Response to polio outbreak in Deir e-Zor province complicated by IS control: ‘You can’t beat polio like this’

In February, Dr. Emad Mustafa received panicked messages from colleagues in his home province of Deir e-Zor in eastern Syria.

While living in Turkey since the Islamic State took control of his home province, Mustafa, the former director of vaccinations with the opposition government in Deir e-Zor, has kept a network of friends and medical professionals inside.

When his contacts reached out to him four months ago, they described children suffering from acute paralysis—one of the main symptoms of polio.

“Everyone understood the danger of the disease,” Mustafa tells Syria Direct’s Alaa Nassar. “And the real possibility of it spreading.”

Polio is a viral disease that mostly infects young children. It is often fatal, with most survivors suffering from paralysis after being cured.

Though once a global killer, the disease has largely disappeared—thanks to the widespread use of the polio vaccine invented in the mid-20th century. Despite the disease’s current rarity, interruptions in the administration of the vaccine can lead to localized outbreaks.

When IS captured most of Deir e-Zor province in late 2014, the militant group “halted” vaccination campaigns for several months, Mustafa says. Localized campaigns were later re-launched, but covered only a fraction of the province, he adds.

A child receives a polio vaccine in Deir e-Zor province in April 2014. Photo Courtesy of Deir News Network

Mustafa fled Deir e-Zor in 2015. Today, he is the head of a Turkey-based NGO coordinating medical aid to Syria, and closely follows developments in his home province.

Local doctors have identified 35 possible cases of polio since the beginning of the year, Mustafa tells Syria Direct. Health workers inside have been able to coordinate with local IS authorities to send samples out of Deir e-Zor and into Turkey for testing.

The Global Polio Eradication Initiative and the World Health Organization (WHO), confirmed an outbreak of polio in Deir e-Zor last week.

“Every day I hear of two or three new possible cases," says Mustafa.

Complicating a response to the outbreak is the fact that IS retains control over most of Deir e-Zor province, and the entry of vaccines or humanitarian workers would require access to those territories.

"The only way to eliminate this disease is to get vaccines to the province and launch door-to-door vaccination campaigns" to prevent new cases, the doctor says. "However, this requires the agreement of the Islamic State."

Q: When did the first cases of polio appear in Deir e-Zor province? How has the situation developed since you began following it?

The first cases of polio in Deir e-Zor province appeared in mid-2013, in the town of Subikhan [65km south of the provincial capital] and several surrounding villages. At the time, I contacted some of my friends who were in contact with UNICEF and the World Health Organization (WHO), informing them about cases I suspected to be polio.

Afterwards, UNICEF and the WHO formed a team comprised of several different organizations that visited a number of the cases in Deir e-Zor, and also searched for new infections. They took samples from the children and sent them to Turkey, and then on to the WHO.

At the time, 12 cases of polio were confirmed in Deir e-Zor.

Polio is very dangerous. It causes paralysis, can be fatal and is easily transmitted via air, water and contaminated produce. Everyone understood the danger of the disease, and the real possibility of it spreading throughout the province or moving to other provinces.

In 2014, [the local council in Deir e-Zor] launched vaccination campaigns, visiting residents’ homes on a monthly basis.

We continued doing this until the Islamic State arrived [in late 2014]. They halted vaccinations for a number of months. In February 2015, IS permitted new vaccination campaigns, but not by going door-to-door. Instead, residents had to visit medical centers to get vaccinations. The only exception was al-Bukamel city, where the local IS medical head allowed door-to-door vaccinations.

The vaccination efforts continued, but [generally] only inside the centers, and did not cover the entire province.

You can’t beat polio like this. You have to vaccinate from home to home.

Q: What’s the reason for the renewed spread of polio in Deir e-Zor province? What are the latest statistics available documenting polio-like symptoms in the province?

In July 2016, IS stopped all of the vaccination campaigns.

In February 2017, several different sources [inside Deir e-Zor] told me of new suspected polio cases in Subikhan city and the surrounding villages. After that, I reached out to other contacts in the province and discovered that there were other suspected cases of polio in the towns of al-Bolil, Biqars, Nayhet a-Suwar and Nahyet a-Kasra. 

As of today there are 35 suspected cases of polio that have been clinically diagnosed.

[Ed: Polio infection can only be confirmed by a stool or blood test, currently unavailable in Deir e-Zor province. Local doctors examine cases of acute paralysis in children to identify possible polio infections.]

One of these cases has been confirmed by laboratory tests—this means that polio has returned to the province.

Each infected child could expose another 200 children to the infection. Unfortunately, every two or three days I am informed of another, new case.

Q: How do you receive test samples from suspected polio cases in IS territory? How are they brought into Turkey?

There is a team of four or five people organized by the Assistance Coordination Unit (ACU) who secure the samples and send them to Turkey.

[Ed: The ACU is a Turkey-based Syrian NGO that coordinates medical aid in Syria and monitors the health situation across all of its provinces, according to its website.]

These people coordinate with IS, placing the samples on buses that travel from Deir e-Zor to the Aleppo countryside. From there, the Turkish government takes possession of them and sends them to Turkey, where they are tested in Turkish laboratories. This is all done with prior coordination from the ACU.

It’s not in the Islamic State's interest to cover up these infections—they live amongst the infected.

Q: Is IS running any vaccination campaigns? Are they effective?

It’s worth mentioning that [after nearly a year of no vaccines] the Islamic State launched a campaign [through its medical centers] two weeks ago, and there was another round of vaccinations in March. However, unfortunately, these two operations used all of the vaccines that have been stockpiled since 2016. 

I received a picture of one of the vaccine bottles [from a contact in Deir e-Zor]—it had been stored since July 2016 and expired. It might hurt someone, but it definitely won’t help.

 A bottle of the polio vaccine from Deir e-Zor. Photo courtesy of Dr. Mustafa Emad.

Of the things that IS needs to do is to vaccinate every child from newborn to five years of age who leaves Deir e-Zor for other areas. If not, the disease could spread.

I don't think these latest IS campaigns will be of much benefit. Vaccinating children requires a lot that IS simply cannot do, and they do not have the experience.

Q: In your opinion, what can be done to stop the spread of polio in Deir e-Zor?

The only way to eliminate this disease is to get vaccines to the province and launch door-to-door campaigns to vaccinate children. However, this requires the agreement of IS.

I was the director of vaccination campaigns in Deir e-Zor, and I know that it takes approximately 1,400 nurses to cover the province with mobile teams.

IS does not permit international organizations to enter Deir e-Zor, nor will they allow house-to-house vaccinations. However, I think that the people working on this issue in the ACU and the WHO need to try and communicate with IS to convince them to let them in—especially since IS is beginning to comprehend the danger of the situation.

Vaccines will not heal those already infected with polio, but it will stop other children from being infected.

Children from Deir e-Zor who reach other provinces can be vaccinated there, yet some displaced families have told me that some of them have not received vaccinations.

Alaa Nassar

Alaa was forced to flee Damascus with her family because of the pressure from the Syrian regime in 2013. She was a student of Arabic Language & Literature at the University of Damascus. She came to Syria Direct because she hopes to find a new direction in her life and to show the world what is happening in her country.

Justin Clark

Justin studied Arabic at Western Michigan University. He continued his studies at Bethlehem University in the West Bank and the Qasid Institute in Jordan. Justin's work and studies have taken him to Jordan, the West Bank, Egypt and Greece.

Aya Emad

Aya is from Homs province in central Syria. She moved to Jordan with her family in 2013. Aya is a journalism student at the Amity Online University. She joined Syria Direct to practice journalism and help her people.