By Wasif Mahmood
Mianwali, December 2016: As the sun goes overhead in the midst of day, Khayal Muhammad; a young man with a limp in left leg, accompanied by a team of polio workers, knocks at a door in the dusty Afghan refugee camp, 55 kilometers off main city of Mianwali of Punjab.
“Have the children returned?” he asks politely from outside. The barely-there wooden door, with a piece of cloth hanging in front, opens with a slight crackle. A man in his mid-forties appears and smiles back. Khayal holds a brief discussion with the man before he disappears behind the curtain. The father comes back holding two children in his arms. The team pumps two drops of oral vaccine in their mouth and leave after exchanging greetings.
Khayal Mohammad displays a finger of a child
he has just vaccinated against polio at the Afghan refugee
camp in Mianwali ©UNICEF/PAK 2016/Wasif Mahmood
Khayal is a polio survivor who lives in the refugee camp with his family including seven siblings after migrating from Afghanistan more than 20 years ago.
“In the 90s my parents migrated from Afghanistan. They left all the belongings behind as they were in a hurry to leave due to war. They rushed to the border and were allowed by the Pakistan government to settle down in this camp”, he recalls.
In the wake of Afghan refugees’ repatriation back home, there is a high possibility polio teams may miss children or they are not informed about new ones thus leaving them vulnerable to polio virus. The priority of the still sprawling camp is high in fight against polio. Set up in 1990s, it was once one of the biggest in Pakistan housing 100,000 refugees.
Today, though, the population has dropped to over 38,000 but challenges remain. Especially maintaining the overall positive environment so that vaccination activities including anti-polio efforts continue unhindered till every child is vaccinated.
“There are so many children in the camp who cannot be vaccinated when team pays them first visit”, says Khayal who has joined the force of social mobilizers to help children get protected from a lifetime disability. “I go house-to-house to confirm the availability of children who are not available during first visit and inform polio teams if the child has returned. If the family is new to the camp I accompany teams to the house for vaccination so that no child remains unvaccinated”.
The Afghan camp reported its first polio case in March 2013 when a three old girl was diagnosed with polio virus. “As very rightly said, women and children are the most likely victims of an emergency, be it a natural disaster or conflict. No one can understand this pain more than me,” says Khayal Muhammad.
“Health facilities were not available. Also polio campaigns were not held door to door. I missed my routine immunization vaccination. At the age of little less than two I suffered paralysis, which was later confirmed to be polio”, he says.
Polio vaccinators in Punjab track children on the
move to ensure no child is missed in the vaccination
effort ©UNICEF/PAK 2016/Wasif Mahmood
“I grew up in Pakistan with disability. Today I am 26. I am one from their extended family and therefore respected and trusted by the elders and parents. So there is no chance that any child may be missed in the camp, be it a guest or local” Khayal says offering his reassurance.
“It was difficult to grow up with disability. But now I support polio teams in the camp. Being local I guide them to homes and help them locate children who have missed their vaccination”. “It is difficult for me to walk, but I consider it my responsibility to find every single child in the camp, whether playing in the street or sleeping at home”, Khayal says.
Vaccination of children who live in high risk conditions is one of the challenges in Punjab. A single child left unvaccinated is not only vulnerable to the virus but may affect other children living in community.
Mianwali shares border with Khyber Pakhtunhwa, which is a polio reservoir, and frequently visited by Afghan refugees. They mostly travel to their homeland using Tola Bangi Khel and Darra Tung routes in Essakhel, a sub-district of Mianwali. After crossing the points they enter into KP and travel further to their homeland across the border into Afghanistan.
Since the beginning of 2016, 2.5 million unvaccinated children were vaccinated by mobile teams accompanied by the social mobilizers in high risk union councils like Kot Chandana during polio eradication campaigns.
Punjab has reported no polio case in 2016 so far but environmental samples collected from various sites in South Punjab as well as Lahore and Rawalpindi indicate transmission of virus from reservoir districts of Peshawar and Karachi. The transmission provides an ample evidence that there are pockets of missed children who are on the move.
Children living in such conditions, who are on the move due to economic reasons during cultivation or harvesting season, are on high priority of the polio eradication programme.
The strategies set by the programme focus on systematically identifying and mapping all mobile, migratory, nomadic and internally displaced populations in Pakistan with a view to ensuring that these populations are included in the plans.
In Punjab over 180 social mobilizers like Khayal are always mobile and ensure that polio frontline workers reach every such child and provide them the much needed vaccine free of cost as per their inborn right.
“To completely eradicate polio it is critical that every single child gets two drops of vaccine every time it is offered”, Khayal Muhammad says.