War and the Outbreak of Disease

“Health experts estimate that each diagnosed case of polio correlates to roughly a thousand infected people who can silently spread the virus for weeks.”

Historically, war, infection, and the outbreak of disease are always inextricably linked. Increased violence from civil war and terrorist activity in the Middle East has caused the largest human displacement in decades.

Healthcare has been interrupted due to the destruction of facilities, a lack of medical staff, and a critical shortage of life-saving medications. A neglected consequence of this tragedy has been the reemergence of polio, hepatitis, typhoid, cholera, dysentery, and measles that is growing at an alarming rate, the World Health Organization (WHO) has warned.

Yemen is facing the “world’s worst cholera outbreak,” with about 1,310 people dying from the disease since late April according to the WHO. More than 200,000 suspected cases of cholera have been recorded in the Arabian Peninsula, and as many as 300,000 people could become infected by the end of August. In just two months, cholera has spread throughout this war-torn country. Lebanon and Jordan reported increased rates of tuberculosis among Syrian refugees.

More than a third of Syria’s public hospitals are out of action; in some areas, 70% of health workers have fled, and 4.25 million internally displaced Syrians are living in overcrowded, unsanitary conditions. Shortages of safe drinking water and disruption to vaccination programs are increasing the risks. Given the scale of population movement both inside Syria and across borders together with deteriorating environmental health conditions, outbreaks are inevitable.

With thousands of Syrians crossing the borders each day, diseases already prevalent inside Syria are being transmitted to neighboring countries, according to the WHO’s regional office for the Eastern Mediterranean. “All the risk factors that enhance the transmission of communicable diseases in emergencies are present in the current crisis in Syria and its neighboring countries,” said Jaouad Mahjour, its director for communicable diseases.

At least 17 children in eastern Syria have been paralyzed from a recently confirmed outbreak of polio, punctuating the health risks to a population ravaged by more than six years of war. It is the second outbreak of the crippling disease to hit Syria since the war began due to the inability of health workers to immunize all children caught in conflict zones where access is difficult and sanitation is poor.

The polio virus, once thought on the verge of eradication, is one of the most contagious diseases in inadequately protected areas. One confirmed case of paralysis is considered an outbreak, as doctors assume it means up to 200 other people may have been exposed to the virus.

Tarik Jasarevic, a spokesman for the World Health Organization in Geneva, said there was an urgent need to vaccinate more than 400,000 children under the age of five in the Deir al-Zour area of eastern Syria, where the outbreak was first confirmed in an announcement made by the organization on June 8. He described the outbreak as “very serious.”

Polio and the Islamic State

We don’t know how many people in IS (Islamic State)-held parts of eastern Syria have contracted the disease, but we do know that the number of confirmed cases likely only scratches the surface of the number infected. If steps aren’t immediately taken, the extremely contagious disease will spread at an alarming rate.

Once polio reemerges within a population, the highly contagious virus is extremely difficult to eradicate. It’s resistant to common disinfectants, including alcohol (though not bleach), and its ability to survive for long periods in food, water, and sewage make the disease extremely difficult to deal with. Most troubling is its ability to hide unnoticed in the vast majority of its carriers. Health experts estimate that each diagnosed case of polio correlates to roughly a thousand infected people who can silently spread the virus for weeks.

The virus mainly affects children younger than age five. At least three rounds of vaccines are needed to fully immunize a child, and even those who are immunized can still harbor the virus in their bodies long enough to infect others.

A United Nations humanitarian aid adviser for Syria said that trucks are being prepared to deliver anti-polio vaccines to areas held by militants of the Islamic State group in eastern Syria. The shipment is to be delivered to Syria’s eastern province of Deir ez-Zor, which is largely under IS control.

UN aid advisor Jan Egeland said the decision was taken to send the vaccine after confirmation of a “very dangerous” outbreak of the polio virus. Just last week, the World Health Organization announced two cases in Deir ez-Zor of a polio strain derived from vaccines that mutated under weakening health and immunization conditions.

According to Egeland, 58 acute flaccid paralysis cases, a possible symptom of polio, had been reported in Deir ez-Zor this year through June 6. “It’s one of the remarkable things of Syria’s war that people have been reached with vaccines, even in the Deir ez-Zor and Raqqa governorates held by IS,” he said.

Apparently, even jihadists don’t want their children to contract polio.

Selective Modernism

With the harsh realities of life in IS territory complete with repression and deadly violence, there is a deeper point to be made here about the Islamic caliphate. It is the nature of political power in the modern world and the Islamic State’s relationship to it. While some devout Muslims don’t reject modernity outright, they are just selective about which parts they integrate.

Things have gotten so bad in IS-held territory that the most basic health services are unavailable. There is widespread suspicion of the vaccination teams, and many people believe conspiracy theories that claim the workers are part of a Western-backed plot to sterilize Muslims.

Such suspicion grew in the aftermath of the US operation to kill Osama bin Laden when it was revealed that the CIA had recruited a Pakistani doctor to establish a vaccination campaign that also had a hidden agenda besides medical health. That program was also used in an attempt to obtain a DNA sample from youngsters in the al-Qaeda leader’s Abbottabad compound to verify if bin Laden was residing there.

Consider this—if conditions in IS-held territories are so bad that even the spread of polio and other diseases cannot be contained, many will suffer. When children start becoming infected with a virus that was under control before IS took over, acceptance, loyalty, and obedience from the local population won’t last long—even at gunpoint.

So there is a jarring convergence of interests for IS and humanitarian groups. They both want to help people in need—but for morally divergent reasons, to put it mildly.

There’s no easy way out of this dilemma. Cutting off aid ensures additional starvation and disease. Continuing aid might empower a group that massacres religious minorities and burns its prisoners alive.

And it’s the perhaps unenviable responsibility of aid groups to figure out how to immunize children and deliver much-needed food and medicine without empowering one of the most brutal terrorist groups on earth.

Lastly—and a point that is not lost on the US government—is the effect that refugees from this war-torn region could have on the US population. In recent years, there has been a movement away from some of the routine and normal vaccinations of our youth. This has led to a US population that has a risk of infection upon exposure.

The reinstated travel ban from countries in this region may very well help to protect the US from an enemy that we have not had to deal with in the US for decades.

One strategy of war and one theory of asymmetrical war is the use of biological weapons. The refugees streaming into the US from Syria, Iraq, Yemen, and other conflict areas could actually be a weaponized form of immigration. It is a scary thought that we must balance the desire to help those in need and weigh that moral value against the possible cost to US citizens, but it is an exercise in logic we must consider.

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Dr. Katherine Harris
Dr. Katherine (Kat) Harris is an OpsLens contributor, a veteran spouse, expat, and former military contractor with over 20 years of expertise in military/family transition, career counseling, higher education, organizational strategic planning, and international relations. She has conducted seminars and workshops for many Department of Army commands, plus many non-profit and community associations. She served as a translator and liaison for American, British, French, and German civilian/military communities in Berlin and Helmstedt, Germany. Academically, Dr. Harris holds a Bachelor of Science in Management Studies from The University of Maryland European Division, a Master of Arts in International Relations from Boston University, and a Doctorate in Education from Rowan University with an emphasis in leadership and higher education in a global context.

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