The World Health Organization and other medical groups are warning about the potential spread of polio this summer. The disease travels through contaminated water supplies, which become more of a problem in hot, muggy weather. Analysts say that data documenting the spread of infectious disease in the country is incomplete, with health workers unable to reach parts of the wartorn countryside.
Last week Iraq saw its first confirmed polio case, raising concerns that a Syrian outbreak could have consequences for the rest of the region. At the time, rumors swirled that as many as 100 cases of polio had been confirmed within the country.
For an expert view we spoke to Dr. Fouad M. Fouad, a Syrian public health doctor and a visiting assistant professor in the Faculty of Health Sciences at the American University of Beirut, and Dr. Annie Sparrow, a pediatrician at New York’s Mount Sinai Hospital with extensive field experience in and around Syria.
Syria Deeply: There are a lot of numbers floating around. How many cases have actually been confirmed?
Fouad Fouad: It’s really a kind of myth now. How many cases have there been? According to WHO’s Damascus office, the confirmed number of cases in Syria is 25. This is as of March 5. According to WHO, 17 are in Deir Ezzor, but they haven’t mentioned where the other eight are. The ACU linked to Etilaf, the opposition alliance, has mentioned 13 cases. Among these 13 cases, they say 10 are in Deir Ezzor, one in Idlib and two in Halab. We don’t know if there’s overlap between the two numbers. Up to now, there’s been no transparency about that, so we don’t know if we need to add the 13 to the 25.
There are rumors being spread in the newspapers and in reports that say something like 80,000 cases or sometimes 90,000 cases of Syrians being exposed to the virus. I don’t know what they’re referring to. Are they saying these are people who are virus carriers? Is this an estimate of, “If we have one symptomatic case, we have over 200 virus carriers in that direct environment?” This is not clear yet, and this is the problem with not having solid data from all parties.
Sparrow: We shouldn’t get hung up on numbers. The government can say 25, WHO can say 38. The numbers are less important than the fact that polio is there. It’s back in Syria, in areas where it had been eradicated, and now it’s back in Iraq.
It’s the same strain that’s been documented within Syria. I don’t think it’s appropriate to underestimate what we’re seeing. We know that it’s crossed the borders. We know that there are also cases that have come into Turkey. Transmission is obviously still occurring inside Syria and now we’re seeing it in the surrounding countries. Polio is on the rise again: if you look at the numbers compared to this time last year, we’re seeing that. And polio peaks in the summer.
SD: Has it spread beyond Syrian borders?
Fouad: We heard about one case in Baghdad last week, but there’s no link to the Syrian cases.
SD: Are refugee camps and poor conditions along the borders aiding the spread?
Sparrow: They are perfect breeding grounds for polio and many other infectious diseases. It’s a highly contagious disease, spread through human contact and through drinking contaminated water and eating contaminated foods. We’re seeing families crowded into tiny living spaces, and they’re not just at risk for polio, there’s so much measles around. And I wouldn’t be surprised to see something like cholera back inside Syria soon. Iraq has thousands of refugees and it shares a major border with Deir Ezzor, where the polio outbreak began. I met a little girl with polio a few miles from the Iraq border [in Deir Ezzor]. We know there’s cases in the borders along the border with Turkey.
SD: How big could the polio issue become?
Fouad: The health system is almost collapsed. According to WHO, 73 percent of hospitals are now out of service, and more than 30 percent of primary healthcare is out of service, mainly in the opposition area. We need access to more data about that. WHO said all 25 polio cases are in opposition areas. That’s very dangerous because that means that wide areas are deprived of quality care, and this is the same with hospitals. All hospitals in Deir Ezzor and 80 percent in Halab and Raqaa are destroyed and out of service, which means the coming days will be very difficult.
SD: Why are so many children only “partially” vaccinated?
Sparrow: Polio needs five to six rounds of vaccination to be effective, it’s not like measles where one shot protects you. There’s a five-year-old in Damascus who’s still there, partly paralyzed, and she had a partial vaccination. A lot of these kids have had partial vaccinations, and they doesn’t work. Turkey is fantastic in that it vaccinates kids as they cross the border, but you’ve got to do that five or six times [from when they’re babies until age 6].
SD: How could summer impact the spread of polio?
Fouad: We should prepare for summer because summer is the season for polio dissemination. Its spread is linked to water, so when we have a problem with the water supply, with hygiene and contamination, we expect to have things become worse. That is what happened last year: the first cases came in July, and because the summer season is long in Syria, we then saw the majority of the cases in September and October, so we should be very careful about that this year. All 25 cases are either the result of under-immunization or complete lack of immunization. This reflects the state of the campaigns to vaccinate: we still have sites that are hard to reach, and we need to evaluate our campaign [before we progress] to know what the conditions will be [in each area].
SD: What needs to be done to better track the spread of infectious diseases?
Fouad: We need to have a strong health information system that can reflect the real situation. When we look at the system established by WHO and the other by the ACU and supporting institutions, we can see there are differences and sometimes two different data sets. The polio cases, measles, hepatitis — all these issues are being reported differently. Organizations like the WHO say that they have a wealth of data available on their websites, but you can’t get clear information from those sites, and you don’t know if the data is being reported nationwide or from the government’s side only.