What is state failure? See my conceptualisation of state failure on the right flank below.

Tuesday, October 23, 2007

One battle won, and arguably underreported

Having discussed the challenges of polio eradication, with special regard to Pakistan (being so close to success globally and yet also far from it because of insecurity in, and inaccessibility of, the remaining hotspots for the disease), I should write of what's been going on recently on the Afghan side of the Afghan-Pakistani border. Because that's positive news after all, which readers who haven't yet come across it, should definitely read about.
Back in March this year, the following conditions typically affected prospects for polio eradication in most-at-risk southern Afghanistan (some excerpts from an IRIN report).
" TARINKOT , 15 March 2007 (IRIN) - Gulalai, 45, has always viewed the health of her children as a top priority and is not afraid to speak up about it. "It's been two years and still no one has come to vaccinate my children against polio," the mother-of-five told IRIN.
But living in the heartland of Afghanistan's Uruzgan province - where a growing anti-government insurgency has made vaccinations all but impossible - Gulalai has no illusions as to why.
"The vaccinators don't feel safe. They won't come and our children will suffer," she said from the town of Madabot, a dust-ridden community of 15,000 people just 15km from the provincial capital of Tarinkot.
Four other women in the area that IRIN interviewed echoed her view.
"People say the children in Tarinkot have been vaccinated, but unfortunately our children haven't," Moahboba, 28, said from the doorway of her simple mud brick home in Dorafshan, 20km northwest of Tarinkot. "The vaccinators do not come here because the security situation doesn't allow it."
Polio is a debilitating disease that mainly strikes children.
For polio vaccinators working on the frontlines of an emerging Taliban resurgence and earning just US $50 per month, the 15 or 20km trip from the provincial capital to outlying towns and villages is too much of a risk to take.
"While I was traveling to Tarinkot, the Taliban stopped my bus and forced me outside," said Hamdullah, a government polio vaccinator who was beaten and harassed on 16 February while on duty.
"They slapped my face. They held me for eight hours before releasing me," the 35-year-old said. "They made me promise that I would not vaccinate any more children - threatening to kill me if I did."
The WHO estimates that in 2006 alone, vaccinators were unable to access an estimated 125,000 children in the south and south-eastern regions of the country due to insecurity.
Of this number, about 75,000 were in the southern provinces of Helmand, Kandahar, Uruzgan, Zabul and Nimruz, and 50,000 in the south-eastern provinces of Paktia, Paktika, Khost and Ghazni.
Saifudin Khan, a health officer for Urozgan's provincial health department, said, "We have not been able to carry out any vaccinations in areas like Dorafshan, Madabot and Charmestan because of the security situation. When any of our volunteers go to these areas, the Taliban destroy their tools and threaten to kill them." "
Here are some pics from a WHO presentation on the polio situation (its deterioration from 2005 to 2006) then. There were some 9 cases in Afghanistan in all of 2005, and then 26 already by the end of July, 2006.
However, this IRIN article from August 7 potentially indicates a fortunate reversal of trends:
" In 2006 there were 40 confirmed cases of polio in Pakistan and 31 in Afghanistan. This year, there have been 11 confirmed cases in Pakistan, including four in Sindh Province, two in Balochistan and four in Pakistan’s North West Frontier Province. In Afghanistan there have been five confirmed cases; three in the southern provinces of Helmand and Kandahar, as well as two in the eastern provinces of Laghman and Nangarhar, close to the border with Pakistan. "
That suggests, even while drawing attention to the threat of a spillover from Pakistan, that there wasn't an equally alarming deterioration from 2006 to 2007 in Afghanistan - in fact the number of cases up till August may show amelioration. And then came the UN's success in calling for "warring factions" to allow polio vaccination to proceed in the South on September 21, the International Peace Day. In contrast with their traditional position on the issue, the Taliban promised it wouldn't sabotage these efforts, and so vaccination went ahead (such a truce is not unprecedented and thus not some sign of newly found wisdom from the Taliban, who did negotiate a similar thing with the Northern Alliance back in 2000; some may be hardheads but some of them more likely just cynically refused to cooperate earlier on). Health workers "hired a lot of local staff" - that is cited as a key to the breakthrough this time.
I'm not sure to what extent vaccination took place eventually in Uruzgan, because news reports, like this one, mention Helmand (including Musa Qala district!) and Kandahar mostly. Anyway, this is surely relevant. This already significantly reduces the immunity gap, and thus gets us closer to so-called "herd immunity." I do seriously doubt, however, if vaccination could have gone ahead in places like e.g. Deh Rawod district in Uruzgan at that time (much fighting there and then in the area).
So global governance has won at least one battle in Afghanistan (surely not the entire polio "war," but at least a battle). Do consider of course that OPV (oral polio vaccine) needs to be administered in a high enough dosis and multiple times, not just once, to children living in the conflict-struck areas of southern Afghanistan.
But still, even with the need for multiple vaccination in mind (or especially with that in mind) why is it then that it's hard to find news reports summing up these developments at the end of the supposedly week-long campaign which must have finished on or around September 28 if I'm correct? Well, at least in the early days of the campaign ABC and al-Jazeera did carry the story, but not any more after that I believe. Was it not newsworthy success? I don't think so. I hope it's just that I'm Google-tarded.

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