Pakistan has struggled to cope with the spread of polio, a debilitating viral disease. Human infections are frequently reported despite government and international agencies’ efforts to eliminate the disease. According to a World Health Organization (WHO) estimate, at least 72 polio cases were recorded in Pakistan in 2013, compared to 58 cases in 2012. In 2014, the number of infected children had already reached 115 through August. The most affected provinces of Pakistan are Punjab, Sindh, and Khyber-Pakhtunkhwa (KP). One key reason behind this spread is the Pakistani Taliban’s propaganda campaign against receiving polio vaccinations, as well as their direct attacks on polio vaccination workers.
This article reviews the Pakistani Taliban’s offensive against the polio immunization program in Pakistan, especially in the Federally Administered Tribal Areas (FATA) and KP, and it highlights how Pakistani Taliban militants—as well as sectarian militant groups—have unleashed a sustained armed campaign against the health workers and the security personnel who escort them. The article also discusses various regional biases against the vaccination programs, while examining Taliban decrees that denounce them.
Attacks on Vaccination Workers
Frequent attacks on anti-polio campaign volunteers and vaccination teams in Pakistan have become increasingly common since the Pakistani Taliban leadership began issuing religious edicts (fatwa) against the government vaccination program and against female health volunteers who have been the core workforce for health care programs. At least 56 individuals, mostly female health workers and security personnel aiding the anti-polio campaign in Pakistan, were reportedly killed in attacks since June 2012 when the Pakistani Taliban reiterated its ban on the ongoing vaccination program.
The most deadly incidents occurred in mid-December 2012, when Pakistani Taliban militants executed a string of attacks in Karachi, Peshawar, Charsadda and Nowshera. The attacks disrupted a three-day national polio vaccination campaign. The militants killed at least nine anti-polio health workers, including five female volunteers.
While attacks on anti-polio workers and their security details continued during various phases of anti-polio drives throughout 2013, a major assault took place on October 7, when Islamic militants targeted a medical distribution camp in the Suleman Khel area in Peshawar, the provincial capital of KP. At least seven people, including four security personnel, were killed in that incident.
In 2014, January and March saw a spike in assaults on anti-polio health workers and their support staff. Six police officers and a child were killed in a bomb blast near a police vehicle in Sardheri market of Charsadda Town in KP on January 21 when security officials were on their way to provide security to a polio team. On March 1, 11 Khyber Khasadar Force personnel—government-backed local tribal militias—who were providing security to a polio team were killed in two separate blasts in the Lashora area of Jamrud in northwest Pakistan.
Intermittent attacks targeting polio vaccination programs continued, and the intimidation and abduction of health workers and officials became increasingly frequent. The most brutal incident took place when female polio vaccinator Salma Farooqi, who was part of the “Sehat Ka Insaf” anti-polio campaign of the KP government, was abducted, tortured and killed by armed militants on March 24.
Tehrik-i-Taliban Pakistan (TTP) claimed responsibility for most of these attacks. The TTP’s affiliates such as Jundullah and Lashkar-i-Islam also claimed credit for some of the violence. Occasionally, the TTP distanced itself from specific attacks. In April 2013, the TTP announced that it would support anti-polio vaccination drives on the guarantee that they are not used by the United States as a cover for espionage and that proof be provided showing that orally-administered polio vaccination drops are in accordance with Islamic tenets. According to TTP spokesman Ehsanullah Ehsan, “If they can convince us that these polio drops are Islamic and the spy agencies are not using it to kill our fighters, we would have no objection to any vaccination drive which is in the public interest.” Despite these statements, the Pakistani Taliban continued its violence against polio vaccinators in the pursuant months.
The Pakistani Taliban’s Propaganda Campaign
Islamist-led propaganda campaigns against government-backed health projects, especially polio vaccination programs, began in Swat and Malakand regions in 2006. Maulana Fazlullah, the present TTP leader, spearheaded the effort. At the time, he was a radical cleric leading another banned organization, Tehreek Nifaz-e-Shariat-e-Muhammadi (Movement for the Enforcement of Islamic Law, TNSM). Fazlullah and his followers carried out a propaganda campaign encouraging people to adopt an ultra-conservative lifestyle. He propagated primarily against entertainment such as music, dance, and television, but he also preached against female education. He criticized the polio vaccination program in KP (then known as the North-West Frontier Province, NWFP) through his illegal FM radio sermons and Friday prayers at the local mosques. He also alleged that the polio eradication campaign was part of a “conspiracy of Jews and Christians to make Muslims impotent and stunt the growth of Muslims.”
Pakistani Taliban fatwa against female health workers in Swat and Malakand sheds some light on the prevailing mindset of the Taliban. One such decree called the presence of women in public spaces a form of indecency, and instructed that it “was a Muslim man’s duty to kidnap the women health workers when they paid home visits, to marry them forcibly even if they were already married women, or to use them as sexual slaves.” Another similar Taliban decree declared that it was morally illegal for Muslim women to work for wages.
For a brief period after May 2007, the situation improved in the region when the NWFP provincial government signed a peace deal with Fazlullah’s TNSM, which agreed to support the polio vaccination campaign and education for girls, as well as government efforts to establish law and order. Fazlullah then joined the TTP by merging the TNSM into the larger Pakistani Taliban conglomerate, and signed a 16-point peace deal with the NWFP government. The Taliban in Swat and Malakand agreed not to oppose vaccination against polio, measles, smallpox and tuberculosis, including all those administered to children, and would not obstruct women’s education.
The situation deteriorated, however, following a continuous army offensive against the Pakistani Taliban in the region. By early 2009, the TTP returned to its original campaign against women’s education and vaccination along with criticism of non-governmental organizations (NGOs). TTP spokesman Muslim Khan reportedly told the media that “the TTP is against polio vaccination because it causes infertility.” He also charged that the vaccine could not be trusted since it was imported. Khan said that the vaccination program is a U.S. tool to reduce the Muslim population, and that it is un-Islamic to “take a medicine before the disease [is contracted].”
Fazlullah and his faction were the first Islamists to tag anti-polio campaigns as part of Western espionage against the Muslim community, much before the CIA-sponsored hepatitis vaccination program that was believed to have helped track down and kill Usama bin Ladin at his hideout in Abbottabad, Pakistan, in May 2011. The judicial trial of Shakil Afridi, the Pakistani doctor involved in the false vaccination program, was given a 33-year prison term in Pakistan after being arrested for helping the CIA track Bin Ladin. The CIA’s actions likely made the Taliban leadership in Pakistan all the more suspicious about the vaccination programs, and it contributed to a renewed armed backlash against polio immunization workers in the country. According to a Taliban fatwa issued in June 2012, “polio agents could also be spies as we have found in the case of Dr. Shakil Afridi has surfaced. Keeping these things in mind we announce to stop the polio dosage. Anybody who disrespects this order will not have the right to complain about any loss.”
The Drone Justification
Even though anti-polio efforts in Pakistan continued amid fierce opposition from the Pakistani Taliban in Swat and Malakand, the drive received a fresh setback when radical Islamic clerics and Taliban commanders issued fresh fatawa against the vaccinations in June 2012. Hafiz Gul Bahadur, the Taliban commander in North Waziristan, announced a ban on polio vaccinations. Days before his call, radical Islamic cleric Maulvi Ibrahim Chisti declared the polio campaign “un-Islamic” in the rural Khan Pur Bagga Sher area of Muzaffargarh (located in southwestern Punjab Province) and announced at the local mosque that jihad should be carried out against the visiting polio vaccination team.
This time, however, the Taliban added a new reason for being against the vaccination campaign. According to Gul Bahadur, the vaccination campaign should be suspended until the United States ceased drone strikes in the Waziristan region. Gul Bahadur’s fatwa pamphlet, printed in Urdu, was distributed on June 16, in Miranshah, the capital of North Waziristan, and threatened anyone involved in the polio vaccination campaign in the troubled region. “We announce a ban on polio vaccination campaign from today,” the pamphlet read. “Anybody who disrespects this order will not have the right to complain about any loss or harm.” According to the pamphlet, “till such time the continuous attack of the drones is not stopped in Waziristan, the restriction on polio drops will remain imposed…Because [we] have nothing to gain from the sympathy of such well wishers (the Americans) who spent billions of rupees on polio drops for eradicating a disease that affects one or two in a million people.” It further added: “the well-wishers (the Americans), with the help of their slaves (Pakistanis), are carrying out drone attacks in Waziristan as a result of which hundreds of innocent child, senior citizens and women have died. And the continuous (day and night) drone flying has driven the people of Waziristan mentally ill or imbalanced and such cases are on the rise. The condition is even worse than polio.”
Arguably, Gul Bahadur’s call prompted other Taliban leaders in KP and South Waziristan to impose a ban on the polio vaccination drive in their respective spheres of influence. A similar pamphlet distributed in Wana, South Waziristan Agency, by the Mullah Nazir faction of the Pakistani Taliban a week later warned health workers to stay away from polio vaccination campaigns or else face dire consequences. Using a similar argument against drones, the pamphlet said, “Polio and other foreign-funded vaccination drives in Wana subdivision would not be allowed until U.S. drone operations in the agency are stopped.”
During that time, U.S. drone attacks intensified on Taliban targets in North and South Waziristan and successfully killed many militant leaders including top al-Qa`ida operative Abu Yahya al-Libi at a hideout in Mir Ali, North Waziristan, in early June 2012. These drone strikes, however, were not free from collateral damage and reportedly caused civilian casualties as well, which gave a further excuse to the Taliban to link the two issues.
In contrast to the TTP’s position on the vaccination campaign, many influential Islamic clerics opposed the ban. In late October 2013, senior religious scholar Maulana Sami-ul-Haq, the head of the Dar-ul-Uloom-Haqqania Islamic seminary and chief of Jamiat-i-Ulama-i-Islam-Sami (JUI-S) and considered to be a spiritual leader of the Taliban, issued a counter fatwa urging parents to immunize their children against polio and other fatal diseases such as measles, tetanus and tuberculosis. He further added that the vaccinations comply with Islamic Shari`a. A small Taliban off-shoot, Ansar-ul-Mujahidin, was quick to threaten both Sami-ul-Haq and politician Imran Khan for supporting Pakistan’s polio vaccination campaign.
Perhaps Sami-ul-Haq’s contentions, coupled with public support for immunization drives as well as sustained government efforts for the vaccination and health programs, forced the TTP leadership to change their position for now. In January 2014, they distanced themselves from some of the violent attacks on anti-polio health workers in Manshera and Karachi. TTP spokesperson Ehsanullah Ehsan said subsequently that in principle the TTP was not targeting polio workers, even though they have strong reservations against polio vaccines because they are un-Islamic and bad for health. He further added, “We have been holding detailed deliberations on the polio issue for some time and have been consulting trustworthy Muslim medical experts. Some of our doubts have been removed.” Despite this claim, the grim situation prevailed as attacks continue against anti-polio personnel.
The Pakistani Taliban’s continued attempts to block polio vaccination through violence against health care workers, security escorts and other civilians in the tribal areas largely jeopardizes Pakistan’s effort for complete polio eradication. Many anti-polio volunteers have left the immunization campaign due to fear of the Taliban. Even though the government engaged thousands of vaccinators, mostly women for door-to-door campaigns, and deployed security forces as escorts, past violent events have deterred many health workers.
Pakistan’s next vaccination campaign began on August 25, 2014, and it will focus on the obvious highest risk districts. Further anti-polio activities are planned for September and October. The militant hostility against the vaccination program demonstrates both the central and provincial governments’ failure to engage the Taliban leadership for a peaceful immunization campaign. It remains to be seen whether the Pakistani Taliban have had a true change of heart when it comes to the immunization campaign, or if they will continue their violent attacks throughout 2014.
Animesh Roul is the Executive Director and Co-founder of Society for the Study of Peace and Conflict, a Delhi-based policy research think-tank. He holds a Master of Philosophy degree from the School of International Studies, Jawaharlal Nehru University, New Delhi and has a master’s degree in Modern Indian History. Mr. Roul specializes in counterterrorism, radical Islam, terror financing, armed conflict and issues relating to arms control and proliferation in South Asia. He has written for Terrorism Monitor, the CTC Sentinel, Jane’s Intelligence Review and CBW Magazine, among others.
 “WHO Statement on the Meeting of the International Health Regulations Emergency Committee Concerning the International Spread of Wild Poliovirus,” World Health Organization, May 5, 2014.
 “Pakistan Records 72 Polio Cases in 2013: WHO,” The News International, December 4, 2013.
 “Four New Polio Cases Emerge in Pakistan in One Day,” Dunya News, June 28, 2014. Also see the Global Polio Eradication Initiative at www.polioeradication.org.
 “Taliban Militants Kill 8 Anti-Polio Workers,” Central Asia Online, December 19, 2012.
 “Bomb Blast at Polio Team Kills 7, Injures 8 in Peshawar,” The News International, October 7, 2013.
 “Blast Targets Polio Security Team in Charsadda, Seven Killed,” Pakistan Today, January 22, 2014.
 “Blasts Targeting Polio Team Kill 11 in Khyber Agency,” Dawn, March 2, 2014.
 “Polio Vaccinator Kidnapped, Killed,” Dawn, March 25, 2014.
 Jundullah’s spokesman, Ahmed Marwat, claimed responsibility for an attack on polio workers in early October 2012, saying that “Jews and the United States want to stamp out Islamic beliefs through these [polio] drops.” Also, the Lashkar-i-Islam militant group has perpetrated violent attacks against the vaccinators and abducted anti-polio workers in the past. See, for example, “Pakistan Militants Kidnap 11 Teachers in Polio Vaccination Campaign,” Reuters, November 23, 2013; “Blast Near Polio Workers Kills Two in Pakistan’s Peshawar,” Reuters, October 7, 2013.
 One of the attacks for which the TTP rejected responsibility occurred when the TTP was reportedly in consultations with clerics about the efficacy of the vaccination drives.
 “Taliban Militants Announce ‘Conditional Support’ for Anti-Polio Drive,” Dawn, April 12, 2013.
 Sadia Qasim Shah, “Peshawar: Cleric Mounts Drive Against Polio Vaccine,” Dawn, December 1, 2006.
 Cited in Iftikhar Ud Din, Zubia Mumtaz and Anushka Ataullahjan, “How the Taliban Undermined Community Healthcare in Swat, Pakistan,” British Medical Journal 344 (2012).
 “Crackdown on TNSM Likely,” Daily Times, July 10, 2007.
 “Govt Inks Peace Deal with Swat Militants, Fazlullah, Comrades Given Amnesty?” The News International, May 22, 2008.
 “PAKISTAN: ‘NGOs Should Leave Swat’ – Insurgent Leader,” Integrated Regional Information Networks, March 22, 2009.
 “Crippled and Blind,” The News International, March 24, 2009.
 “Taliban Blocks UN Polio Treatment in Pakistan,” Telegraph, March 27, 2009.
 Mark Mazzetti, “Vaccination Ruse Used in Pursuit of Bin Laden,” New York Times, July 11, 2011.
 There were virtually no attacks against polio health workers in 2010 and 2011. Following the revelation of the false hepatitis vaccination program in July 2011, an infuriated Taliban vowed to avenge the deception and imposed a ban on legitimate vaccination programs including polio. In June 2012, the Taliban blocked polio vaccination in North Waziristan, issued fatawa against polio vaccination and carried out attacks. See Declan Walsh, “Taliban Block Vaccinations in Pakistan,” New York Times, June 18, 2012; “Polio Resurgence in Pakistan Following Backlash from CIA Vaccination Ruse in Hunt for Osama bin Laden,” ABC News, May 27, 2014.
 Hafiz Gul Bahadur’s fatwa pamphlet, June 15, 2012.
 “No Polio Drives in N Waziristan Unless Drone Strikes Stop: Hafiz Gul Bahadur,” Express Tribune, June 16, 2012.
 “Cleric Declares Jihad Against Polio Campaign,” Express Tribune, June 13, 2012.
 Hafiz Gul Bahadur’s fatwa pamphlet, June 15, 2012.
 “Another Militant Group Bans Polio Vaccination, Seeks End to Drone Strikes,” Dawn, June 25, 2012.
 “Al Qaeda Confirms Death of Bin Laden Confidant Libi,” Reuters, September 11, 2012.
 Even though the drone strikes killed senior al-Qa`ida and Taliban militant leaders, the strikes have also caused civilian deaths and damaged property. For a detailed study, see Alice K. Ross and Jack Serle, “Drone Strikes in Pakistan: Most US Drone Strikes in Pakistan Attack Houses,” The Bureau of Investigative Journalism, May 23, 2014; “Pakistan Furious as US Drone Strike Kills Civilians,” Express Tribune, March 18, 2011.
 “Samiul Haq Believes Taliban are Patriots,” Pakistan Today, May 21, 2014.
 “‘Father of Taliban’ Backs Polio Vaccines in Pakistan,” Dawn, December 10, 2013.
 “Militants Warn Khan, Haq Against Polio Campaign,” Newsweek, December 19, 2013.
 “Taliban’s Change of Heart on Polio Vaccination,” Dawn, January 22, 2014.
 “Polio: 400 Volunteers Turn Back on Vaccination Drives,” Express Tribune, December 24, 2013.