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Courtesy of Craig Wilson
While the worldwide incidence of polio has declined dramatically in the last 25 years, we are actually seeing more cases in some areas.

Editors note: Craig Wilson wrote the vast majority of this piece.

War has more casualties than we know.

We learned in September 2013 that an outbreak of the deadly polio virus occurred in Syria. It was the first in that country since 1999. While the worldwide incidence of polio has declined dramatically in the last 25 years, we are actually seeing more cases in some areas. Syria is one of those.

There are but three endemic countries left in the world where the wild polio virus breeds. Those countries are Pakistan, Afghanistan and Nigeria. But the virus can and does travel. The virus can be traced to a country, even a province and in some cases to a specific village. In Syria, where 17 new cases were reported during 2013, the virus probably came from Pakistan.

In 2012, there were 262 reported cases of polio worldwide. There were 362 reported in 2013. Nigeria and Afghanistan reported respectively 50 percent and 33 percent decreases; Pakistan's cases increased by 35 percent. Syria is up from zero. Why the increases despite magnified efforts to eliminate the scourge of polio? It's because of violence, which has attracted some to the war in Syria, and violence toward polio workers. Violence curbs efforts to immunize, and in each of these countries, violence can be ever-present.

In early 2013, at least 20 health workers in Afghanistan, Nigeria and Pakistan were killed.

The New York Times reported on Dec. 14, “Attacks on polio teams in northwest Pakistan … killed a polio worker and two police officers assigned to protect one of the teams ….” Pakistani militants have killed more than a dozen polio workers and police officers protecting them over the past year. The militants accuse health workers of acting as spies for the United States and claim that the polio vaccine is intended to make Muslim children sterile. North Waziristan is the area in Pakistan with the largest number of children being paralyzed by the polio virus. Immunization activities have been suspended by local leaders since June 2012.

The New York Times reported on Dec. 28 in Islamabad, Pakistan, “A health worker supervising a polio vaccination campaign was fatally shot and two others were wounded … when gunmen opened fire at a hospital.”

Most of the increase in polio, however, came in one country: Somalia. Some 183 cases were reported, while in 2012 there were none. Somalia has not had an effective central government for two decades. The BBC reported that “medical charity Medecins Sans Frontieres (MSF) said it was closing all its programmes in Somalia after 22 years working in the war-torn country.”

The U.N. Office for the Coordination of Humanitarian Affairs (UNCHA) reported in August 2013 regarding Somalia, “[while] some four million people have been vaccinated, getting drugs to more than 600,000 children in southern and central Somalia — areas partly under control of the Al-Qaeda-linked Shebab, who block vaccination efforts — is ‘extremely challenging.’ … The inability to fully access these areas constitute a major threat to the control of the outbreak. … Somalia remains one of the most difficult and dangerous environments in the world for aid workers."

On the other hand, there is good news and miracles do happen. Former Rotary International President Sakuji Tanaka once said, "however we define peace, whatever peace means to us, we can bring it closer through service ….” That service, represented by WHO, Rotary and many other people and organizations through the Global Polio Eradication Initiative has made and continues to make amazing progress.

Rotary International responded quickly to Syria’s need with a $500,000 emergency grant to the World Health Organization. Rotary and WHO have long been partners in the global effort to eradicate polio. Dr. Robert S. Scott, chairman of Rotary’s PolioPlus program, said that “these and other recent polio cases in previously polio-free countries serve as a reminder that as long as polio still exists anywhere in the world, all unimmunized children everywhere remain at risk.”

In other good news, “The Horn of Africa outbreak is on the decline, including in Banadir, Somalia, the ‘engine’ of the outbreak (no cases since July 2013).” The recent immunization effort in the Middle East has already protected 1.6 million children against polio, mumps, measles and rubella since Oct. 24, 2013. That same effort will reach 22 million children under the age of 5 in countries including, and those bordering on, Syria over the next six months.

According to Rotary, the annual number of new polio cases has plummeted by more than 99 percent since the 1980s, when polio infected about 350,000 people annually. Rotary also reports that since then more than 2 billion children have been immunized in 122 countries, preventing 13 million cases of paralysis and 250,000 deaths.

Cease-fires have been negotiated to allow for immunizations. Around the world in places as diverse as Afghanistan and Congo, Iraq and Tajikistan, pauses in hostilities so that children can live disease-free have occurred over the past 20 years. Variously known as Humanitarian Cease-Fire; Days of Tranquility; Corridors of Peace; Safe Havens; Sanctuaries of Peace; and Zones of Peace, they all allow for the provision of health and humanitarian assistance. That can happen again in some of the most war-torn parts of Syria.

John Hoffmire teaches at SaÏd Business School at the University of Oxford.

R. Craig Wilson is a director of Progress Through Business and immediate past district governor for Rotary International for northern Arizona.