The World Health Organisation has confirmed Iraq’s first polio case in 14 years after a baby boy in Baghdad who developed paralysis tested positive for the virus.
The government in Baghdad has yet to publicly acknowledge the outbreak, although a mass immunisation and surveillance campaign is already underway in a bid to contain the highly contagious but easily preventable disease.
The genetic strain of polio detected in the six-month-old, who lives in the impoverished Babal Sholm area, on the eastern side of the Tigris River, matches one found in Syria late last year.
It is not yet known how the virus made it to the capital because the boy’s family is not believed to have any links to Syria, and there are fears the virus could already have been widely transmitted throughout the country.
“We do have concerns this may not be the only case and we are expecting and preparing for more cases,” said Marzio Babille, the representative for the UN’s Children’s Fund in Iraq.
“When you have a certified case, usually the transmission has been going on for at least four to five months. For each paralysed child we have to consider a minimum of 200 or 250 could be carrying the virus and transmitting to other people. We are extremely concerned.”
What is known is that the boy, who had not been immunised, caught the virus from his three-year-old sister who is a carrier but who hadn’t developed any symptoms.
As well as door-to-door surveillance and vaccination drives in parts of Baghdad to try to contain any potential spread of the virus, health workers will also focus on Iraq’s Anbar province.
Anbar shares a long border with Syria, particularly Deir Ezzor, where the first of what is now 25 polio cases surfaced last October.
Anbar’s vulnerability to the virus has been further heightened from months of fighting between Iraqi’s Shia-dominated security forces, Sunni tribal leaders, affiliates of the formerly Al Qaeda-affiliated Islamic State of Iraq and the Levant (ISIL), and other militant groups.
The violence, which erupted in the cities of Ramadi and Fallujah in January, has led to the displacement of an estimated 400,000 people and badly affected public health services inside the province.
According to the WHO, vaccine campaigns carried out in Anbar earlier this month as part of a pre-planned regional response to the Syrian outbreak, reached less than 50 per cent of their target, compared to a 98 per cent penetration elsewhere in the country.
How the virus might have come to Baghdad from Anbar is now being looked into.
Dr Jaffar Hussain, the director of the WHO’s mission in Iraq, said: “There is no direct movement or travel history of this family history to Syria or contact with Syrian refugees.
“But, there have been internally displaced people from Anbar in the area, so we are investigating that probably may be the possibility that any families travelling from Anbar to this part of Baghdad may have been carrying the virus.”
Dr Hussain said the continued fighting in Anbar would pose a “challenge” for the effectiveness of the new immunisation drive, which begins in April.
He said the WHO planned to work with the Iraqi Red Crescent to reach the parts of Fallujah and Ramadi where UN agencies had only limited access because of the violence.
A vaccination campaign is also being planned in northern Iraq’s semi-autonomous Kurdish region. An inter-ministerial meeting was to take place there this week to discuss the response and media and social mobilisation campaigns.
However, Baghdad has been less forthcoming. Two senior officials from health ministry told The National they were unable to comment on the polio case.
One said the government was choosing not to announce the issue at the moment because of “security reasons”.
Iraq is to hold a general election on April 30 and an aid agency representative that asked to remain anonymous suggested that the prime minister, Nouri Al Maliki, is trying to play down the polio outbreak to avoid negative headlines tarnishing his campaign.
Doctor Adam Coutts, a Research Fellow at the London School of Hygiene and Tropical Medicine, questioned why the health ministry did not want to go public about the outbreak.
He warned not doing so may reduce the effectiveness of any campaigns and the wider health response to the Syria crisis.
“Polio like many communicable diseases requires an open and transparent reporting and response system otherwise no one accurately knows what is going on,” said Dr Coutts, who has been studying the polio outbreak in Syria. “Delaying confirming cases can turn a manageable situation into chaos.”