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From: Terje Rod-Larsen
To: mJeevacation@gmail.comm <Jeevacation@gmail.com> 
Subject: Fw: Fwd: 2nd update from nasra hassan 
Date: Fri, 03 May 2013 15:47:19 +0000 
From: Andrea Pfanzelter 
To: Terje Rod-Larsen 
Sent: Fri May 03 11:38:39 2013 
Subject: Fwd: 2nd update from nasra hassan 
Terje, 
Nasra came back yesterday. These are her first impressions. The report is interesting but incomplete and some 
sections need further explanation (like mis-reporting and under-reporting). If it is sent on, you should make it 
clear that these are just some first impressions that will be further developed. 
Andrea 
Andrea Pfanzelter 
Director IPI Vienna 
International Peace Institute 
Begin forwarded message: 
From: Nasra Hassan < 
Date: 03. Mai 2013 14:54:42 MESZ 
To: Andrea Pfanzelter < 
>, 
Contacts:
Over 5 days, between 27 April and 1 May, met enough sources to acquire a fairly clear picture of the present 
state of play. These contacts/discussions included non-official sources (from FATA tribal areas as well as 
Frontier areas) in Peshawar, the seat of both the tribal FATA Secretariat as well as the Provincial Govt; and 
official sources in the national capital Islamabad -- including by coincidence Dr Wager Ajmal, the 
Pakistani technical polio person in the Foundation, who is based in Seattle but was visiting Pakistan. 
Background: 
The information acquired in small meetings, to encourage a more open sharing of views, leads to the 
conclusion that religion-based refusal is a very small part of the problem; the rest is pressure tactics by not 
only the Taliban but also local communities (see below); one-upmanship; poor follow-up & monitoring; the 
security situation (i.e. the one-day polio eradication campaign with anti-polio drops cannot be carried out if the 
Pak Govt is carrying out a military operation in the area); problems relating to the anti-polio campaign 
visavis the other routine immunizations; and the vast amount of jobs & money involved. Funding is not 
a problem, eg. FATA about to sign MOU with UAE Govt, which will give a huge grant covering all polio 
vaccination campaigns 100% for the next 3 years (see below). 
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Mis-reporting & under-reporting: 
A major new issue, conceded by only one official source, but comparable to similar mis- or under-reporting in 
the developing countries, a phenomenon well-known to UN social development agencies. Could be part of the 
picture when very low polio cases were reported in years past. 
Right now, the entire country is in a pre-election mode: suicide bombings by the Taliban against "secular" 
parties; bombings by unknown groups not linked to the Taliban; and a general law & order situation, including 
communal hysteria. Unlikely that the new post-elections Govt will be ready before mid-June, at the earliest. 
Views expressed by the reps from each of the 7 tribal FATA agencies, as well as from semi-settled border 
areas with similar  problems visavis  polio -- compressed & aggregated under themes for easy perusal: 
Surveys: 
Since 9/11, Pakistan has been surveyed to death! All reps laughed & made fun of survey sponsors, at their 
"stupid" questions, and categorically stated that the majority of questionnaires were filled out by a few persons 
(for reasons of $ and lack of effort) and that depending on the theme, those surveyed deliberately gave wrong 
info or provided answers which would please the sponsor -- probable some applicability to polio as well. 
Present Polio Eradication Campaigns (M): 
Carried out in those areas of FATA where the Pak Army gives the go-ahead, except in South Waziristan Agency 
(SWA) and North Waziristan gency (NWA). In SWA, the PC is carried out in those few areas only under Pak 
Army control, where IDPs have returned. In the rest of SWA, the Mullah Nazir Group ("good" Taliban) has a 
ban in effect -- if drones don't stop, no PC. There are other, more pressing reasons. Interestingly, the "good" 
Taliban leaders do try to acquire anti-polio drops for their own children! 
Tribals from SWA and NWA who have fled their homes and crossed over into a safer location, do bring 
their children for the drops.
Structural issues: 
Problems relate to inaccessible terrain; weak polio teams; jobs assigned on basis of patronage; lack of adequate 
monitoring (same person may be both judge & jury); the lack or degradation of a sound health centre 
network, where kids were earlier given drops as part of a general maternal & child health service -- now, owing 
to a variety of factors, these HCs are closed or do not provide the proper care and services. FATA reps were 
very critical of the Govt authorities. 
Corruption: 
Eg. "ghost" PC teams, eg. funds provided for 15 teams, but only 10 actually exist, ditto transport, fuel etc. In a 
vast area with no jobs, PC is a good regular income. 
Religion-based:
PC worked fairly well for years, despite inherent difficulties & weaknesses -- it got linked to religion basically 
after 9/11, the drones and the general conflict & security situation. The ban by the "good" Taliban was issued in 
June 2012, not before! There are obviously certain other aspects, eg. suspicion against the ingredients (cause 
impotence, sterility, infertility); why vaccinate a healthy child; polio, like everything good & bad, comes from 
Allah. 
Note: I have acquired a collection of pro polio-eradication fatwas, which could be widely distributed. 
PC as  pressure tactics: 
The Pak Govt has pushed polio eradication with all its might, leading communities & groups to see this 
importance as a bargaining point. Interest groups use the PC (i.e. the stop) to achieve other objectives, eg. the 
communities object to the high-profile and well-funded PC, with a parallel neglect of other routine 
immunizations; when a community has no clean water or electricity, they impose a local ban on the PC teams 
"no PC until we get electricity". So, knowing of the importance the Pak Govt assigns to polio eradication, 
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many groups (eg. Taliban both "good" and "bad", criminal groups, local leaders, others) use this as a bargaining 
chip, eg. getting their prisoners or family members released from Govt detention, or 2 groups fighting for 
political & other control in an area, ban the entry of polio teams in their bilateral struggle. 
Lack of awareness: 
Less of a problem than it appears, as the Provincial Govt as well as the FATA Secretariat have had quite a good 
campaign info & awareness campaign in the past -- their info materials could certainly be improved as well as 
other hitherto-neglected aspects included, eg. more vigorous & regular radio programming. WHO & UNICEF 
etc also have good info. 
Security-related: 
Owing to attacks on polio teams or intimidation of the locals, in certain FATA areas the Govt refrains from 
announcing the PC dates in advance, hence many communities are unaware of the visit. In those areas where 
the Pak Army is not in control, either the PC cannot/will not be implemented; the military checkpoints make 
even normal movement of residents so time-consuming that fathers bringing their kids is not really an option. 
Cross-border PC: 
To be included in detailed report. 
Funding:
No lack of funds. As mentioned earlier, the UAE Govt is ready to sign a Memorandum of Understanding 
(MoU) under which it will cover through a 3 year grant of $ 110 million 100% polio-eradication in FATA -- the 
health authorities understandably want non-FATA adjacent areas to be included to prevent infection -- this point 
is still being negotiated. 
Note: I have learnt that senior Pak Army leaders are thinking of implementing the UAE-funded programme 
under its own supervision -- no further details available. 
General security situation in Pakistan as well as in Afghanistan  post-2014: 
Pre-election turbulence; when a new Govt emergences in June at the earliest, it may well introduce a fresh 
approach towards the militants -- maybe negotiations or military operations. In Afghanistan, if the US 
withdrawal leaves behind an unstable environment, and depending on who comes to power after the elections 
in 2014, and if there is no agreement with the Af Taliban -- civil war is likely to break out. If there is an orderly 
withdrawal, there will still be a dip in the security situation. Right now, all groups are positioning themselves. 
This dip/civil war will spill over into Pakistan, with consequent impact on social & health services in 
vulnerable areas, esp. FATA. 
Conclusions & recommendations, esp. sustainability: 
In later report. 
End. 
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