Invisible threat

In a cold, bleak car park behind the city's public health office, the Turkish health ministry recently launched its drive to vaccinate 1.5 million children against polio.

More than 50 mothers and fathers patiently waited among the suited bureaucrats as they were reassured that Turkey would be ready should polio spread from its southern neighbor, Syria. And as health workers dropped vaccine in the mouths of tiny babies wrapped resolutely against in the chill in blankets and woollen bonnets, the reality of war on the border slowly dawned on the mostly untouched Turkish industrial city.

Violent clashes and a bomb that killed 51 people in the Turkish border town of Reyhanli in May have been the biggest impact of Syria's two-year war so far.

New threat

The threat of polio is just the latest. Yet confidence is high among officials from the Turkish Government and UNICEF that the program will successfully ensure the disease won't spread to Turkey where the immunization rate stands at 97 percent.

Since the first polio case was discovered in Deir Ezzour, a province in Western Syria split between opposition and regime forces, a further 15 children have been officially diagnosed with the disease there - all under the age of five.

Last week, the World Health Organization announced two additional cases, one in rural Damascus the other in Aleppo, confirming the spread of the virus. Unofficially, the overall figure has been put above 60.

Tough conditions

Dr. Adnan (surname protected for security reasons) can only work on the ground floor of his hospital in Aleppo - the upper floors were destroyed by shelling three months ago. A week ago the 33-year-old says he was lucky to survive when a barrel bomb exploded 30 meters from his hospital killing 40 people.

Two weeks ago he diagnosed what is thought to be the first case of polio in Aleppo City - a seven-month-old baby who is now completely paralysed in his left leg.

"When I first saw him he had a high fever and diarrhea. Three days later he was paralysed from the waist down," Dr Adnan told DW from a Turkish hotel lobby where he was meeting colleagues to discuss the outbreak.

"A week later, his right leg was moving a bit, but his left leg was completely paralysed - we call it Acute Floppy Paralysis (AFP). His family are from a very poor area and his mother was scared for her three-year-old daughter who also hadn't had the vaccine. I told her there are people who are sometimes able to bring some vaccine from health centers in the regime held area of the city, so maybe she could try to get that."

Vaccination drives have already been rolled out by the Syrian government, as well as in Lebanon, Jordan, Iraq and Turkey.

Political constraints

While the WHO insists it will work with anyone who is working to provide humanitarian assistance to the Syrian population, there are political constraints on working directly with the opposition coalition as the Syrian government remains the legitimate representative of the Syrian people to the UN.

Dr. Bashir (surname protected for security reasons), the doctor leading the Polio Taskforce, a group made up of Syrian NGOs, INGOs and the opposition's humanitarian wing, the Assistance Coordination Unit (ACU), blames the WHO for dragging its feet in providing them with funds and vaccine - which have still not been delivered.

"We were told it would come at the beginning of December. Well, December's here now." The taskforce has put the cost at $9.3 million to reach a target population of nearly 3,000 children under the age of five in opposition held areas.

In Gaziantep, Dr Mehmet Ali Torunoglu, Vice President of Communicable Diseases at Turkey's Public Health Institution, admits that there is confusion as to how to deal with the divided sides. "We know the government of Syria has already started its polio vaccination program, but we don't know anything about what will happen in the opposition-controlled area - who will take care of the vaccination activities there, when they will start or who will provide the vaccination."

While figures for the regional response are as yet unknown, the cost of the roll out for the vaccination programme in Turkey is anticipated to be $10 million alone, where it will cover 1.5 million Turkish and Syrian children, as well as high-risk groups in the seven border provinces.

Coordinated campaign

According to UNHCR figures, Turkey currently hosts 586,000 Syrian refugees, but countless more cross illegally everyday. The health ministry says it is relying on community leaders, municipality mayors, district governors and Turkish and Syrian NGOs to find the unregistered Syrian children and ensure they are inoculated to prevent the spread of the virus north to Europe.

For the Middle East region, WHO spokesman Oliver Rosenbauer says the organization's emergency response team is planning campaigns across seven countries to reach as many of the 22 million children under the age of five as soon as possible. In many areas the campaign will need to continue well into 2014.

Up until 2010, Syria had a high immunization rate of upwards of 90 percent but that has dropped to below 70 percent. But despite the extremely dangerous and political nature of the Syrian conflict, especially in divided Aleppo, Rosenbauer has said a successful response is not impossible given the relatively low number of target children for vaccination.

Delivery of the vaccine, however, to violent and besieged areas is only the first step.

"At the moment we just don't have enough clarity to determine exactly where the vaccine is going, how many children are there and if they're being missed, which at the moment they certainly are. We have to do a comprehensive approach right across the region because we have to assume that this virus is travelling around. Unfortunately there are a lot of unknowns epidemiologically," Rosenbauer told DW.

For Dr Adnan and his patients in Aleppo, though, this is not good enough as they suffer the torment of knowing children just a few kilometers away are receiving the drugs, while theirs go without.

"We know they are getting the vaccine and we are not," he said. "People in Aleppo are very scared for their children because they are at risk when they haven't had the vaccine. They need it. Polio is extremely infectious and it's entirely preventable. This is the crime."