The struggle for a Polio-free Pakistan

What is behind the the sudden upsurge of violence towards polio vaccinators in Pakistan?

On Sunday 16 June, gunmen on motorbikes shot dead two polio workers carrying out a vaccination drive in Peshawar, a crowded city in Pakistan’s north-west. One of the men who died was a schoolteacher, the other a paramedic. Both left behind grieving families. Their deaths bring the total tally of polio workers assassinated in Pakistan up to nearly 20 since last December.

“People are scared,” says Muslim Raza, who heads the polio team in the Karim Poora area of Karachi. “Before this happened, many local people would come for a day’s training before joining the vaccination drives [which normally run for between three and five days each month]. Now nobody is volunteering to work.”

The attempt to stamp out polio through oral immunising drops has been running in Pakistan since 1994. In recent years, huge strides have been made towards stamping out the disease, which used to affect tens of thousands of people every year. In 2011, there were 198 new recorded cases of the polio virus in Pakistan; in 2012, just 58.

Yet Pakistan is one of just three countries – including Nigeria and Afghanistan – where it remains endemic. While paralysis strikes just a small percentage of those carrying the virus, the effects are devastating. Unable to support themselves, many people disabled by polio beg at the side of the traffic-filled roads in Pakistan’s big cities.

The attacks started on 18 December 2012, when five female health workers were killed within 20 minutes of each other, four in the southern port city of Karachi and one in Peshawar, in a brutal co-ordinated attack. News of the assassinations, shocking even by Pakistan’s blood-soaked standards, spread across the world.

In the aftermath of those first attacks, the three-day vaccination drive, which would have immunised 5.2 million children in Karachi alone, was suspended. In the intervening months, the programme has resumed. The chalk markings which denote that the polio team has been to visit can be seen on gates, doors, and walls outside houses across the country, from the upmarket areas of Islamabad, to slums, and remote villages. But despite high security in the problematic areas – the north-western province of Khyber-Pakhtunkhwa (KPK), parts of Karachi, and the Federally Administered Tribal Area – the death toll has risen. Many, though not all, of the victims have been women.

As yet, no-one has claimed responsibility. The Tehreek-e-Taliban Pakistan has denied they are behind the attacks, although they have spoken out against vaccinations in the past and are certainly responsible for perpetrating misinformation. The attacks are clearly planned and co-ordinated, but there have been no arrests and no high profile investigation – merely a huge increase in the number of police escorts. The latest development is that the new provincial government in KPK is planning to give polio workers weapons licences to carry their own guns.

Meanwhile, teams of health workers – partly made up of civil servants drafted out to the polio campaign, and partly of local volunteers working for a fee of 200 rupees (£1.50) per day – are continuing to go out to immunise children. Who are these unsung heroes? And why has this senseless campaign of violence begun?

Khoram Shehzad, 29, is a polio vaccinator from Karachi’s Kimari Town area. Like many vaccinators, he comes from the local community. Experts say that employing local volunteers is a crucial component of the programme as it means that the community feels a sense of ownership over the vaccination drive. “More than anything, more than police protecting you, the best protection is from those vaccinators coming from the community itself,” says Dr Elyas Durry, head of the World Health Organisation (WHO)’s polio team in Pakistan.

Shehzad left a job as a computer engineer three years ago to join the polio campaign, and currently earns 250 rupees (£2) per day for each four day immunisation drive. “I didn’t start doing this for the money. I am doing this for the people of Pakistan. These are the children, the future of the country,” he tells me when we speak on the phone. “We are all afraid because of the targeted killings. Some people don’t want to work in the field any more, but it is important for our country and our people.”

The resistance to the vaccine is deep-rooted. Several rumours circulate. One – perpetrated and spread by extremist Islamic leaders – is that the vaccine is a CIA plot to sterilise Muslim children. Another is that it contains materials forbidden by Islam, such as alcohol and pig’s blood.

“Some uneducated people don’t take the drops,” says Shehzad. “They say the medicine in the vaccine is haram [forbidden by Islam]. We tell them the government wouldn’t start this if it was bad for your children.”

The misconceptions are worse among the Pashtun population, who come from the conservative north-west of Pakistan. The rumours and misinformation have been perpetrated through radio broadcasts and other propaganda channels of extremist organisations. Shehzad’s area in Karachi, where there is a high security risk, is 85 per cent Pashto-speaking.

“It is mainly illiterate and uneducated people that refuse the vaccine,” says Fahmeeda Malik, a polio worker from Rawalpindi. “We reason with them, saying, if the government wanted to give you family planning medicine, there are a lot of places they can do it for grown ups. Why children? If they think over it, they normally agree. But if they don’t, we are helpless.”

Across the country, polio workers I speak to say that refusals make up just a tiny minority of the whole. Yet that small percentage is enough to jeopardise the goal of totally eliminating polio. The problem is compounded by the fact that Pakistan’s population is highly mobile, so the disease can easily spread outside the pockets where it is cornered as people are displaced or relocate in search of work.

“Often we ask people, who told you this is against the preaching of Islam? Mostly they say it is the leaders of mosques, so we go to them and convince them,” says Dr Khaled Randhawa, district health officer of Rawalpindi. In May this year, a group of international religious scholars met in Islamabad and issued an edict saying that the polio vaccine did not contravene Islam. “Depriving a child of polio drops is equal to committing a sin. Protecting your child from disease is a religious obligation,” said one of the scholars. This was a positive move, although it is too soon to say how much impact it will have.

“I have been working with these misconceptions about the vaccine for my whole life – in Somalia, in Nigeria, elsewhere,” says Durry. “But I don’t understand – nobody does – how it became such a violent reaction here in Pakistan. I don’t know why it has escalated.”

Many point to the CIA’s assassination of Osama Bin Laden. In the run up to the operation, the CIA ran a false hepatitis B vaccination drive so it could gather the DNA of local residents. It was a spectacularly irresponsible policy that leant credence to the conspiracy theories that were already widely circulated. The film Zero Dark Thirty depicted the fake drive as a polio campaign.

Yet is this alone responsible for the sudden upsurge of violence? Many experts believe it goes deeper. “It’s another way of trying to control the population through fear,” says Mustafa Qadri, Pakistan researcher at Amnesty International. “The aim is to terrorise, to make people scared, to make their conditions worse, and in that way to influence the society. Polio is not socially sensitive in the way that, for example, reproductive rights are: it is a very basic health requirement. When you’re attacking people’s access to these basic rights, you’re attacking their ability to live a normal life. And I think that is the overall objective: to control and to suppress the society.”

In the areas of the country where the risk is highest, polio field workers and team coordinators feel under siege.

“There is a big threat to these volunteers,” says Javed Marwat, the deputy commissioner of Peshawar, the provincial capital of KPK. “The situation is not good for anyone in the city. Every day there are bomb blasts, but the daily explosions get ignored. When a polio worker is killed, this news spreads to other countries, in the international media. The terrorists continue to kill polio workers because it has so much impact. More people die in blasts, but nobody cares about that.” Indeed, against the violent context of today’s Pakistan, the daily news of small scale terror attacks no longer makes an impact; the constant news of death is simply the background music to life. Increasingly, it is violence against unexpected or soft targets – the schoolgirl activist Malala Yousafzai, or health workers delivering life-saving vaccines – that makes national and international headlines.

At the District Health Office in Rawalpindi, I attended an evening meeting of polio workers. Here vaccination teams gathered in the evening to feed back on the day’s work. Most of them were women, clad in bright headscarves and face coverings, and drawn from the same conservative communities they are serving. They confidently talked through the day’s results, speaking over their male supervisor with details of refusals and the ways they had tackled them. “The woman in the house would not come out in front of a man, so I told my male colleague to leave,” says Saba, one of the vaccinators. Another, Aisha, added: “Since the last drive, we spoke to local notables about the refusals, and they have told people they should take the vaccine.” Of the 1,700 vaccinations they had carried out between them over the course of the day, there had been just one refusal.

It has been suggested that there is a gendered aspect to the violence. Not all polio workers are women, and some of those gunned down in recent months have been men. However, while the targeting of polio workers has suddenly escalated, there is a 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. 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. It found that not only did community health suffer significantly, but that lady health workers were socially ostracised after public vilification by the Taliban. It also found that many others stopped working or left the area due to their threat to their lives. Against this context, the recent attacks on polio workers could be yet another demonstration of the deep discomfort among the conservative elements of Pakistani society about women in public space, and women taking ownership of their bodies.

“By attacking these workers, the perpetrators of these attacks are cutting down people’s rights to services, particularly women and girls,” says Qadri. “When you target these people, you are effectively trying to destroy those parts of society that allow people to live with dignity.” In addition to this, he explains, the fact that the attacks have been sustained, despite extra security, compounds the desired effect of spreading terror. “Health workers are being targeted even when they have police escorts. They just feel very scared: even when the state is trying its best to protect people, they’re not safe. The impact for the community is profound.“

For the polio workers in the hotspots of Karachi and Peshawar, life goes on, for now. “My heart is full of terror when I hear that more workers, more workers, more workers are being targeted,” says Sadia Zaidi, a vaccinator from Peshawar whose name has been changed for security reasons. “Sometimes we don’t like to stay in one place for too long to convince refusers to take the vaccine, because we are at such risk. But we carry on. Some of my colleagues don’t even take the money because they just want to work for the people. My family is afraid for my safety, but I am doing this so my children can live in a polio-free Pakistan.”

 

A Pakistani health worker administers polio vaccine drops to a young child at a polio vaccination center in Karachi. Photograph: Getty Images

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Why is it called Storm Doris? The psychological impact of naming a storm

“Homes being destroyed and lives being lost shouldn’t be named after any person.”

“Oh, piss off Doris,” cried the nation in unison this morning. No, it wasn't that everyone's local cantankerous old lady had thwacked our ankles with her stick. This is a different, more aggressive Doris. Less Werther’s, more extreme weathers. Less bridge club, more bridge collapse.

This is Storm Doris.

A storm that has brought snow, rain, and furious winds up to 94mph to parts of the UK. There are severe weather warnings of wind, snow and ice across the entire country.

But the real question here is: why is it called that? And what impact does the new Met Office policy of naming storms have on us?

Why do we name storms?

Storm Doris is the latest protagonist in the Met Office’s decision to name storms, a pilot scheme introduced in winter 2015/16 now in its second year.

The scheme was introduced to draw attention to severe weather conditions in Britain, and raise awareness of how to prepare for them.

How do we name storms?

The Name our Storms initiative invites the public to suggest names for storms. You can do this by tweeting the @metoffice using the #nameourstorms hashtag and your suggestion, through its Facebook page, or by emailing them.

These names are collated along with suggestions from Met Éireann and compiled into a list. These are whittled down into 21 names, according to which were most suggested – in alphabetical order and alternating between male and female names. This is done according to the US National Hurricane Naming convention, which excludes the letters Q, U, X, Y and Z because there are thought to be too few common names beginning with these letters.

They have to be human names, which is why suggestions in this list revealed by Wired – including Apocalypse, Gnasher, Megatron, In A Teacup (or Ena Tee Cup) – were rejected. The Met Office received 10,000 submissions for the 2016/17 season. According to a spokesperson, a lot of people submit their own names.

Only storms that could have a “medium” or “high” wind impact in the UK and Ireland are named. If there are more than 21 storms in a year, then the naming system starts from Alpha and goes through the Greek alphabet.

The names for this year are: Angus (19-20 Nov ’16), Barbara (23-24 Dec 2016), Conor (25-26 Dec 2016), Doris (now), Ewan, Fleur, Gabriel, Holly, Ivor, Jacqui, Kamil, Louise, Malcolm, Natalie, Oisín, Penelope, Robert, Susan, Thomas, Valerie and Wilbert.

Why does this violent storm have the name of an elderly lady?

Doris is an incongruous name for this storm, so why was it chosen? A Met Office spokesperson says they were just at that stage in their list of names, and there’s no link between the nature of the storm and its name.

But do people send cosy names for violent weather conditions on purpose? “There’s all sorts in there,” a spokesperson tells me. “People don’t try and use cosy names as such.”

What psychological impact does naming storms have on us?

We know that giving names to objects and animals immediately gives us a human connection with them. That’s why we name things we feel close to: a pet owner names their cat, a sailor names their boat, a bore names their car. We even name our virtual assistants –from Microsoft’s Clippy to Amazon’s Alexa.

This gives us a connection beyond practicality with the thing we’ve named.

Remember the response of Walter Palmer, the guy who killed Cecil the Lion? “If I had known this lion had a name and was important to the country or a study, obviously I wouldn’t have taken it,” he said. “Nobody in our hunting party knew before or after the name of this lion.”

So how does giving a storm a name change our attitude towards it?

Evidence suggests that we take it more seriously – or at least pay closer attention. A YouGov survey following the first seven named storms in the Met Office’s scheme shows that 55 per cent of the people polled took measures to prepare for wild weather after hearing that the oncoming storm had been named.

“There was an immediate acceptance of the storm names through all media,” said Gerald Fleming, Head of Forecasting at Met Éireann, the Irish metereological service. “The severe weather messages were more clearly communicated.”

But personalising a storm can backfire. A controversial US study in 2014 by PNAC (Proceedings of the National Academy of Sciences) claimed that hurricanes with female names lead to higher death tolls – the more “feminine” the name, like Belle or Cindy, the higher the death toll. This is not because female names are attached to more severe storms; it is reportedly because people take fewer steps to prepare for storms with names they perceive to be unintimidating or weak.

“In judging the intensity of a storm, people appear to be applying their beliefs about how men and women behave,” Sharon Shavitt, a co-author of the study, told the FT at the time. “This makes a female-named hurricane . . . seem gentler and less violent.”

Names have social connotations, and affect our subconscious. Naming a storm can raise awareness of it, but it can also affect our behaviour towards it.

What’s it like sharing a name with a deadly storm?

We should also spare a thought for the impact sharing a name with a notorious weather event can have on a person. Katrina Nicholson, a nurse who lives in Glasgow, says it was “horrible” when the 2005 hurricane – one of the fifth deadliest ever in the US – was given her name.

“It was horrible having something so destructive associated with my name. Homes being destroyed and lives being lost shouldn’t be named after any person,” she tells me over email. “I actually remember at the time meeting an American tourist on a boat trip in Skye and when he heard my name he immediately linked it to the storm – although he quickly felt guilty and then said it was a lovely name! I think to this day there will be many Americans who hate my name because of it.”

Anoosh Chakelian is senior writer at the New Statesman.