BMJ 2014;348:g1208 doi: 10.1136/bmj.g1208 (Published 29 January 2014)

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NEWS Three more polio workers are killed in Pakistan Anne Gulland London

Three polio vaccination workers in Karachi, Pakistan, were shot and killed last week, raising concerns about the level of protection that aid workers receive. Media reports stated that health workers in the city refused to continue with their work after the killings of two female workers and one male worker on 21 January, all of whom were Pakistani nationals. However, the polio vaccination campaign in the city has now resumed, said the World Health Organization. Dr Elias Durry, WHO Senior Polio Emergency Coordinator in Pakistan, said that Karachi was a city with significant security problems.

“It’s not just polio workers that are being targeted. The whole law and order situation is such that providing civil protection is a real challenge,” he said. “When there’s a shooting it understandably raises fears among health workers. Karachi is a challenging place to run polio campaigns [in] because there’s always so much going on in the city—and the safety of the vaccinators must remain the primary concern.”

The Pakistani government’s polio monitoring unit said that 22 polio workers and 16 security personnel had been killed in targeted attacks since July 2012.1 2 Last week, six policemen who were on their way to provide protection to polio vaccination workers were killed in a bomb attack in the Khyber region of the country, along with one bystander. Karachi and the Khyber area have faced problems with militants in the past, and vaccination campaigns are sometimes staggered to ensure adequate security, said WHO. All polio workers in Pakistan are employed by the Pakistani government, which has insisted that their safety is paramount. Ayesha Raza Farooq, the prime minister’s spokeswoman on polio, condemned the shooting of the workers.

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“Polio workers are our frontline volunteers who are risking their lives for our healthy future,” she said. She added that Pakistan was a “frontline state in the war against terrorism” and that attacks on polio workers should be seen in that context. She said that the federal government had issued strict security guidelines for conducting immunisation campaigns and that an investigation would be carried out to uncover the security breach. The Pakistani government has stepped up its polio eradication efforts in an attempt to rid the country of the disease this year, with vaccination points being set up in train stations and airports. However, no vaccination campaigns have taken place in the provinces of North and South Waziristan since June 2012 because of a ban imposed by militants.

The latest worldwide figures from the Global Polio Eradication Initiative, a partnership led by WHO, showed that there had been four cases of polio this year, all in North Waziristan. The initiative said that the district had the largest number of children with polio in the world. “As long as polio still exists in reservoirs like North Waziristan the world will always be at risk of outbreaks,” the initiative said. Pakistan had 91 cases in 2013—nearly a quarter of the global total of 389. This compared with 58 cases in Pakistan in 2012, and 198 in 2011. 1 2

Anne Gulland. More polio workers are killed in Pakistan. BMJ 2013;346:f15. Anne Gulland. Polio vaccination worker is shot and killed in Pakistan. BMJ 2012;345:e5061.

Cite this as: BMJ 2014;348:g1208 © BMJ Publishing Group Ltd 2014

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Three more polio workers are killed in Pakistan.

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