invoked to disqualify many a candidate. Inevitably, this has most hurt left of centre parties like the PPP, Muttahida Quami Movement (MQM) and Awami National Party (ANP). These parties have also been specifically targeted by the TTP through physical intimidation because of their “secular” leanings and endeavours to take on militancy. As a result, they have not been able to campaign effectively and their election rallies have been few and far between. Thus, the election scene is skewed in favour of Islamist candidates and right of centre parties like Imran Khan’s Pakistan Tehreek-e-Insaf (PTI), Pakistan Muslim League (N) and a slew of Islamic parties like the Jamaat-i-Islami and the JUI (F).

This, coupled with the anti incumbency factor generated by years of massive misrule, will result in a sharp decline of seats won by the PPP and its allies, notably the MQM, ANP and PML (Q).

The PPP, hitherto was the largest party in Pakistan with 126 seats in a house of 342, is likely to get no more than 60-70 seats on account of the reasons cited above, extreme demoralisation and the absence of any star campaigner like Benazir or the sympathy factor. It will take massive losses in Khyber Pakhtunkhwa and Baluchistan where the increasingly radicalised electorate will be much more supportive of right of centre and Islamic parties. It is likely to get only five or six seats as against the 19 in the previous elections. In Punjab, too, from where it obtained 63 seats in the last elections, it will possibly witness major losses as it is clearly unpopular in urban Punjab and may be expected to obtain around 30 seats mainly from Southern Punjab. In Sind, it will retain its core support but as against the 40 seats it secured in the last elections it is likely to only get around 30.

Nawaz Sharif’s PML(N), the second largest party in the last elections with 91 seats, of which as many as 81 were from Punjab, is widely expected to emerge as the largest party with a projected 110 to 120 seats in the upcoming elections. This will, however, not enable it to form a government on its own even if it is able to win over many independents. The party’s somewhat improved showing will result from the absence of any anti-incumbency factor as its rule in Punjab had provided acceptable levels of governance and had certainly not been disastrous. The decimation of the PPP vote bank and that of the latter’s ally PML(Q), which in the last elections got as many as 35 seats in the Punjab, and PML(N)’s own conservative Islamic affiliations will naturally stand it in good stead in a steadily radicalising Pakistan. As in the previous elections, the bulk of PML(N)’s seats will come from Punjab, mainly at the cost of the PPP and PML(Q), and will most likely increase from 81 to little over 100. It may also be expected to get an additional 15 seats from the other three provinces as against only five in the last elections, giving it a total strength of 110 to 120 seats.

The third largest party is likely to be the PTI. Estimates about the seats likely to be secured by this party are the most variable, ranging from 10 to 100. The uncertainty of its showing stems from the fact that it is a new party with a fragile organisational structure which is, of course, compensated to an extent by Imran Khan’s name, recognition and popularity, particularly among the youth. Whether his popularity will translate into votes is a question mark. The bulk of the party’s support will come from Khyber Pakhtunkhwa and Punjab. In the former, it could get around 15-20 seats out of a total of 43 and in the latter it could get around 30 by eating into the PML (N), PML (Q), and PPP.

In Sindh the MQM, which has hitherto been the predominant party, will likely see some decline in strength with its seats falling from 25 to 15. Similarly, Khyber Pakhtunkhwa, which was the stronghold of the ANP, will see a dramatic decline in the fortunes of that party with its seats declining from 13 to three or four. Islamic parties like the Jamaat-i-Islami and JUI (F) will be the main beneficiaries of these developments in both provinces, apart from the PML (N) to a less extent.

An election outcome with a fractured mandate as projected above in which no party will be able to form a government on its own even with the support of independents will be unfortunate for Pakistan. More so, because none of the three largest parties notably — PML(N), PPP and PTI — will find it easy to link up with either of the other two due to their differing ethos and backgrounds, and as far as the PPP is concerned even ideology.

Should political expediency drive any two to form a coalition government, this is likely to be riven by dissent and an inability to effectively address the many pressing economic, security and foreign policy issues facing the country. Indeed, this could ultimately lead to a reversion to military rule.

As far as India is concerned, while all the three major parties profess to want good relations with the neighbour, each is also focused on Kashmir. The PTI refers to the resolution of the Kashmir “dispute” as a core issue, while the other two stress the need to take into account the UN resolutions for its closure. But above all, we should be concerned by the increasingly radicalised nature of Pakistani polity which does not bode well for us.