Almost 1 million children in Kandahar province alone need at least one dose of oral polio vaccine a month to head off the disease, health workers say. But many of them also live in the most violent and socially disrupted parts of southern Afghanistan, where the Taliban control large areas and do not want government health workers going door to door.
These realities make a sustained vaccination campaign brutally difficult for health workers here. And Afghanistan, one of three countries where polio is still endemic, is losing ground. Officials have registered 19 cases of polio this year, up from 13 each of the previous two years, according to World Health Organisation figures.
In August, I followed a polio vaccination crew in Kandahar and saw how, even in areas where health workers have been able to function, many things stand in their way: security fears and drought, deep poverty and stifling tradition, widespread illiteracy and superstition.
Still, starting just after dawn each day, the vaccination teams are at it, hoping to reach just a few more children.
Mawlawi Abdul Rashid of Kandahar City, a religious scholar and member of one team, said most of the residents were poor and worried about what their children would have to eat each night. Drought adds to the daily burden.
Given that, Rashid said, “They dont care about polio vaccine as much.”
Mohammad Shah, 38, said that as a vaccine campaigner in the city he had been visiting more than 100 houses a day in temperatures reaching 100 degrees Fahrenheit. He said some families asked for food and other necessities instead of the vaccine.
Despite efforts to have religious scholars express support for the vaccine, Shah said mistrust about it still existed. Many worry about whether strict interpretations of Islam allow the vaccine.
Many families know the Taliban are suspicious of the government vaccination drive, and worry that they will become targets if they are seen allowing the health workers into their homes.
Zabiullah Mujahid, the Taliban spokesman, said that the insurgents were not against the vaccine and that they supported administering it in areas under their control. But they will not allow government teams to go door to door in their areas, saying they believe the workers sometimes act as spies.