Officials from the World Health Organization (WHO) say the number of confirmed cases of polio in Sudan has made a dramatic rebound in a country that had been declared polio-free three years ago.
The tiny, sand-blown Arab village of Hara al-Zawiyah in a remote corner of Darfur appears to be spared the violence and suffering endemic to the rest of western Sudan. But even here, people are increasingly fearful of the diseases taking hold after two years of civil war.
Polio has surged to the top of their list of concerns after a child in the town of Kass, less than 90 miles to the south, was paralyzed by it six months ago.
Since then, World Health Organization officials say the number of confirmed cases of polio-induced paralysis in Sudan has soared to 54. Because paralysis of limbs occurs in only one in 200 cases, health experts say there is a high probability that more than 10,000 Sudanese have been infected with the virus, prompting several U.N. aid agencies to issue repeated warnings that Sudan is in the midst of a massive outbreak.
Particularly disturbing for health workers is the virus' potential for spreading in the crowded, festering camps of western Sudan and neighboring Chad, where nearly two million people have sought refuge in the wake of atrocities by pro-government Arab militias aiming to crush a rebel uprising.
In much of Darfur, ongoing attacks by Arab militias and rebel fighters have forced U.N. agencies and non-governmental aid groups to evacuate their workers, halting the distribution of food and medicine to hundreds of thousands of people left homeless by the conflict.
Bruce Aylward, head of WHO's global polio eradication initiative, explains why the surge in Sudan's polio cases is sending shockwaves through the international health community. He speaks by telephone from Geneva.
"There're three factors that make the situation in Sudan particularly alarming," said Mr. Aylward. "First of all, it's the largest country in Africa in terms of land mass and borders nine other countries. So there are porous borders with nine countries across which this virus could now spread. Secondly, there's the internal situation in the country where there's civil unrest or disturbances in two large areas of the country, which really could allow the continued propagation of the virus within the country. And then finally the Sudan being both an Arab and an African country in many ways has got important international links which could lead to the further dissemination of the virus and even the re-infection of the Middle East."
Health workers have eliminated the virus in the Americas, Europe and most of Asia. But in Africa, which has 90 percent of the world's polio cases, armed conflict and persistent distrust of Western vaccines continue to hamper efforts by health workers to immunize about 74 million children most vulnerable to the virus.
In Hara al-Zawiyah, a health team from UNICEF, the United Nations fund for children, visited on a recent morning. The health workers took only a few hours to squeeze two drops of vaccine on each tongue of hundreds of the village's children. About 2,400 health workers have fanned out across Darfur to administer the vaccine to nearly two million children five years old and younger.
It's a significant achievement, especially in this volatile corner of Darfur, the stronghold for the Arab militias, known as the Janjaweed, accused of carrying out a campaign of murder, rape and looting that has left up to 70,000 people dead.
For Ahmed Hanafe Salih, the village's 71-year-old sheik, having the children in his village vaccinated means one less thing to worry about.
His villagers feared a spike in polio cases as hundreds of Nigerian soldiers were airlifted into their country as part of the 53-nation African Union's 3,500 strong peacekeeping force in Sudan.
Many Sudanese balked at having such a large African force in their country, partly because they feared the troops, mainly Nigerians and Rwandans, would bring with them the diseases like HIV/AIDS and polio that plague their own countries. It's a fear that most health experts rule out, at least as far as polio is concerned.
Still, several cases of polio in Sudan and Botswana have been traced back to Nigeria, believed to be the epicenter of the virus in Africa. The northern Nigerian state of Kano reported nearly 700 confirmed cases, seven times the number of cases reported by India, the world's second most polio-prone country.
Mr. Aylward, head of WHO's global polio eradication initiative, says the surge in Sudan's polio outbreak threatens the success of the $2 billion anti-polio drive, the largest-ever health initiative in the world.
"What we are seeing again is the fragility of the progress that has been made against polio eradication," he said. "Many people are taking comfort in the very low numbers of polio in the world, but what happened in the Sudan reminds us that this disease can explode in a country where we've not seen it for a long time. And it can spread from there into other areas. Particular concern of course [is that] from the Sudan it could get into the Middle East or with the borders with the Congo it could re-infect that country. And any of these developments would make the global eradication much, much higher risk, much, much more difficult, and much, much more expensive."
The virus often infects young children. Once the virus enters in the bloodstream, it attacks the central nervous system, causing muscular atrophy, deformation, paralysis and sometimes death.
In addition to the problems in Sudan, the campaign to eradicate polio has hit another snag: a $200 million budget shortfall as some countries have yet to deliver promised funding to the program. The shortfall has led some U.N. officials to consider postponing or reducing immunization programs in Africa and Asia.