The Polio Emergency - 2014

Polio Emergency: Pakistan's polio crisis exacerbated by Taliban attacks

In Karachi, at least 40 health workers have been shot and killed while vaccinating children against polio. The Taliban claim the inoculation programme is a western plot to undermine the country.

Naseem Munir dispenses vital preventative medicines to children in the suburban sprawl of Pakistan's largest city. Here, polio -- a crippling disease eradicated in all but 3 countries in the world -- still threatens. "This is my mission. I see myself as a soldier. I don't want to see my country paralysed." Her battle, however, is not only against the spread of the highly contagious viral infection in Pakistan's seething urbanisations, but also against an entrenched culture of suspicion and hostility towards aid programmes in general. Following revelations that the CIA used a sham vaccination campaign as cover for intelligence work, extreme Islamist groups now see those involved as legitimate targets. "This polio vaccination is not a medicine for any disease", claims a local Taliban leader. "It's for the destruction of the culture and morality of Islam." Violent attacks on polio workers are becoming increasingly common, and have made the task of cauterizing the disease practically impossible. With the World Health Organisation declaring the situation an emergency, the courage of these women on the ground is unlikely to be enough to safeguard the world's most vulnerable populations.

Produced by ABC Australia - Ref 6159

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Transcript

Beachgoers	Music	00:00
	EDWARDS: Karachi is a kaleidoscope that captures a nation's extremes.	00:17
	Music	00:21
	EDWARDS: Down by the beach, the scenes are breezy, carefree and of course, counter intuitive. They're at odds with images many outsiders conjure at the mention of Pakistan.	00:28
Karachi GVs	Music	00:38
	EDWARDS:  But in this, its largest city, Pakistan's extreme contradictions exist together in a chaotic and dangerous jumble. A place where saving lives can get you killed.	00:42
Naseem at home cooking	Music:	00:54
	EDWARDS: Naseem Munir is a loving wife and a proud mother of three. She's also got a job that means when she heads off to work, she may not come home. NASEEM MUNIR: "I don't know if I will come back or not, and I don't know if I'll see my children or not. And I'm ready for that.	01:02
	NI do this work because it is important for the health of children and to protect them from disability.	01:35
Naseem	If a child becomes paralysed, the entire family is affected.	01:42
Naseem serves food	To die or to get polio means the same thing in countries like ours - there is no future for these children, no life for these kids".	01:51
Family eat	EDWARDS: It's no exaggeration to say protecting kids against a disabling and deadly disease makes Karachi a battleground and Naseem a warrior.	02:04
	NASEEM MUNIR: [to her young daughter] "You can't go to the Polio drive. How can you go? They are killing polio workers. I don't take children with me".	02:14

Husband	NASEEM MUNIR'S HUSBAND: [to young daughter] "You go to Grandma's". NASEEM MUNIR: [to her young daughter] "Haven't you seen, they killed workers?"	02:25
Edwards with Naseem	EDWARDS: "You've got a big day ahead of you, are you nervous when you go out?" NASEEM MUNIR: "No, I am not nervous. I am happy to go to endangered areas so I'm not afraid of anything. I am soldier". EDWARDS: "You're a soldier?" NASEEM MUNIR: "Yes I am soldier". EDWARDS: "That's the way you look at it, you've got to fight a war against polio". NASEEM MUNIR: "Yes, it is my mission".	02:31
Naseem leaves house/Into Tuk Tuk	Music	02:52
	EDWARDS: It's a mission that shouldn't exist. Polio has been eradicated in just about every corner of the world, but Pakistan is one of only three countries where the crippling virus still threatens. The others - Afghanistan and Nigeria. And for as long as polio exists anywhere, it's a global threat.	02:55
	Music	03:19
Naseem organising vaccination program	Recently the World Health Organisation declared it a public health emergency.	03:23
	NASEEM MUNIR: [organising vaccination program] "Send two teams. Zohra and this guy! And you, come here!".	03:30
Security guards and police	EDWARDS: And very soon we get a sense of why it's such a difficult problem to control. The size of the security detail hints at the suspicion and outright hostility that lurks within this neighbourhood.	03:34
Naseem with security detail	Music	03:45
Naseem visits village, gives vaccinations	EDWARDS:  Many residents have been convinced by a concerted propaganda campaign that the polio vaccination program is an international plot against the people of Pakistan.	03:52
Naseem at woman's door	NASEEM MUNIR: [knocking on door of house] "I have to give polio drops to children. Do you have any?" WOMAN OF APARTMENT: "He's been vaccinated. Look at his mark". NASEEM MUNIR: "There's the mark. Any more kids?" Do they have any? WOMAN OF APARTMENT: "They might have, but they also got vaccinated". NASEEM MUNIR: "Ask them if their kids got vaccinated, and who did it?" VACCINATION TEAM MEMBER AT ANOTHER APARTMENT: "Yes they had it. How many? Okay... two". NASEEM MUNIR: "Ask her are there any upstairs?" CHILD AT OTHER APARTMENT: "Mummy, don't let them come in, father has refused".	04:11
Naseem and Team Member climb stairs	EDWARDS: While some parents allow their children to have the drops, others do their best to keep their kids away from the inoculators.	04:40
Naseem at apartment door	NASEEM MUNIR: [at another apartment door] "Good morning. Do you have any children under five? You don't have any under-fives? We heard there are children in your house. No younger children? MAN AT APARTMENT: "I am the youngest one here". EDWARDS: But she's not giving up that easily.	04:52
Naseem with Edwards/Knocks at apartment door	After the man in this apartment says no young children live here, Naseem realises that he has the key to the rooftop where we want to film. So she knocks again. NASEEM MUNIR: [knocking on door and can hear young children through door] "There are small kids. I have doubted there are children... there are children. Do you have a key to the rooftop door? To film with the camera? MAN AT APARTMENT: "Rooftop?" NASEEM MUNIR: "Yes, the rooftop, please open it. He is now five? Hey listen, has this boy turned five yet? MAN AT APARTMENT: "Yes". NASEEM MUNIR: "He seems very small".	05:08
Naseem vaccinates boy	"So open your mouth, it's nothing, it's nothing. Every child drinks this, now go and watch TV. So you have the key?" EDWARDS: Because so many people in Pakistan have never been vaccinated against polio,	06:07
Naseem climbs stairs/Vaccinating children	the risks are greater - even for those who have had the drops. So every child needs to be immunised multiple times until they turn five. It's the only way to be sure. That means Naseem and her colleagues face danger over and over again.	06:26
	Just a few months ago, three of her colleagues were killed as they gave out the drops. In the past two years, more than 40 vaccinators have died across Pakistan.	06:44
Photos. Men with guns/Taliban	Music	06:57
	EDWARDS: So who is it waging war on the health workers? Militant groups like the Pakistani Taliban.	06:59
Taliban leader interview	TALIBAN LEADER: [interview footage] "This polio vaccination is not a medicine for any disease. It's for the destruction of culture and morality - to destroy the culture and morality of Islam".	07:07
Bodies of murdered vaccinators	EDWARDS: At their base near the Afghan border in February, senior Taliban leaders were asked if they ordered the attacks.	07:20

Taliban leader interview	INTERVIEWER: "Talking about polio, it's said that you people are responsible for getting those people killed?" TALIBAN LEADER: "It's not just the Pakistani Taliban. All sensible people of Pakistan who believe in the religion of Islam are against the polio campaign".	07:30
GVs Karachi	Music	07:45
Photos. Pakistani Taliban/Bin Laden/Dr Afridi	EDWARDS: The Pakistani Taliban increased its attacks on polio workers after the US tracked down and killed Osama bin Laden in 2011. It's claimed that the CIA was helped by a local doctor, Shakil Afridi, who used the cover of an immunisation drive to help confirm bin Laden's whereabouts.	07:51
Photo. Afridi	Dr Afridi is now in prison, despite intense US pressure to free him.	08:13
GREG V/O: Karachi	Music	08:18
Taliban leader interview	TALIBAN LEADER: "Shakil Afridi, there is no bigger criminal. He's a bigger virus than polio".	08:22
GVs Karachi	EDWARDS: The American government has just promised that the CIA will never again use immunisation as a cover for intelligence work. But the suspicion and hostility is now entrenched.	08:32
Fatima playing with her mother	Two year old Fatima lives in a Karachi suburb that's been infiltrated by the Taliban. She has polio. Vaccinators can't come here regularly - the Taliban regard them as spies. It's too dangerous for us as well - we've asked a local journalist to film.	08:48
Refugee children	Many living here are refugees from near Afghanistan, and very poor.	09:13
	There's no sanitation so conditions are perfect for polio transmission. It's spread through faecal matter and the virus can survive in places like this for days.	09:22
Fatima visits hospital	We've organised for Fatima to see a specialist at Karachi's biggest children's hospital.	09:39
Dr Raza examines Fatima	DR JAMEEL RAZA: [National Institute of Child Health] "What is her name?" FATIMA'S FATHER: "Fatima". DR JAMEEL RAZA: "Fatima, what happened, what happened, what happened? Come with me child..."	09:50
	EDWARDS: The family says their little girl was given the drops, but clearly not enough to make her immune.	09:59
Edwards with Dr Raza	DR JAMEEL RAZA: "You can see the child is moving this leg, but is not lifting up this leg.... right? Even if I'm giving the stimulus, there's a little bit of movement here but not... not a lot".	10:06
	EDWARDS: But there's some good news. DR JAMEEL RAZA: "But the muscles which have not been affected or have only been partly affected will gain some strength with physiotherapy and hopefully she'll be able to put... bear some weight on the leg that is affected".	10:17
	[to Fatima] "Stand up, stand up... come here".	10:30
	EDWARDS: Even though she'll almost certainly have a limp, the doctor thinks Fatima will be able to walk. DR JAMEEL RAZA: "Sometime you are able to help them out with braces and rehabilitation	10:38
Dr Raza. Super: Dr Jameel Raza National Institute of Child Health	mechanism, and make them walk - but of course the more severe cases it is not possible to make them walk and they remain severely disabled".	10:49
Archival. Children with polio	Music	10:59
	EDWARDS: Polio hasn't been seen in the West for decades but at its peak in the ‘40s and ‘50s, it killed or paralysed over a half a million people every year.	11:04
	Terrifying epidemics saw healthy children and young adults struck down without warning.	11:17
	Music	11:23
	EDWARDS: The disease was brought under control by the development of a vaccine in the 1950s,	11:32
Pakistani boy with polio	but as late as the 1980s, there were still hundreds of thousands of infections - mostly in the developing world.	11:38
Photos. Children receiving immunisation	Since 1988, a massive global immunisation program has almost eradicated polio, with just a few hundred cases now reported each year.	11:45

Pakistani children in water	But in Pakistan, the numbers are going up, not down. DR JAMEEL RAZA: "It's never nice to hear that but that is unfortunately the truth. We also don't want to be	11:56
Dr Raza	the only remaining country in the world harbouring the polio virus and in a way responsible for passing it on to others".	12:11
Edwards walks in drain	EDWARDS: Recent outbreaks of polio in the Middle East and China have been traced back to Pakistan - some to water sources right here in Karachi.	12:17
Children	Every confirmed case is treated like an outbreak because there'll be two hundred silent carriers who can infect others.	12:33
Bus passes		12:43
Edwards boards bus	To try to deal with the problem, vaccinators have been stationed at all major transit points across the country.	12:56
Polio workers checking children/ Vaccinating children	At this toll station on the outskirts of Karachi, polio workers are on duty 24 hours a day, checking every bus for kids under five. Many are coming from the tribal areas in the north where the majority of cases are being reported.	13:03
Woman on bus	"Is this the first time your child has been vaccinated?" PAKISTANI WOMAN ON BUS: "She's had them before".	13:20
Child on bus	VACCINATION WORKER: "Do you mind if we vaccinate your child?"	13:26
Woman	PAKISTANI WOMAN ON BUS: "Don't people die from the drops? That's what I heard". VACCINATION WORKER: "Who said that?" PAKISTANI WOMAN ON BUS: "People are saying it". EDWARDS: Often it's simply a fear of the unknown	13:30
Man vaccinates child	or due to rumours that the vaccine contains urine or causes infertility. VACCINATION WORKER "The people of Peshawar,	13:40
Edwards with Vaccination Worker	the majority is refusing. EDWARDS: "Most people from the tribal areas and KPK?" VACCINATOR ON BUS: "The tribal areas, yes".	13:51
	EDWARDS: "Are they scared or are they suspicious?"	13:55
	VACCINATION WORKER: "Those who refuse don't explain why - like some say that because someone in their neighbourhood is not vaccinating his kids, then why should I? They don't have a solid reason".	14:00
Vaccination Worker to Passenger	[to man on bus] "You are not having drops?" PAKISTANI MAN ON BUS: "No, we never have them". VACCINATION WORKER: "Why not take them?" PAKISTANI MAN ON BUS: "We don't accept them".	14:14
Mosque	EDWARDS: To help change attitudes, the government's enlisted key religious figures.	14:21
	MUFTI NAEEM: "Look, I am again openly saying on the media that these polio drops are not bad for Islam and Muslims.	14:29
Mufti Naeem	The extremists who are doing this, who are killing polio people, are doing wrong".	14:43
Edwards with Mufti	EDWARDS: Mufti Naeem is a conservative Karachi cleric who runs one of the most influential Islamic schools in the country. Like many other Islamic scholars, he supports the drops.	14:49
Edwards walks with Mufti	MUFTI NAEEM: "They are to protect all of humanity. It's a basic duty, it is necessary". EDWARDS: But he says the role of Dr Afridi in Osama bin Laden's capture has fuelled conspiracy theories. MUFTI NAEEM: "People believe that Afridi is involved in this work - otherwise, why is America demanding his release over and over?	15:04
Mufti	They're not opposed to the polio campaign, they're opposed to America".	15:31
Taliban/Aid photos	Music	15:39
	EDWARDS: The Pakistani Taliban question why aid organisations focus on vaccinations instead of US drone strikes in Waziristan that have killed dozens of children.	15:45

Taliban leader interview	TALIBAN LEADER: "There's no disease other than drones, but it seems nothing is being done to stop it. There's no NGO or any other organisation, they're just advertising polio, polio, polio".	15:56
	Music	16:14
Mufti	MUFTI NAEEM: "People have made up their mind that whatever is happening, the drone attacks are just happening in the name of the polio campaign".	16:20
Vaccination team board bus and vaccinate children	EDWARDS: Regardless of their attitude to America's role in their country, the vast majority of Pakistanis want the drops. They don't believe the propaganda and they're desperate to protect their kids against polio.	16:38
	But the vaccinators have become the innocent victims in a long running war between militant groups and the state. Killing them creates chaos and harms Pakistan's international reputation.	16:57
GVs Karachi	The state is fighting back - but faces opposition on multiple fronts.	17:14
	RADICAL MUSLIM CLERIC: "Those who bring the polio drops, do they come to your town?"	17:23
	Music	17:30
	EDWARDS: Foreign Correspondent obtained the audio from Friday prayers in a town in rural Sindh, not far from Karachi.	17:33

	RADICAL MUSLIM CLERIC: "And the Americans have no feelings that they are killing Muslims - but they have only feelings about the polio that children are suffering...send them some drops".	17:41
	EDWARDS: The self-styled cleric from a radical Islamic party wouldn't go on camera, but confirmed the voice is his from two years ago and he says he continues to spread this message.	17:58
	RADICAL MUSLIM CLERIC: "Whoever has taken the drops is now impotent".	18:10
	Music	18:19
Naseem listens to recording of cleric	NASEEM MUNIR: "He is lying. Uneducated man". EDWARDS: Naseem listens as a man she's never met incites the crowd to attack women like her.	18:24
	RADICAL MUSLIM CLERIC: "Hit them in such a way that their shit will come out of their pants like when you fire from the repeater and a bullet goes out".	18:36
	NASEEM MUNIR: "He is not a mullah or a scholar who can issue a Fatwa in this way - he just wants to brainwash. If I was in government I would arrest him and punish him".	18:48
Residential street	EDWARDS: Naseem wants the government to crack down harder on extremists so fellow vaccinators like Salma Jaffar can be safe.	19:05
Salma at doorway	Salma's lucky to be alive. In January her polio team was fired on by men on motorbikes.	19:17
Salma shows injuries	SALMA JAFFAR: "One bullet hit me hard and then came out the other side. Another bullet lodged here for twelve days. The bullet was stuck there for twelve whole days. And two more bullets hit me here. These hit me here and came out of my back".	19:30
Salma puts on scarf	EDWARDS: She's still deeply traumatised. Her best friend, Anita, died in her arms.	19:50
Salma	SALMA JAFFAR: "They opened fire on Anita and she got shot here [points to cheek]. As she got hit, she shouted loudly... "Sister!" I stood up and rushed out. Obviously it took me a while to get up. Meanwhile, they opened fire again, and she fell straight down. I thought she was unconscious but she wasn't unconscious... she was finished. I took her head in my lap, but she... [crying]".	20:00
	Music	20:32
City streets		20:36
Photos. Fahad	EDWARDS: 22 year old Fahad Khalil died in the same attack. The avid body builder wasn't even a full time vaccinator.	20:44
	Music	20:52
Father looking at picture of Fahad	"He was 22?" FAHAD KHALIL'S FATHER: "22 years." [crying].	20:57
	Music	21:03
Photos. Fahad	EDWARDS: He worked for the health department but volunteered to give out the drops because he felt strongly about protecting children.	21:07
Father places photo of Fahad	His family is inconsolable.	21:16
	Music	21:18
Fahad's mother	FAHAD KHALIL'S MOTHER: "I don't know who these cruel people are. Why do they want to kill the polio workers? They could refuse the vaccinations, or throw away the equipment. They didn't have to kill. Three precious lives wasted without reason - all of them valued by their families".	21:24
Vaccination team vaccinating children	EDWARDS: Naseem Munir was working nearby when the vaccinators were killed. She's been shot at herself and says not enough is being done to protect the polio teams. NASEEM MUNIR: "If the government thinks polio is so important,	21:45
Naseem	then why haven't they arrested the killers, yet?"	22:02
Naseem administering vaccination	EDWARDS: She and her colleagues are risking their lives for less than three dollars a day. Even in Pakistan, it's a pittance. But she won't give up. "Are you optimistic	22:09
Naseem	that you're actually going to win the war on polio here in Pakistan? NASEEM MUNIR: "Yes, I say we will win, if we live.	22:23
Naseem knocks on door	Now it's up to the government to provide us with security... full security.	22:34

Naseem	And if people like us live, it is not a difficult task. We can do it. The job is not difficult, we just need hard work and sincerity".	22:41
Children's hospital. Hafsa in hospital		22:51
	EDWARDS: Back at the children's hospital, another suspected polio case has just been admitted. 18 month old Hafsa is paralysed in both feet.	22:56
Father by bedside	The family are refugees escaping the war in Waziristan.	23:07
Hafsa's father	HAFSA'S FATHER: "We brought her here, with the grace of God. These doctor people are wonderful, they are wonderful. She was vaccinated, but she hasn't completed the entire course, we are moving around so much".	23:13
Interior of children's hospital	EDWARDS: The government has just made the polio drops compulsory for anyone travelling out of the tribal areas, but at least 300,000 children living there are being denied access to the vaccines because of the security situation. HAFSA'S FATHER: "The people who are dangerous and stop kids from being vaccinated,	23:29
Hafsa's father	are cruel to their children. Look at her, she's already losing the use of her leg. It's an injustice to her.	23:49
	Look at the pain, and for anyone to become disabled is not a good thing. She can't stand up, she won't be able to offer prayers or go to the restroom. Isn't that a cruelty?"	24:00
GVs	Music	24:14
	EDWARDS: Until Pakistan wins the war on extremism, it's unlikely to win the war on polio. And as long as the polio virus still exists, the world will always be at risk.	24:31
Snake charmer	Music	24:43
	DR JAMEEL RAZA: "There is a global drive and a need to get rid of the virus from every country,	24:49
Dr Raza	even if one country is harbouring the virus, the disease is not eliminated in the true sense from the world".	24:54
Beachgoers	Music	25:02
B/W Stills	EDWARDS: Naseem Munir was killed, not in the street by a stranger, but shot at home by her husband according to the police. She was 38 and left three children - the youngest 9 year old Ayesha. Pakistan has lost a brave and dedicated woman and her country will be poorer for it.	25:17
Credits	Reporter: Michael Edwards Camera: Aaron Hollett Editor: Garth Thomas Additional footage: Saleem Mesud; Norman Khan Research: Amar Guriro Producer: Marianne Leitch Executive producer: Steve Taylor	25:50

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