There is no choice: everybody has to be vaccinated. It's not a matter of 'I want to,' (or) 'I don't want to.' No. With polio there is no cure, you have nothing but prevention. —Soha Boustani, UNICEF
TRIPOLI, Lebanon — Health officials are rushing to vaccinate millions of children from Egypt to Turkey, fearing a polio outbreak in Syria could spread as tens of thousands of refugees flee the civil war.
The officials want to reach all children under 5 years old in seven vulnerable places: Egypt, Iraq, Jordan, Lebanon, the Palestinian West Bank and Gaza Strip, Turkey and Syria, about 22 million in all.
The $30 million campaign by the U.N. and Arab health officials seeks to inoculate even those who already may have been vaccinated against the highly contagious virus that can paralyze or kill.
"There is no choice: everybody has to be vaccinated. It's not a matter of 'I want to,' (or) 'I don't want to.' No. With polio there is no cure, you have nothing but prevention," said Soha Boustani of the U.N.'s children's agency, UNICEF.
The scramble to vaccinate is palpable in neighboring Lebanon because of the sheer number of refugees overwhelming the health care system.
This week, hundreds of health workers and volunteers were fanning out across Lebanon — especially in its vulnerable slums — offering free vaccinations and hoping to reach the country's half-million children under age 5.
U.N. officials established new vaccination points across Lebanon's eastern and northern borders with Syria to catch children before they cross. Radio spots urge parents to vaccinate their children in local clinics.
The four-day campaign was due to end Tuesday but was extended until Friday because of the need to knock on nearly every door, said a Lebanese health official, speaking condition of anonymity because she wasn't allowed to talk to reporters.
Another vaccination campaign will start in December, health officials said.
Syrian refugees in Lebanon said officials ordered them to bring their children for vaccination as a compulsory step to renewing U.N. identity cards entitling them to aid, but U.N. officials denied that.
"We heard on the television that we have to vaccinate the children," said Ghufran Turun, a 28-year-old mother of three, at a U.N. center in the northern Lebanese city of Tripoli, where dozens of families waited on rows of plastic chairs.
Turun's mother-in-law clutched her unvaccinated granddaughter, 2-month-old Loujain, while Turun's 4-year-old son, Zein al-Abedeen, had to be revaccinated.
Nearby, two other girls worriedly clung to their father as they waited. Their brown eyes widened as their mother handed their toddler brother — too young to know what was happening — to a nurse who swiftly injected him as he cried in pain and surprise. The little girls inched closer to their father.
The polio vaccine is usually administered orally but the U.N. also was offering injections against measles, rubella and chicken pox.
Inside Syria, in areas beset by fighting, health officials were trying to reach children in mobile clinics, UNICEF said.
The campaign began after the World Health Organization, a U.N. agency, confirmed 10 polio cases in the northeastern Syrian province of Deir al-Zour in November. On Monday, another three children in the area were found to have the virus.
The WHO also found strains of the virus in sewage samples in Egypt, Israel and the Palestinian territories. Although Arab countries traditionally have high immunization rates of about 90 percent, tens of thousands of children were seen as vulnerable, said Mike Ryan, WHO's polio response coordinator.
The polio vaccinations did not guarantee full protection, which is why millions had to be inoculated again, Ryan said.
The campaign underscores how one effect of Syria's three-year conflict — the collapse of its medical system in some areas — has rippled through the region.
Syria's 90 percent vaccination rate plummeted to 68 percent during the civil war, leaving a half-million children without inoculations, the U.N. estimated.
The children are among the 4 million Syrians who have fled to other parts of their country and the 2 million who have left it entirely.
Lebanon is particular at risk, Ryan said, with 1.4 million Syrians pouring into the country in the past two years — a mix of refugees and immigrants.
The poorest crowd into apartments, unfinished buildings, storefronts and about 40 tin-shack slums, the U.N. said, and many have no running water or sewage systems. Polio is usually spread by food and drink contaminated with feces.
Turun and her family are among those poorest of refugees. They live with other relatives in a room of an apartment under construction, with no toilet, running water or power. They use bricks to block gaping holes in the wall.
In such impoverished parts of Lebanon, health services are overstretched by the influx of Syrian refugees, and the families sometimes skip immunizations, health officials said. In addition, some of the Syrians are not registered with authorities.
As a result, even though health officials estimate Lebanon's vaccination rate at 98 percent, it is likely to be lower.
Last winter, a measles outbreak affected an unprecedented 1,400 Syrian and Lebanese children — also because of poor vaccination rates. The U.N. and partner groups bulked up their health services but still were overwhelmed, UNICEF's Boustani said.
"When you look at the Syrians and their conditions (in Lebanon)," Boustani said, "you realize the urgency of the issue."
The WHO said a joint resolution by 21 nations who are part of the U.N. health agency's Eastern Mediterranean region have called on Pakistan to urgently vaccinate all of its children to prevent the virus from spreading internationally.