POLIO AND THE TALIBAN

(This article appeared in the January 9th issue of the Wall Street Journal)

Risky Ally in War on Polio: the Taliban

MEHTAR LAM, Afghanistan -- Knocking on door after door, thousands of volunteers fan out every month across southern and eastern Afghanistan, vaccinating children against polio, a disease eradicated almost everywhere else in the world.

Usually, the volunteers -- sent by the government and sponsored by United Nations agencies -- bring a single-page letter requesting people to cooperate, "for the benefit of our next generations." The letter's signatory: Mullah Mohammad Omar, the one-eyed supreme leader of the Taliban.
"We always carry a copy," says Dr. Attar Wafa, the chief of polio vaccinations in the insurgent-infested province of Laghman, much of which is a no-go area for government workers and foreigners.
The antipolio campaign brings together the Taliban, President Hamid Karzai's central government, Unicef and the World Health Organization in an uneasy but functioning partnership -- one that recognizes the reality of the insurgents' stranglehold over large chunks of the country.

"We always carry a copy [of the letter] with us," says Dr. Attar Wafa, left, chief of polio vaccinations in Laghman province.
The arrangement shows the possibilities and perils of cooperating with the Taliban. It brings the world a major step closer to eradicating a crippling disease. Yet "there is no doubt that it is a political victory for the Taliban," says Afghan lawmaker Sardar Oghli. "The Taliban are trying to show the world that they are in control."
Mr. Karzai, with Western backing, has repeatedly called for ending the eight-year Afghan war through a broad political settlement with the insurgents. The Taliban leadership has rejected negotiations with Kabul as long as U.S.-led foreign troops remain in the country. But the antipolio drive is already leading to de-facto collaboration between the insurgents and representatives of Mr. Karzai's administration.
"There used to be a ping-pong diplomacy, and now we have a vaccination diplomacy," says Afghan parliament member Daud Sultanzoi, referring to the sports contacts between China and the U.S. in the 1970s that paved the way for talks between the two nations.
For U.S. military commanders in Afghanistan, the arrangement represents a moral dilemma. Coalition military officials shy away from criticizing the WHO and Unicef for reaching out to the Taliban. In an interview, U.S. Lt.-Gen. David M. Rodriguez, the commander of U.S.-led coalition forces here, said: "We support all the efforts to help the people of Afghanistan."
Nevertheless, the fact that the international community and Afghan government authorities must request Taliban permission to operate in large parts of the country makes some Western officials wince. "It's a pact with the devil," says one senior Western diplomat in Kabul. "But it's a pact in order to save lives."
A spokesman for the U.N.'s secretary-general said, "Around the world, the United Nations has tried to make sure that it has acceptance by all parties on the ground to carry out its humanitarian work." The spokesman added, "We always face security challenges, but it's important to carry out inoculations so people do not die."
To access contested areas, some U.N.-affiliated vaccination teams carry a letter signed by Taliban chieftain Mullah Omar. A child gets oral vaccine.


Taliban-led insurgents either control or exert strong influence in about one-third of the country, mostly in the south and east -- areas where the bulk of the polio cases are located. As the insurgents' power grew in recent years, polio teams increasingly faced problems with access to Taliban-dominated districts, according to Dr. Tahir Mir, the WHO's chief of the polio-eradication program in Afghanistan.
Since Mullah Omar's first letter was issued, in August 2007, vaccinators gained entry to dozens of previously out-of-bounds villages, WHO officials say. More importantly, the Taliban endorsement allowed many vaccination teams that considered pulling out because of safety concerns to continue operating in other districts, even as fighting intensified.
Mullah Omar's cooperation with Afghanistan's polio drive contrasts with the ban on polio vaccinations imposed by leaders of the separate, but affiliated, Taliban movement in neighboring Pakistan. The relative access enjoyed by vaccination teams in Afghanistan amid an escalating war also shows the degree of control that the Afghan Taliban's central leadership, mostly based in the Pakistani city of Quetta and headed by Mullah Omar, exercises over Afghanistan's many insurgent groups.
Antipolio campaigns have long been opposed by conservative clerics across South Asia as an American-led conspiracy to sterilize or poison Muslim children. This is a key reason why the disease persists in India and Pakistan. Nigeria is the only other country with endemic polio, also largely due to opposition by Islamic preachers.
Eliminating polio in the remaining four endemic countries -- a top U.N. priority -- would eventually render it unnecessary to vaccinate hundreds of millions of children elsewhere every year. Last year, Afghanistan had 31 diagnosed cases of polio, the vast majority in the insurgency-wracked Kandahar and Helmand provinces, up from four known cases in 2004. The polio virus can cause irreversible paralysis in about one out of 200 infected children.
In the U.S., children usually receive four injections of a vaccine made from the dead polio virus. By contrast, kids in southern and eastern Afghanistan ingest oral doses of the weakened, live virus almost monthly. The reason: The live vaccine is eventually excreted by the children and enters the typically unhygienic local water supply -- providing a secondary dose to unvaccinated neighbors.
But unlike the dead virus used in the West, an oral vaccine carries a risk, albeit very small, of actually infecting a healthy child with polio. That possibility helps fuel the anti-vaccination conspiracy theories. For instance, in the Swat Valley in Pakistan, Maulana Fazlullah, a Taliban-affiliated warlord, outlawed polio vaccinations until that area was retaken by government forces last summer.
Afghanistan's Mullah Omar adopted the opposite approach. His letter, viewed by The Wall Street Journal and issued on behalf of the movement's parallel government, the Islamic Emirate of Afghanistan, urges all jihadi fighters and Taliban sympathizers to work with Unicef, WHO and the polio teams. It instructs villagers to take children to a specially designated area where they can receive their dose.
"The Taliban want legitimacy," says Zefnoon Safai, an Afghan lawmaker representing Laghman province, southeast of Kabul. The use of Mullah Omar's letter by U.N. agencies such as the WHO, she adds, "means that these organizations believe that in addition to the Afghan government and international forces there is a third power here, the Taliban."
The Taliban have little love for the U.N., which they view as an instrument of American occupation because the Security Council authorized the presence of some 110,000 U.S.-led foreign troops here. In October, Taliban-affiliated insurgents attacked a U.N. guest house in Kabul, killing several UN electoral workers.
Yet on the issue of vaccinations, the Taliban seem to have suspended this enmity, constrained by Afghan public opinion and, just like the foreign troops, eager to win hearts and minds. "When the Taliban were in power, they supported our program, and now that they are in opposition, we expected them to do the same, and we have received a positive response," says Dr. Mir of the WHO.
In mid-2007, when Dr. Mir first asked for a Taliban letter of support, polio teams encountered growing difficulties in accessing insurgent-held areas.
At the time, some vaccinators were beaten up and their rosters snatched by local Taliban, because the teams' frequent home visits and detailed documentation of who lives where aroused suspicions that the health workers were spying on militants. "But now, if they have any problems, they just show the Taliban letter, and it works," says Khushhal Zaman, the WHO's polio-eradication team leader for four eastern Afghan provinces, including Laghman.
It's easy to imagine why insurgents might have been suspicious. On a recent morning, a three-man team -- armed with a bucket of vaccine vials and a roster of residents' names and addresses -- walked from house to house in the rural outskirts of Laghman's main city, Mehtar Lam. The team's supervisor, a 26-year-old trainee teacher named Nasiullah, used chalk to mark the entrance to every home with a code assigned by the vaccination program, jotting down the number of resident children under five years of age.
"Give me your kid," Mr. Nasiullah demanded as 27-year-old mason Mohamed Hashim brought out his two-month-old daughter, Amida. Then, squeezing the crying baby's cheeks, he poured the vaccine into her mouth. Another team member marked the girl's pinkie with indelible violet ink to indicate she had been vaccinated.
Mr. Nasiullah, who like many Afghans uses only one name, had also been here the previous day, to vaccinate Mr. Hashim's two other children. Just as he started berating the father for not having Amida at home during the earlier visit, their conversation was interrupted by the boom of an explosion on the valley floor below.
While health officials across southern and eastern Afghanistan agree that the Taliban letter is undoubtedly helpful, it isn't always foolproof. In the province of Kunar, east of Laghman, some insurgent commanders have rejected it as a fake, saying they don't recognize the wavy "M.O." initials that constitute Mullah Omar's signature. Similar problems occurred in Kandahar and Helmand, where some local militias maintain little contact with Quetta.
"The letter from Quetta is an umbrella, but how it all trickles down to the local level is not always clear," says Helene Kadi, Unicef's Kandahar-based representative in southern Afghanistan. "This is why negotiations with the local commanders are always important."
The WHO and Unicef aren't dealing with Quetta and Mullah Omar directly: U.N. agencies have been banned from contacting the Taliban, which the world body blacklisted as terrorists, since the attacks on America of Sept. 11, 2001.
Instead, the International Committee of the Red Cross, the only international organization that maintains regular communications with the Taliban command, acts as an intermediary every time a new letter of support is issued. That happened 10 times in 2009, each time a new vaccination campaign was launched.
Dr. Mir of the WHO says he decided to ask the International Committee of the Red Cross, or ICRC, for assistance after watching how that organization facilitated talks between the South Korean government and the Taliban that led to the freeing of 23 Korean hostages kidnapped by the insurgents in July 2007.
"It struck us, if they can help with this, they can certainly help the children of Afghanistan," says Dr. Mir.
Afghan insurgents generally respect the ICRC's neutrality, unlike their counterparts in Iraq, who blew up the organization's Baghdad headquarters in October 2003. The ICRC maintains first-aid posts in some Taliban-held parts of the country and runs special taxi-ambulance services that evacuate wounded Taliban fighters from the battlefield as well as Afghan civilians caught in the crossfire.
"We have a very constructive dialogue with the armed opposition, and we have contacts with the local leadership as well as the highest leadership sitting in Quetta and in Peshawar," says the ICRC's deputy head in Kabul, Eloi Fillion. "We've gained the trust of these groups because we are efficient in the field."
Red Cross workers coordinate with the Taliban almost daily their movement through insurgent-dominated areas. And the organization has established channels of communication that allow it to receive responses on requests sent to the Taliban's senior leadership within hours, Mr. Fillion says. He declined to elaborate on how that system works because the information could enable the U.S. and its allies to kill or capture Taliban leaders.
Once the ICRC relayed to Quetta the WHO's request for a vaccination-support letter in 2007, the Taliban took about a month to ponder their decision, Dr. Mir says. In the end, the appeal of what amounted to a gesture of international recognition proved irresistible for a movement that views itself as Afghanistan's legitimate government.
These days, Mullah Omar quickly issues a new letter for every vaccination round. The WHO staff then print thousands of copies, distributing them to volunteers.
Dr. Mir says that, because of the rise in insurgent activities in the previously safe northern Afghanistan, vaccination workers now must carry the Taliban letter in northern provinces such as Kunduz and Baghlan, in addition to the south and the east.
In the insurgent-dominated areas, it's the Taliban who select the local vaccination teams and their supervisors. These Taliban-appointed vaccinators then receive the vaccine and the documentation from government health offices, and report back the results once the round is over.
"The insurgents know these locals," says Dr. Mohammad Ishaq, who oversees the polio program in the Kunar province. "They trust them and cooperate with them."