EFTA01190773.pdf

9 Sept 2014 Strictly Confidential: Report on IPI Mission to Pakistan 18-23 August 2014 Status of polio & Pak Army military operation in North Waziristan: A humanitarian disaster but an unmitigated success for polio eradication. Below are major points resulting from IN efforts since Nov-Dec 2013: Note: IPI's efforts, especially during regularfield trips since May 2013 have focused on: (i) acquiring on-the-ground data which does not appear in official accounts; (ii) via interlocutors attempting to reach extremist groups opposing polio eradication; (iii) approaching senior officials dealing with military & security to request & recommend concrete steps to ensure access to tribal children in inaccessible areas of the tribal belt. IPI can report success in all three areas, the full extent of IPI's confidential efforts & sensitive information can be elaborated in confidential briefings only. This brief report focuses on Pak Army's diligent role, with other data/figures intentionally excluded herein. As a result of the military operation by the Pakistan Armed Forces in North Waziristan (bordering Afghanistan) started in mid-June 2014, ca. 800,000 — 1,000,000 persons had to evacuate into safer areas. These internally displaced persons (IDPs), called "temporarily displaced persons" (TDPs) by the Govt of Pakistan/Pak Army, were forced to evacuate through a single entry checkpoint only at Saidgai. This created a huge bottleneck lasting for weeks, with families, old persons, children, livestock, other household goods -- on foot, in private or rented vehicles, over-crowded buses, animal-drawn carts — waiting in extremely hot areas to register and enter and move towards TDP camps in Bannu. SUCCESS RESULTING FROM PAK ARMY MILITARY OPERATION/ACTION: This bottleneck, which created miserable conditions — led to all people (not just children), being given anti-polio drops, from the oldest to the youngest — universal immunization in the fullest sense of the medical term. This meant that all the children from North Waziristan, the majority of whom had never been vaccinated, received anti- polio drops. No one got through the Saidgai checkpoint without the drops. The fact that everyone had to register to receive aid rations including cash, which meant double registration & ensured the direct delivery of anti-polio drops. Interestingly, no objections/refusals on religious or other grounds, were voiced. There have been almost no attacks on polio health teams, reinforcing IPI's analysis that the majority of such attacks in the past had other causes. In the four months preceding the mlitary operation, the Pak Army could not go into no- go zones in some of the tribal agencies, so it had set up 36 transit points in inaccessible areas, where anti-polio drops were administered. Free Army medical camps were set up, with women doctors in 30 transit points, for families & children which did not move through the 36 transit points. Mobile medical vans dovetailed with these 30 camps, with private compartments where anti-polio drops were discreetly administered. Pak Army EFTA01190773 carried out "hujra vaccinations", i.e. when tribesmen gathered in guesthouses for males only, the Army gave them anti-polio drops to take home. 48 special anti-polio campaigns were planned for 25-28 August, with military support. Where campaigns could not be undertaken or completed, special follow-up campaigns will be carried out. Remaining inaccessible tribal areas have been/are being evacuated, with children receiving anti-polio drops on their way out. Registration of TDPs (verification is continuing): Males: 260,000; Females: 288,000; Children: 460,000. The 10,000-13,000 tribesmen from North Waziristan who fled into Afghanistan (unofficial figures are higher) received anti-polio drops in Khost; those who have returned (because they were ostensibly in a detention camp) were registered at Alizai checkpoint, numbering ca. 40,000 (higher figure includes the return of tribesmen who had left earlier). Perception management is being undertaken via the Ministry of Information. The Pak Army is monitoring the polio situation, with senior civilians reporting to 2 very senior Pakistan Army Generals. Taliban position: Gul Bahadur, the "good Taliban" was removed from his leadership position in mid-August. IPI has been informed via interlocutors that the Taliban central body will not officially rescind the ban but will allow the polio eradication campaigns. The intra- Taliban tussles now taking place and the resulting new groups and leaders will hold a similar position, as also confirmed via interlocutors. NEW DANGERS: Field visits as part of the recent IPI mission found that the majority of the TDPs have spread away from the initial arrival area (ca. 40,000 remain in Bannu) into adjoining areas, into towns farther away, and some into distant towns & other provinces — mainly based on where they have family connections and fellow tribesmen. Although the Provincial and tribal health authorities have made plans to follow up the new "arrivals" in each district or province, and to include these in their normal polio eradication campaigns, via tracking systems (eg. the cellphone SIM which shows where the owner is located & receiving aid) there are justified concerns based on past in-depth IPI field missions that these will not be rigororous & thorough and therefore vulnerable to the same ills which have continued to dog the Govt's anti-polio efforts up to now. Hence while "catching everyone" from North Waziristan as they entered via the single Saidgai entry point was a complete success, there is now the greater fear that the migrating/spreading tribal children will not be adequately tracked and covered by the normal campaigns — and will therefore be a fresh source of infection/re-infection in their new locations, not only for polio but also other communicable diseases. At least while these children were confined to North Waziristan, the spread was largely contained. EFTA01190774 At present, owing to the stand-off & demonstrations between 2 opposition parties and their supporters (ca. 40,000 together) in Islamabad against Prime Minister Nawaz Sharif, as well as ensuing turbulence in other towns, there is a freeze of all normal Govt activity, including delays & postponements in the normal & special planned polio eradication campaigns, or these campaigns are being carried out in limited areas only. For example a planned campaign in the distant Sindh province was postponed owing to the inability of the central health authorities to deliver vaccines. As of 5 Sept 2014, 138 polio cases have been recorded, with the vast majority traceable to the thus-far inaccessible tribal areas. IPI continues to monitor the situation, in particular the new dangers mentioned above. Another Field mission may be required to follow-up on how civilian & security solutions to the new dangers are being implemented in practice, not simply on paper. This field visit will take place after the present regime situation & standoff return to normal. End. EFTA01190775