EFTA00591873

POLIO PAKISTAN 
BACKGROUND BRIEFS FOR BMGF SECURITY AND ACCESS 
STRATEGY SESSION: PAKISTAN 
1. Drivers of insecurity and conflict 
NB: Because of the sensitive nature of 
the 
subject matter, 
information 
denoted with an asterisk (*) is 
confidential and can be elaborated 
upon in oral briefings with Pl. 
Pakistan was close to 
complete polio eradication 
when a combination of 
external 
circumstances 
(conflict, terrorism, US 
drones 
and 
anti-US 
sentiment, 
killing 
of 
Osama 
bin 
Laden 
& 
preceding fake vaccination 
campaign, 
a 
Taliban-
imposed anti-polio drops 
ban, and attacks on health workers) 
as well as management issues 
(relating to massive corruption, 
accountability, misreporting, too 
exclusive a focus on polio eradication 
to the detriment of other routine 
immunizations, poor infrastructure, 
Army operations) created again a 
continuing increase in the number 
polio cases, mainly in the tribal and 
adjacent areas. 
Key groups involved in the nexus of 
insecurity and conflict differ in the 
four provinces, and there is no 
monolithic Pakistan Taliban entity. 
The Tehreek Taliban Pakistan are a 
grouping of major Taliban and allied 
groups, with over 40 sub- and 
splinter groups. Some are purely 
criminal 
structures, 
others 
are 
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traditional clan-based allies, whose 
services are used by many, as 
required.* The 
mainly Pashtun 
Taliban have links not only with 
different Taliban and other groups in 
Afghanistan, but also with non-
Pashtun allies, both from other 
Pakistani provinces especially the 
Punjab, as well as with many foreign 
groups such as those from the Arab 
world, Central Asia, Caucasus, and 
Europe. There is evidence of the 
involvement of external state actors 
as well.* 
CONFIDENTIAL- DO NOT CIRCULATE 
IPI 
INTERNATIONAL 
PEACE 
INSTITUTE 
HIGHLIGHTS 
• The unstable security situation 
along the Af/Pak border makes 
access difficult. 
• Despite the hostile environment, 
experience shows that local leaders 
can be convinced not to block polio 
eradication efforts. 
• Obstructing 
polio 
eradication 
efforts is often used as leverage for 
achieving other objectives. 
• A high profile for polio eradication 
in a region that has so many other 
problems makes it a target for anti-
Western/anti-government attacks. 
• Post-election 
developments 
in 
Afghanistan will have an impact on 
stability in the border regions with 
Pakistan, and therefore on polio 
eradication. 
EFTA00591873

POLIO PAKISTAN 
2 
The demands and grievances of the 
key domestic groups vary, although 
they invariably use the rhetoric of 
Islam, sharia and jihad. In practice, 
however, they are characterized by a 
clear pragmatism. After ploughing 
through the obligatory rhetoric, the 
bottom 
line 
is 
about 
justice, 
corruption, jobs, basic services and 
infrastructure. 
The 
appointment 
of 
Maulana 
Fazlullah of Swat to head the Pak 
Taliban, 
a 
departure from all 
previous such appointments, should 
not be over-emphasized in relation 
to polio. In his Swat years, he had set 
up many illegal radio channels and 
broadcast 
fiery jihad 
sermons, 
earning 
the 
nickname 
"Mullah 
Radio? 
However, the post 9/11 
history of Pakistan Army-Taliban 
deals 
show 
that 
these 
have 
invariably been violated by the 
former. * 
The polio eradication ban was 
imposed in June 2011 by a Taliban 
group closely allied to the Pakistan 
Government, i.e. by the "good 
Taliban". Extensive field research by 
IPI shows that the ban and parental 
refusal have both less to do with 
Islam, and more with holding the 
authorities 
hostage 
to 
their 
demands, 
including 
electricity, 
roads, stoppage of drone attacks, 
and a spectrum of health services 
beyond anti-polio drops. There is 
little difficulty in delivering the anti-
polio drops as part of routine 
vaccinations 
— the high profile 
accorded to polio often becomes 
counter-productive. 
Sometimes 
remote hamlets are bypassed using 
parental refusal as an excuse. 
It cannot be baldly stated that the 
ban "holds in Waziristan" — but 
mainly in those areas of North 
Waziristan 
Agency 
where 
the 
Taliban hold power, or where there is 
no security; in South Waziristan 
Agency, the difficulty is only in 
Taliban-controlled 
pockets. 
In 
October/November 
2013, 
a 
madrassa close to the Taliban issued 
a fatwa stating that all vaccinations 
were fully compliant with Islam. The 
Taliban have not taken issue or 
pronounced themselves on this 
fatwa, a positive sign. 
Parental 
refusals have also been recently 
recorded in provinces far outside the 
Taliban sphere of influence. 
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taking place between the main 
Taliban grouping and a committee 
composed of members nominated 
by both the Govemment and the 
Taliban. This is a rocky path and 
many interruptions can be expected. 
The current suicide operations and 
attacks on health staff are being 
carried out by splinter Taliban and 
allied groups who (i) are not part of 
the mainstream Taliban, (ii) have 
little to gain and nothing to lose by a 
successful 
outcome, 
and (iii) are sabotaging 
the talks. 
KOHAT 
PAKISTAN 
INDIA 
Trends 
By mid-2013, as a result of efforts, 
including by IPI, there was a 
noticeable softening in the Taliban 
position, although the ban was not 
officially lifted.* However, in the 
second half of 2013, the situation 
was worsened by the following 
factors: 
the 
newly-elected 
Government still has not in any 
concrete 
manner 
pushed 
polio 
eradication; 
corruption 
has 
continued; and a number of Taliban 
leaders, 
including 
the 
head 
Hakimullah Mehsud, were droned to 
death, which led to a new cycle of 
Taliban suicide and other attacks 
against 
the 
Army 
and 
Army 
operations against the Taliban. 
Consultations and negotiations are 
CONFIDENTIAL- DO NOT CIRCULATE 
Impact 
When attacks on health 
workers are analyzed, it 
emerges that about a 
quarter 
are 
directly 
related to the polio 
eradication campaign. 
The majority are a mix 
of 
attacks 
on 
the 
security 
and 
other 
militias accompanying 
health 
workers 
(a 
declared target of the 
Taliban), retaliation for unrelated 
issues, selection of health workers 
(hence wages) based on exclusion of 
many groups and sub-tribes; and 
some attacks are related to property 
issues. 
EFTA00591874

POLIO PAKISTAN 
Prospects for 2014 & 2015 
Even if the current negotiations 
eventually bring positive outcomes, 
there is no guarantee that all the 
sub- and splinter groups will fall in 
line. If the talks fail, will the Pakistan 
Army undertake targeted or broader 
operations in the North Waziristan 
Agency? This, too, depends on what 
happens 
across the border in 
Afghanistan and whether the post-
election Kabul regime will be 
considered friendly to Pakistan or 
not. * 
All the militant and allied groups in 
the tribal belt are also waiting to see 
developments in Afghanistan as of 
mid-zoM onwards. There will be 
continued pockets of insecurity on 
the Pakistan side of the tribal belt, 
exacerbated by an inflow of Afghan 
Pashtun refugees from the provinces 
bordering Pakistan — all these factors 
will have a negative effect on the 
very geographic areas where access 
is a problem. 
There 
are 
reports 
that 
the 
Government is preparing for a worst-
case scenario with 3 million Afghans 
fleeing into Pakistan over the 
summer. 
CONFIDENTIAL- DO NOT CIRCULATE 
Recommendations 
• First and foremost, while BMGF is a 
very high-profile donor and seen as 
a 
perpetual 
benefactor 
(jobs, 
funds) the Foundation should 
refrain from taking any kind of 
high-profile role in security-related 
issues. It should obviously continue 
its financial support and discreet 
pressure 
on 
the 
civilian 
Government, but not in a manner 
which reaches the media and 
irritates not only the Taliban but all 
who 
have 
issues 
with 
"the 
Americans".* 
• BMGF should encourage, in fact 
insist, that the Pakistan national 
authorities pay equal attention to 
all routine immunizations, and not 
simply to polio — this is a huge 
irritant 
among 
recipient 
communities which see diseases 
which kill being ignored in favor of 
one which "merely cripples" . 
• In particular, BMGF should insist on 
better 
accountability 
and 
transparency in the use of the 
massive donor funding for polio 
eradication. * 
EFTA00591875