The killings of up to seven polio workers in Pakistan in just the past week of course spells a major catastrophe for the South Asian country’s increasingly dysfunctional healthcare system. But equally so, the events leading up to the killings and thereafter have exposed a continuing crisis of governance where the gap between the rulers and the ruled continues to widen by leaps and bounds.
For years, the anti-polio campaign has been targeted by Pakistan’s conservative fringe, arguing that the effort will somehow spell disaster for the country’s coming generations. Over time however, the criticism has failed to be supported by credible scientific evidence, demonstrating the degree to which such apprehensions are well-founded.
In the meantime, the crippling effects of the debilitating condition which targets polio-stricken children are all too evident. Children struck by polio are left with a permanent handicap to their limbs, unable to go through life as normal and able bodied individuals.
In this background, the killings of the polio workers first in Karachi and then in the northern Khyber-Pakhtunkhwa province, mark a major setback for Pakistan. The World Health Organisation (WHO) and Unicef, the UN’s global body responsible for child health, have together practically withdrawn from the field till water-tight security conditions are enforced.
For the moment, Pakistan’s ruling structure has done what it knows best; lip service and hollow promises without credible evidence of exactly how decisive action will be undertaken. Since the killings, telling scenes of the government’s failure to rise to the occasion have shown a policeman or two accompanying polio workers’ teams heading out to deliver drops for infants from neighbourhood to neighbourhood. Such scenes offer no more than a symbolic response in the face of well-armed gangs out to block the effort.
What is at stake is not just the future of Pakistan’s polio campaign. Indeed, on the line is the ability of an increasingly eroding state to begin asserting itself in the face of challenges to its authority. Over time, while budgetary allocations to health care have declined in real terms, there has also been a growing failure among the top echelons of authority to lead the effort from the front.
In its determination to devolve more decision-making to the provinces, President Asif Ali Zardari’s regime elected in 2008, also chose to get rid of parts of the federal health ministry’s authority in favour of undertaking decisions in the provinces. But now comes the hard stuff. The setback to the polio campaign has demonstrated the degree to which centralised authority is necessary in some areas of vital decision-making. Clearly, the future of the polio campaign is indeed one.
In the worst-case scenario, if indeed the WHO and Unicef withdraw permanently from the campaign, the consequences could be potentially disastrous. Pakistan remains among the world’s three countries where cases of polio are still prevalent.
For Pakistan’s coming generations, a failure to eradicate polio will potentially mean that future travellers from the country could face additional obstacles in crossing borders to other states. Even health documents issued by Pakistani authorities testifying to an individual having received a polio prevention drug, will likely become suspect, if issued without the oversight of UN agencies. The challenge is so monumental that Pakistan’s leaders ought to rise and tackle the issue head-on.
But Pakistan’s history hardly provides much encouragement. Since the country’s present day rulers came to take charge of Pakistan, one controversy after another has plagued the ruling structure. Within this series of controversies, the cause of popular well-being has suffered while corruption has increasingly prevailed in Pakistan.
Going forward, there are indeed signs of the authorities looking for an emergency response. But that is just not enough. The government has to take the challenge of polio eradication as a common national cause, as many ordinary Pakistanis yearn for a fresh way forward. To begin with, revamping the health care system and equipping it with all of its basic needs must be an important goal.
But with elections looming in the next few months, the cause of children from mostly disempowered homes will likely become another easy sacrifice. Coming out of the crisis unleashed by the killings, the danger for Pakistan is indeed that anything beyond a quick fix is unlikely to be of central interest to the country’s ruling class.
Farhan Bokhari is a Pakistan-based commentator who writes on political and economic matters.