Militant groups have intensified attacks against polio vaccination teams and their police escorts in Pakistan amid a dramatic resurgence of polio cases in the country.
Officials say because of the deteriorating security situation, polio vaccination teams cannot reach communities in high-risk areas where polio is endemic.
On Tuesday, militants attacked two health centers in the tribal districts of Orakzai and Waziristan that are being used in the polio vaccination campaign. Two police officials were killed in the attack in the restive region along the Afghan border.
According to local officials in North Waziristan, militants took guns from the police officers guarding the polio team and warned the health workers not to take part in the anti-polio campaign.
Pakistan Interior Minister Mohsin Naqvi, in reaction to the latest violence, said in a statement, "The terrorists' attack on the polio team is an attack on the safe future of Pakistan."
Violence has heightened safety concerns among front-line polio workers in the country.
"When I go out as part of [a] polio vaccination team, I am not sure I will return home safely," Fahima Bibi, a front-line polio worker supervising vaccinations in northwestern Pakistan, told VOA.
But Bibi said she is determined to do the job.
"The cause is bigger and needs bigger commitment and sacrifice," she told VOA.
Bibi's concerns for safety are shared by many of her co-workers.
According to the Pakistan National Emergency Operations Center for Polio Eradication, 225,440 female vaccinators are working in the immunization workforce, going door to door to administer polio drops to children. They travel to hard-to-reach and remote, conservative regions in Pakistan, breaking cultural barriers.
Ihtesham Ali, minister of health in Pakistan's northwestern Khyber Pakhtunkhwa province, expressed concern Wednesday over the surge in attacks. He told VOA that the "security situation in the southern districts of Khyber Pakhtunkhwa is quite bad. And it is affecting access to communities. It is creating difficulties in our access for polio vaccinations."
'A fearful environment'
Most of the recent cases in Pakistan were reported in southwestern Balochistan province, which borders Afghanistan and Iran.
World Health Organization officials in southern Balochistan province say militant violence has affected polio campaigns in the province.
"Polio teams go house to house in a fearful environment," said Dr. Nayyar Khan Loni, a WHO official in Balochistan. He said that the recent attacks in Balochistan have forced polio teams to rush the vaccination of children in some areas.
He said immunization campaigns have been modified because of security concerns. He attributed the recent polio outbreak in Balochistan to several factors, including cross-border mobility with Afghanistan and misinformation among certain parents about polio vaccines.
Campaign against polio vaccinators
Pakistan's hard-line extremist group Tehreek-e-Taliban Pakistan (TTP) has sustained a violent campaign against polio vaccinators and security forces guarding polio team workers in Pakistan for nearly 15 years. Militants spread false claims that polio vaccines are part of a Western agenda to sterilize Muslim children. Also, militants target polio teams suspected of being government spies.
In January, at least five policemen were killed and more than a dozen injured in a major attack on polio teams and security personnel in northwestern Pakistan.
According to the Emergency Operations Center in Khyber Pakhtunkhwa, militants have carried out 23 attacks against polio teams and security escorts in Pakistan this year.
Overall, militant-sponsored violence has increased in Pakistan since the Taliban took over Afghanistan in 2021.
According to independent think tanks tracking violence in Pakistan, militant violence has killed more than 1,000 Pakistanis, half of them security forces, in the first 10 months of this year.
The Safeguarding Health in Conflict Coalition identified 16 incidents of violence against or obstruction of health care in Pakistan in 2022, an increase from seven in 2021. Nearly 90% of these incidents involved threats and violence against polio vaccination workers, undermining health care providers' ability to meet vaccination targets.
Experts say the TTP has ignored local and international religious scholars' fatwa (edicts) that support polio vaccination in Pakistan.
Fakhar Hayat Kakakhel, a Pakistan-based researcher on militancy, said that because of military operations, militants lost space and polio vaccination teams gained more access to conflict areas.
"After August 2021, when the Pakistani Taliban regrouped in the region and got space, they restarted their anti-polio vaccination campaigns. And now we are seeing a sudden surge in cases of polio," he said.
Sindh province health officials say the security situation in Sindh is not like Khyber Pakhtunkhwa, but police are providing security to polio teams in Karachi and other parts of the province.
"Police are patrolling the streets in Karachi so that polio teams feel safe. We do not have any security issue, but [the] police department is with us," Shumaila Rasool, spokesperson for Emergency Operations Center in Sindh, told VOA.
Afghanistan and Pakistan launched synchronized polio immunization campaigns on Monday. Pakistan and Afghanistan are the only two countries in the world where the spread of polio has never been stopped.
VOA Deewa reporter Usman Khan contributed from Peshawar.