Exitus Acta Probat: Negotiating humanitarian access

As I write a commentary about how the CIA’s attempt to locate Osama bin Laden under the cover of a hepatitis vaccination drive endangered the polio eradication effort (and vacciation efforts everywhere), I realize that I am beating a dead horse (so to speak). The collective global health and development community has complained about how ill-advised and irresponsible the plot was until it was blue in the face. We all understand the ramifications; we all shake our heads in unison when reports of health workers being attacked roll in. I saw no point in hashing it out again.

That is, until I shared my views with my non-professional network on Facebook.

Those of you who are more avid Facebookers know that in addition to it being a place to share pictures of new babies, social antics, culinary ventures, and personal details that no one really wants to know, it is a space for people to air out their political and religious beliefs, and to comment (and flame) others’ similar beliefs. Election season can be particularly miserable. While I refrain from doing this most of the time, I will occasionally share stories on things that I find interesting or (in this case) frustrating. In response to this article on the consequences of the CIA’s scheme, I got the following comment:

I fail to see what the CIA has to do with polio. It’s the Taliban that is attacking workers and keeping the vaccine from getting to people.

On the surface, my friend’s comment is true: it is the Taliban, not the CIA, that is attacking health workers and reversing out progress toward polio eradication. But the fact of the matter is that public health and humanitarian workers will always have to work around unsavory characters to reach those most in need. That is why the medical workers are negotiating with the Assad’s government to gain access to the wounded in Syria; it is why health providers worked with al-Shabaab and local warlords in Somalia; it is why midwives work through armed rebel groups to educate ethnic minority communities in Burma. Though affected by all of it, people’s health goes beyond foreign policy, diplomatic relations, and political stalemates. Whether an area is controlled by government forces, extremist groups, or local warlords, its people – and in the case of polio, most critically, its children – will get sick if they can’t access disease prevention. More importantly still, if health workers lose access to these vulnerable populations, progress made in containing disease will be lost – and they can spread even further. Letting up the pressure of polio vaccinations in Pakistan has allowed the virus to rear its ugly head in China and, more recently, Egypt.

After some discussion, he conceded that I had a point. Now I just wish that Obama would do the same and ban the CIA from implementing this kinds of bad ideas to gather intelligence. Bad guys come and go, but negotiating with them to obtain humanitarian access is a reality that will never go away.

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