As if the country is not enough plagued by a medley of miseries, the World Health Organisation is mulling over placing tough restrictions on Pakistanis travelling overseas. These restrictions are being considered in the wake of a series of polio cases triggered by virus originated from Pakistan and detected in different countries. Such cases were detected in China, Egypt, Israel and Palestine.

These cases have alarmed the international community. A European health journal "The Lancet Medical Journal" has also warned that Pakistani polio virus could become a threat for Europe. India has already banned Pakistani travelers who were not immunized. According to a press release issued by Indian High Commission in Pakistan, all adults and children travelling to India from Pakistan after January 30, 2014 are required to carry their record of vaccination as evidence. The action has been taken under the recommendation of Independent Monitoring Board for Polio Eradication.

The board will hold a meeting in January in which 23 countries will participate to consider a collective decision. Health Department officials have disclosed that they have been warned by donors and polio monitoring agencies that if the situation did not improve, the country should brace for serious restrictions on visa and overseas travel.

Polio cases are being reported from all provinces of Pakistan and FATA. Previously, most of the cases were reported from restive Khyber-Pakhtunkhwa and FATA but it is not confined to these areas any more. Three cases have recently been reported from Multan, Sahiwal and Toba Tek Singh districts of Punjab. Similarly a confounded Sindh government is also grappling with a challenge of spiraling polio cases in the province. Breeding in the cesspool of nepotism, the provincial bureaucracy has very limited capacity and professional-will to confront this new challenge. 

Law and order initially debarred vaccinators to access parts of the province but the recent wave of attacks on polio workers has further deteriorated the situation. But what is causing deeper consternation is a recent trend of refusal by parents which was not so common in Sindh province.

Health officials reported an alarming 23,723 refusals in a recent vaccination campaign. Most of these refusals are noticed in the districts of upper Sindh, mainly Shikarpur and Kashmore. Refusals have also been reported from Pakhtun enclaves of Karachi and Jamshoro district. Whereas refusal by Pakhtun communities follows the trend, what baffles is the permeation of this alarming trend among native Sindhi families.

North Sindh has a relatively juvenile proclivity of religious extremism and the refusal to polio vaccination merits serious rumination. A network of religious seminaries is fast unwinding in these areas, mostly managed by non-local clerics. Recent years witnessed some grisly incidents in Shikarpur.

In 2010, Taliban claimed responsibility for torching 27 Nato tankers in Shikarpur. Shrine of Hajjan Shah was also attacked that claimed two innocent lives and injured more than a dozen. Pernicious rise of extremism is now manifesting in refusal of polio vaccination.

The federal government is also perturbed over the sudden surge in polio cases in the province. Sindh had four polio cases by the middle of November. Three more cases -- two in Karachi and one in Kashmore -- surfaced in less than a month. Five of these cases have been detected in Karachi and one each in Kashmore and Dadu districts. Baldia, Gadap towns and Gulshan-i-Iqbal neighbourhood have been identified as the areas where the polio virus has been active in Karachi.

Like Khyber-Pakhtunkhwa, Karachi has also faced a wave of terror against polio vaccinators. In 2012, the vaccination campaign came to a screeching halt after attacks on a World Health Organisation’s doctor and polio vaccinators in Karachi. In July 2012, a local paramedic associated with polio vaccination was shot dead and a World Health Organisation doctor, Fosten Dido, from Ghana and his driver were injured in two separate attacks in the Sohrab Goth area.

Law and order and religious extremism are making Sindh a hotbed of polio in the country. This explains an official estimate of 743 polio cases during the last 17 years in Sindh. UNICEF included seven districts of Sindh among 33 high risk districts in the country. All these districts are located in north Sindh contiguous with South Punjab. These districts include Ghotki, Kambar-Shahdadkot, Kashmore, Khairpur, Larkano, Shikarpur and Sukkur. These districts are afflicted by a chronic law and order situation. Abduction for ransom, murders, honour killings and robberies are rampant in these areas. Dominated by tribal chieftains, north Sindh districts are ruled by criminal gangs. This situation limits ability of immunization workers to reach the inaccessible parts of these districts.

Apart from Pakistan, the only two other countries where polio cases were reported last year included Nigeria and Afghanistan. In 2013, Pakistan has emerged as the worst country dwarfing polio cases in Nigeria and Afghanistan. Afghanistan has reported 11 polio cases in 2013 compared to 30 in the previous year. Similarly, Nigeria has reported 50 per cent less polio cases in 2013. Whereas Pakistan reported 85 polio cases i.e. 40 per cent higher than 58 cases in 2012. This indicates the alarming trend of increase in incidence of polio in Pakistan.

According to a report, some 7.8 billion dollars have been spent in Pakistan to eradicate polio yet the results are abysmal. What is really shocking is the fact that 24 per cent of the children who were reported to have contracted polio till November 2011 were those who had received seven or more doses of vaccine. A Pakhtun girl Sonia from Gadap, Karachi contracted polio virus even after having received nine doses of vaccine.

Security of immunization workers is a major cause of inadequate polio vaccination. In December 2012, over 3.5 million children were missed out in the national anti-polio campaign. Sindh had the highest number of unvaccinated children i.e. 1.75 million when the campaign was scuttled after killing of four female vaccinators on the second day of the campaign. Similarly, the campaign was terminated in KP on the first day after the vaccinators were attacked. The trend persisted in the subsequent years as well.

In April 2013, 1.83 million children did not receive polio vaccine. In July 2013, some 0.68 million children missed polio vaccine in high-risk zones mainly due to the deteriorating law and order situation. Punjab alone had nearly half of the missed children i.e. 332,694, followed by Sindh with 163,806 unvaccinated children. The data indicates the magnitude of vulnerability of millions of children to contract polio.

Apart from law and order situation, more worrying is the trend of parents’ refusal to vaccinate their children. During a campaign in September 2013, some 65,947 families in the country eschewed vaccination to their children. KP had the highest number of 36,923 families followed by Sindh with 18,918 families who refused vaccination to their children. Osama Bin Laden episode has also stigmatised the polio vaccination campaign. Certain religious clerics also misinterpret religious injunctions to demonise Polio vaccination.

Reasons apart, international community is seething with impatience and tough travel sanctions seem imminent for Pakistani travelers. Separate queues of Pakistanis at international airports not merely for ignominious frisking but also to present polio vaccination certificates will rub salt into un-healing wounds of already tormented Pakistani citizens.