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.

Photo: HANNAH MCKAY/REUTERS
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The lure of Lexit must be resisted – socialism in one country is a fantasy

Much of the left still must learn that the existing British state is the prison of their hopes.

Lexit, the left-wing case for leaving the EU, is rising from the dead. Its hopes were best captured in 1975. In the run up to the first referendum on EU membership, E P Thompson, the historian of the early English working class, published his clarion call to leave what was then called the Common Market. Doing so would see “Money toppled from power” as Britain moves “from a market to a society”.

“As British capitalism dies above and about us”, Thompson asserted, in a revealing passage worth quoting at length, “one can glimpse, as an outside chance, the possibility that we could effect here a peaceful transition – for the first time in the world – to a democratic socialist society. It would be an odd, illogical socialism, quite unacceptable to any grand theorist…  But the opportunity is there, within the logic of our past itinerary. 

"The lines of British culture still run vigorously to that point of change where our traditions and organizations cease to be defensive and become affirmative forces: the country becomes our own. To make that leap, from a market to a society, requires that our people maintain, for a little longer, their own sense of identity, and understanding of the democratic procedures available to them…”

Thompson spoke for the majority of the British political left at the time, from the then numerous Communists and Trotskyists through to the conservative-wing of the Labour Party and trade unions via the Bennites. All were hostile to sharing sovereignty with the capitalists running the rest of our continent. All believed that just as Britain was the birth-land of the industrial revolution so it could create a unique socialism across its land by going it alone.

I expected a resurgence of a similar left anti-Europeanism in last year’s referendum, and a renewed advocacy of a British road to world progressive leadership. Instead, with few exceptions, the inherently right-wing nature of Brexit bore down on advocates of left-wing politics. Owen Jones, with his family roots in that past history, flirted with Lexit. He has described how his comrades across Europe, such as those in Podemos in Spain, were appalled at the prospect and he wisely backed away.

Labour Leave was mainly business-oriented in its call for UK democracy. The decisively working class vote for Brexit was neither socialist nor social democratic. It simply and understandably rejected the all-party consensus that things should carry as hitherto. Given a chance to say what they thought of ‘the whole lot of them’, millions of Labour voters displaced their disgust with Westminster onto the EU.

The event that resuscitated the Anglo-Lexiteers was not the referendum result but this year’s UK general election. On the summer solstice, two weeks after its astounding outcome, the Lexit-Network posted its first blog entry. It’s aim to help steer a future Corbyn government. In parallel, the New Socialist website, with its strapline for “robust debate and intransigent rabble rousing”, launched a week before the election, also gives voice to Lexiteers.

Prominent among them are sirens from across the Atlantic: Joe Guinan and Thomas M. Hanna and Harvard’s Richard Tuck. They draw on the outstanding work of Danny Nicol who has shown how the EU’s constitutional structures embed neoliberalism. Their arguments – often published in the New Statesman and openDemocracy – pre-existed the referendum. But only as opinions. Now they are gathering energy with the prospect of a Corbyn-transformed Labour Party taking power.

The underlying dream of ‘socialism in one country’ may be potty. But it is essential to recognise the core issue that could give legitimacy a left-wing call for Brexit, a democratic argument anchored on the moment that changed British politics, the launch of Labour’s 2017 election manifesto.

The June 2017 general election was a political watershed. The outcome was due to combination of the 5 “M”s. The man, the movement, the manifesto, May and McDonnell. Of the five, the keystone was the manifesto, whose architect was John McDonnell. In the first place, however, it was “the man” who was crucial.  

Jeremy Corbyn was the personal embodiment of unbroken resistance to the military and financial priorities of Blairism. His personal vision, however, is mostly limited to opposition to tangible injustices and he is not a natural leader. But the outrageous presumption of his unsuitability by a failed New Labour establishment and the torrid injustice of the media contempt unleashed a surge of support. The blowback to the ruthlessness of the assault upon him generated the credibility of the call for a halt that he personified. With poetic justice, the elite aura of entitlement provoked a wave of solidarity that crystallised around Jeremy. A movement was born that took a new form suitable to the age of the platform capitalism of Google, Facebook and Amazon.

Thanks to Momentum, Corbynism became a social-media driven ‘social movement’ independent of Labour officials and MPs. The confinement of politics to parliamentary routines permits the corporate acquisition of policy. The hysteria around Momentum signalled the pain of a genuine threat to its domination.

Even so, the combination of the man and the movement was incapable of moving public opinion. Especially when it seemed that the Tories under May, with the Brexit breeze filing their sails, were now a party of ‘change’. The local election results on 4 May this year saw Labour crash to 27% support, with the Tories establishing an 11 per cent lead and making gains after seven years in office. The general election had already been called. What turned things around was Labour’s Manifesto. It was leaked shortly after the local elections (probably to ensure it was not filleted by the party’s executive) then published. It turned the tables on a Tory party whose leader had foolishly decided to present herself as the allegory of ‘stability’.

After two decades of the wealthy stealing from the rest of us, Labour set out how it proposed to take a little from the rich to help the poor. After decades of rip-off privatisation, it proposed nationalising railways and water to remove them from what are in effect a publically subsided form of taxation by profiteering monopoly suppliers. In the face of an acute rise of indebtedness among the young, it proposed free university education. A neat contrast of the winners and losers was posted by the New Statesman’s Julia Rampen.

The key to its success was that Labour’s manifesto was not an opportunist response of unfunded promises concocted in response to the surprise challenge of a general election that the government had repeatedly pledged it would not call. McDonnell told Robert Peston on the Sunday following: “We geared up last November. As soon as the Prime Minister said there would not be a snap election we thought there would be”. The result was a fully-costed, professional challenge to the outrageous inequity of the neoliberal consensus. By contrast it was Theresa May’s manifesto that was composed in secret, bounced on the Cabinet, contained amateurishly formulated commitments and had to be promptly disowned by the Prime Minister herself.

The outcome was the most dramatic upset in the history of general election campaigns and, more important, a reversal of the terms of Britain’s domestic politics, grounded on Labour’s well-judged pledges. As Jeremy Gilbert argues, “The June 2017 UK General Election was a historic turning point not just because it marked the full emergence of the Platform Era. It also marked the final end of neoliberal hegemony in Britain” – although not he emphases, neoliberalism itself.

It follows that quite exceptionally for the platform of a losing party, Labour’s manifesto has an afterlife. This poses a fundamental question with respect to Brexit. If the UK were to remain in the EU would a Labour government be allowed to carry out the nationalisations and redistribution that its manifesto promises? If the answer is ‘No’ then the democratic case against continued membership is immeasurably strengthened. Whatever the immediate costs, it would be essential to leave the trap of an EU in order even to start to build fairer and more just 21st century society. 

The Lexiteers claim exactly this. That the EU would prevent Labour from renationalising, under its rules favouring the private sector. The argument quickly becomes technical and clearly there are ways that EU membership restricts a government’s freedom of action. But it does not prevent the exercise of all self-interested national economic measures.

In July, to take the most immediate example, the still fresh President Macron nationalised shipyards about to be taken over by an Italian bidder. In the same month, in his barbaric speech in on how Europe should belong to Europeans, Hungary’s Prime Minister Orban claimed he had achieved, “clear majority national ownership in the energy sector, the banking sector and the media sector. If I had to quantify this, I would say that in recent years the Hungarian state has spent around one thousand billion forints on repurchasing ownership in strategic sectors and companies which had previously been foolishly privatised."

Both the French and Hungarian measures are right-wing forms of national takeover to which the Commission will be naturally less opposed than a Corbyn one. But the Lexiteer argument is not that there will be resistance, there will be plenty of that here in the UK as well, but that EU membership makes nationalisation illegal and therefore impossible as beyond politics. The only response to the EU, therefore, is Leave!

The tragic reality is that the UK political-media class, especially the Tories, made the EU a scapegoat for their domestic policies. They hid behind the EU to claim they were powerless to prevent unpopular policies they were in fact themselves pursuing. The most egregious example was immigration. But the UK is not powerless within the EU. Brussels would not be able to prevent Labour from implementing a social-democratic reorientation of the economy to ameliorate the gung-ho marketisation that is the legacy of Cameron and Osborne’s six disastrous years.

But what about red-bloodied socialism? Could this be allowed by the corporatist constitution of the European elite? Of course not. But, however much this might be McDonnell’s and my own dream, it is hardly on the immediate agenda. The stated priority for Labour is securing jobs, preserving the benefits of the EU’s single market and reversing the acute regional inequalities that have made the UK the most territorially unbalanced society in the whole of the EU (mapped by Tom Hazeldine in New Left Review).

Absurd as it may seem, however, the lure of Lexit is a belief that a Corbyn majority can unleash British socialism while the EU groans under the austere regimentation of the Eurozone.

For example, Guinan and Hanna writing in New Socialist assert that Labour can “seize upon the historically unique opportunity afforded by Brexit to throw the City under the bus”. Apparently the ‘opportunity’ of a Commons majority created by first-past-the-post means a Labour government can snap its fingers at the House of Lords and the monarchy not to speak of the media and the banks, to use the imperial British state to “assert public control over finance, and rebalance the UK economy”. No consideration is given the fact that the ‘opportunity’ is likely to be based on considerably less than 50 per cent support amongst the voters. Meanwhile, the country’s largest export market will, apparently, despite its ineradicable neoliberal character, sit idly by as the path to socialism is pioneered on its largest island.

Perhaps we should be grateful to brazen Lexiteers for being carried away when others, such as the Guardian’s Larry Elliot are less candid about the logic of their views.

It hardly needs the genius of a Varoufakis to grasp that the UK is made up of European nations and when it comes to the dominant economic system this will be changed only through a shared European process that defies EU corporatism, or not at all. Much of the left still must learn that the existing British state is the prison of their hopes and will never be the instrument for their delivery.

Back in 1975 when E. P. Thompson hurled his diatribe against the ‘grand theorists’ of socialism he had Tom Nairn in his sights, whose fine polemic, The Left Against Europe had recently scorched every corner of anti-European prejudice. Against the fantasy of socialism in one Britain, Nairn had argued:

“The Common Market—Europe’s newest ‘constitutional regime’—represents a new phase in the development of bourgeois society in Europe. To vote in favour of that regime ‘in a revolutionary sense alone’ does not imply surrender to or alliance with the left’s enemies. It means exactly the opposite. It signifies recognizing and meeting them as enemies, for what they are, upon the terrain of reality and the future. It implies a stronger and more direct opposition to them, because an opposition unfettered by the archaic delusions of Europe’s anciens regimes”.

Nearly 50 years later the terrain of reality and the future is still shunned by the Lexiteers as they cling to the fetters of the old regime. 

Anthony Barnett’s “The Lure of Greatness: England’s Brexit and America’s Trump” is published by Unbound

This article first appeared in the 21 September 2017 issue of the New Statesman, The revenge of the left