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Originally produced for UNICEF

On the eve of war

One month before the 2003 invasion of Iraq, Abdullah Yagoob was one of 14,000 vaccinators who swept through the country to track down and vaccinate more than 4 million Iraqi children against polio. Each day of the 5-day campaign Yagoob was out of his house at dawn, and into the poor neighbourhoods that lie on the outskirts of the southern city of Basra. Going from door to door, he laughed with mothers in their doorways and played with the kids on the street, he tickled babies’ chins, dropped the polio drops into open mouths and left the mark of his passing on gates and walls.

Despite tension and dread over what may lie ahead for Iraq, this week’s polio campaign went off as smoothly as any. It was an exercise in precise planning and execution and a matter of growing national pride.

“It is something impressive for Iraq,” said Dr. Mohamid Al-Ani, Manager of the national Expanded Programme of Immunization, “to achieve the eradication of polio under the conditions we face.”

Iraq has been running twice-yearly polio campaigns since 1995. Each campaign consists of two rounds, held one month apart. The results of those campaigns suggested high coverage but in 1999, 77 children contracted polio. The size of the outbreak showed that many under-fives had been left unvaccinated.

“We sat down with UNICEF and WHO and took a hard look at what we were doing,” said Al-Ani. “We might have held on to the excuse that sanctions simply made polio eradication too difficult for us, but this was not acceptable. We were determined to show the world and ourselves that Iraq had the skill and the will to get rid of polio, no matter what.”

Earlier campaigns had been managed from Baghdad. The new strategy developed by the Ministry of Health, UNICEF and WHO called for much greater responsibility to be placed at the district-level, involved greater investment in equipment, increased numbers of vaccinators, who would now deliver polio vaccine to the door, and a much more aggressive communication effort. The European Commission Humanitarian Aid Office (ECHO), stepped in with critical funding – more than $2 million since 2000.

Tracking Children

The Alawi Qasim Primary Health Care Centre serves a poor mobile population clinging to the outskirts of Basra city. Some families here look toward the city for their incomes, others rely on the surrounding farmland. The land is dry and dusty. The buildings, mostly constructed from cement, are almost indistinguishable from the monotone landscape.

Dr. Liqaa Jaffer, a petite dynamic woman, serves as director at the Alawi Qasim Health Centre. When the new polio strategy was introduced, Jaffer became a member of the local Basra campaign team and attended a training course on “micro-planning” that was supported by UNICEF. For Jaffer it was an eye-opener.

“We learned the mechanics of planning and managing the campaign,” she said. “I became responsible for recruiting and training vaccinators and for enlisting the support of community leaders. One month before every campaign we surveyed every house in the community to identify all the children under five.”

The list was used to ensure accurate forecasting of the right number of vaccines, but its value to Jaffer went much further. “For the first time we knew how many children there were in our community, where they were, whether they had come to the clinic before.”

The district team was responsible for ensuring vaccines were delivered in the right quantities, to the right locations, for reporting broken refrigeration equipment and ensuring sufficient ice packs and cold boxes were available for the increased vaccination teams. With the new door-to-door strategy, the number of teams nationwide had expanded to 7,000 – each including one vaccinator and one registrar.

Before 2000, the vaccinators were paid only 50 cents a day. “It was not enough,” said Al-Ani. “Some of the vaccinators had to give up a day’s work to join the vaccination teams. They needed a decent wage.” With support from ECHO, vaccinator pay was raised to $2 per day – a significant amount for health workers like Yagoob who earned a basic average of $2 per month. Funding from ECHO also helped to supply kerosene refrigerators, thermometers, generators, cool boxes, vaccine carriers, ice packs and deep freezes, and, in 2001, helped UNICEF directly supply 10 million doses of polio vaccine following delays in procurement through the UN Sanctions Committee.

UNICEF supported a national communication campaign that was launched two weeks before every round. Announcements were emblazoned on banners strung across the busiest streets. The call to vaccinate went out from mosques and community groups, from schools and women’s groups. Television spots ran every half hour, reminding parents to vaccinate their children. Organizations like the Federation of Iraqi Women backed these efforts, calling on their members throughout the country to volunteer for the campaign.

Polio Day

It is the last week of February, 2003, and tens of thousands of Iraqis who play a role in the vaccination drive are up and out of their homes at dawn. They are gathering polio vaccines and registration books from hundreds of health centres and heading out to deliver the drops to millions of children. Their supervisors follow not far behind, seeking the children that the vaccinators might have missed. At nightfall on every polio day, the district teams gather to survey progress, identify gaps and make plans to ensure targets would be reached.

For five days, while the eyes of the world are trained on the crisis that threatens to engulf Iraq, Yagoob, Jaffer and many thousands like them are wholly engaged in the fight against polio, as are millions of Iraqi parents. For all of them, the polio campaign is an act of hope and faith in the future.

A few weeks later, on 19 March, the invasion began.

In Al Tanuma, a poor farming community on the outskirts of southern city of Basra, Iraq, health worker and polio vaccinator Abdullah Yagoob marks a door to show that 11-month-old Tebark Ali and all other children in the household under 5 years have been vaccinated against the disease.