Last January Salma Jaffar was shot while she was going door to door in Karachi, giving children drops of the polio vaccine.
"Even when they took out the pistol, I couldn't understand why he was taking out the gun," Jaffar says of the two men who pulled up on a motorcycle and started shooting at the vaccination team.
"But when he opened fire, that is when I thought it was the end of the life," she says. "My first thought was that I won't be able to see my children again."
Jaffar was shot four times: twice in her arm and twice in her chest. She spent the next three weeks in an intensive care unit.
Three of her colleagues weren't as fortunate and died in the attack. They are among the more than 60 polio workers who have been killed since the Pakistani Taliban banned polio immunization in 2012.
Today the militant group continues to threaten to kill not only vaccinators but also parents who get their children immunized. That threat has had a chilling effect on anti-polio efforts nationwide. And it completely halted vaccination drives in some Taliban-controlled areas. It's in these places that the crippling virus has come roaring back — and threatened to stymie global efforts to wipe out polio.
The worldwide campaign to eradicate polio has been going on for more than two decades. It has cost more than $10 billion. Now the success of the campaign hinges on whether Pakistan can control the virus.
At its peak in the 1950s, polio paralyzed about 350,000 people a year around the world. This year, so far, there have been only 128 cases recorded. Ninety-nine of them have been in Pakistan. And the South Asian nation is the only country in the world where the number of polio cases is rising significantly.
The edict by the Islamic militants to ban immunization was in response to the CIA's setting up a fake hepatitis vaccination campaign in Pakistan. The covert operation was part of an attempt by the U.S. spy agency to verify whether Osama bin Laden was holed up in the city of Abbottabad.
The polio problem in Pakistan right now is a result of the CIA's actions in the country, says Mufti Muneeb Ur Rehman, a prominent and moderate cleric in Pakistan. He personally accepts the polio vaccine. He encourages people at his mosque to get their kids vaccinated.
"But there are certain areas in Pakistan where the people resist [the polio vaccine] because the CIA used the polio campaign for intelligence purposes," he says.
Like many Pakistanis, Ur Rehman erroneously says the CIA operation against bin Laden used a polio campaign for cover, even though it actually used a fake hepatitis B campaign. "The one who can use hepatitis for intelligence," he says, "they can use polio for intelligence."
And the CIA's actions were an insult to Pakistan, he says. As a result, more children are now being paralyzed by polio in Pakistan than anywhere else in the world.
Before the Taliban prohibited polio vaccinations, the country was on the verge of eliminating the disease. In 2012 it notched only 58 cases. "The whole thing just then got reversed when vaccinators started to be targeted and killed," says Elias Durry, who leads the World Health Organization's polio operations in Pakistan.
The Pakistani government is doing what it can to keep the outbreak from spilling out of the Taliban-controlled area and into the rest of the country, Durry says.
The Health Ministry runs mass immunization campaigns that involve about 200,000 vaccinators, trying to reach millions of kids. There are polio roadblocks on major highways, where vaccinators immunize kids passing through in cars and trucks. Vaccinators also ply bus stations, railway stops and even airports immunizing any child that appears to be under age 5.
But all this hasn't been enough to wipe out the disease. As long as the Taliban blocks vaccinations in the territory it controls, Durry says, the virus can't be defeated either in Pakistan or the world.
The immunization ban is in the North and South Waziristan districts, along the Afghanistan border. Officials think about 250,000 kids there are missing their vaccinations.
In the regions under government control, the country is doing all the right things to curb the polio outbreak, Durry says. "But to win the war," he warns, "we have to be able to access children who are currently not available for vaccination."
And there's no indication when the armed conflict between the Taliban and the government will subside — or when the Taliban will allow vaccinators to reach all the children of Pakistan.
LINDA WERTHEIMER, HOST:
The global effort to eradicate polio has been going on for more than two decades at a cost of over $10 billion. In the 1950s, polio paralyzed 350,000 people a year. This year, there have been just over 100 cases recorded. Health officials say they're on the verge of wiping out polio entirely, except in one country, Pakistan. The effort to eradicate polio there is being derailed by the Pakistani Taliban. NPR's Jason Beaubien reports.
JASON BEAUBIEN, BYLINE: In a small house, down a small alley in Karachi, Salma Jaffar still waits for a phone call that's never going to come - a call from Anita Zafar, her friend and fellow vaccinator. Months after the two of them were shot, Salma still struggles to accept that Anita is dead.
SALMA JAFFAR: (Foreign language spoken).
UNIDENTIFIED TRANSLATOR: She says that I still believe that she will call one day and will say she was busy and was not able to call her. She said she can't die. So she is unable to believe this.
BEAUBIEN: On January 21 of this year, Salma and Anita were going door to door in Karachi as a part of a mass polio immunization drive. They were in a crowded slum in this crowded city of 2 million people on the Arabian Sea. Small, blue ice chests were slung across their shoulders. The vaccine coolers with the words, end polio now, on the front, have become emblems of the polio eradication campaign. Suddenly, two men on a motorcycle screeched to a halt in front of them. The man on the back pulled out a gun.
JAFFAR: (Through translator) Even when they took out the pistol, I couldn't understand why he's taking out a gun. But when he opened the fire that was the moment I thought that it is the end of the life.
And the first thing which came to her mind was that I will not be able to see my children again.
BEAUBIEN: Salma's friend, Anita, and two other vaccinators were killed in the attack. Salma herself was shot four times - twice in the chest and twice in her arm. She spent the next three weeks in an intensive care unit. Now she's still recovering from her injuries at home. In Pakistan, the fight against polio is no longer a medical issue or just a public health campaign. The battle against polio in Pakistan has become embroiled in an armed conflict between Islamic extremists, the Pakistani government and the West. It's a clash that's leaving children paralyzed and vaccinators dead in the streets. Salma Jaffar, however, says she won't be cowed by armed extremists. And she plans to rejoin the door-to-door vaccination campaigns as soon as she's healthy.
JAFFAR: (Through translator) I'm not afraid at all because God has given me this life. And he will say look apart from this incident. I'm alive so I'm not afraid of death.
BEAUBIEN: The three vaccinators killed in the January attack, on Salma's team, are among more than 60 polio workers who've been gunned down in Pakistan since 2012. That's when the Taliban put out a ban on polio vaccination. The edict was in response to the CIA setting up a fake hepatitis vaccination campaign in 2011, to gather intelligence on Osama bin Laden. The militants threatened to kill not only vaccinators, but also parents who got their kids immunized. This had a chilling effect on anti-polio efforts nationwide and halted vaccination drives completely in some areas. Mufti Muneeb Ur Rehman is a prominent, moderate cleric in Pakistan. He runs a madrasa on the northern outskirts of Karachi. Mufti Muneeb says he personally accepts the polio vaccine and encourages people at his mosque to get vaccinated.
MUFTI MUNEEB UR REHMAN: But there are some certain areas in Pakistan where the people resist because the CIA used the polio campaign for intelligence purpose.
BEAUBIEN: I tried to point out that this is technically not correct and that in the CIA operation against bin Laden, it was actually a hepatitis B campaign.
REHMAN: The one who can use hepatitis for intelligence - they can use polio for intelligence.
BEAUBIEN: And he says the CIA using a humanitarian medical campaign as cover for espionage was unacceptable. He says it was an insult to Pakistan.
Is it solely because of the CIA that this has become so controversial?
REHMAN: Yeah, when I consult with those people who are in those areas, according to them, this is the main cause.
BEAUBIEN: Now, because of that insult, more children are being paralyzed by polio in the Taliban-controlled swath of the Pakistan-Afghan border than anywhere else in the world.
ELIAS DURRY: Almost three-fourths of cases, globally, this year, is coming out of Pakistan.
BEAUBIEN: Elias Durry is the World Health Organization's point man on polio in Pakistan. He says before the ban, Pakistan was on the verge of eliminating the disease. In 2012, the country only recorded 58 cases.
DURRY: The whole thing just then got reversed or got in trouble, where vaccinators started to be targeted and killed.
BEAUBIEN: Pakistan is currently in the low season for polio. Yet, the country has already recorded more than 88 cases this year. And almost all of those cases are in the Taliban stronghold. Pakistan is doing what it can to keep the outbreak from spilling out into the rest of the country. In Northwest Pakistan, police have set up a polio roadblock along the main highway entering the Punjab province. This is the historic Grand Trunk Road that traverses the subcontinent from Calcutta to Kabul. The motorway cuts through the rest of federally-administered tribal areas, where the Pakistani military, along with the help of U.S. drone strikes, is battling Taliban militants. Polio vaccinators move through the stream of Toyota vans and large Daewoo buses, searching for children to immunize.
MUBBASHIR SARDAR: We are going to prevent it - to come into the Punjab.
BEAUBIEN: One of the vaccinators, Mubbashir Sardar, says because vaccinators can't get into the Taliban-controlled areas, west of here, the goal is to vaccinate children as they come out.
SARDAR: Because if the people will travel, automatically the virus will come with them from there.
BEAUBIEN: And right now, this is the strategy against polio in Pakistan - repeatedly vaccinate all the kids you can in government-controlled areas through mass immunization drive. When you can't get inside an area to reach kids, try to vaccinate around the edges. In addition to polio vaccination posts on major roadways, immunizers ply the bus and railway stations across the country, vaccinating any child that appears to be under the age of five. But all this isn't enough to wipe out the disease. Elias Durry at the World Health Organization acknowledges that as long as the Taliban block vaccination in territory they control, the virus can't be defeated - either in Pakistan or the world.
DURRY: Yes, we will do all of this supplementary activity and maintain to keep the immunity level of the majority of the country. But I think to really win the war, we have to be able to access children who are currently not available for vaccination.
BEAUBIEN: And there's no indication when the armed conflict between the Taliban and the government will end or when the Taliban will allow vaccinators access to all the children of Pakistan. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.