Though the killing of health workers and members of NGOs engaged in social activities is not a new phenomenon in Pakistan, what has been striking during the last two months, is the intensity and geographical spread of the phenomenon. Initially, such killings remained exceptions and were limited to the tribal regions in Pakistan’s Northwest; but now, one can observe their occurrences at regular intervals, including in cosmopolitan cities like Karachi.

Why is there a sudden spurt in the killing of health workers in Pakistan who, by administering polio vaccinations, are doing a great humanitarian service?

Target Health Workers: Mapping the Expanse
Consider the following major killings to understand the nature, intensity and the geographical expanse of the attacks on health workers:

01 January 2013, Swabi (Khyber Paktunkhwa): Six aid workers were ambushed on the Islamabad-Peshawar Motorway.
19 December 2012, Charsadda (KP): A female health worker and her driver were shot dead in Charsadda district.
18 December 2012, Karachi (Sindh): In a coordinated attack, four female workers were killed in different localities (reported to be dominated by the Pashtuns) of the city.
18 December 2012, Peshawar (KP): A female health worker was killed in a village close to the city.
16 June 2012, Miranshah (North Waziristan): Hafiz Gul Bahadur, a TTP commander banned polio vaccinations in the region, “as long as drone attacks are not stopped in Waziristan.”

Targeting Health Workers: Understanding the Motivations
Three reasons could be cited for the killings of these innocent workers. First, they make for an easy target. Given the number of health workers and the places of their work, providing them security is a herculean task. They have to travel widely in interior regions, where the law and order situation is worse, thus becoming an easy prey for the TTP. Most of them are outsiders and strangers to the areas they visit to administer vaccinations. Society therefore, should double up their efforts to ensure the workers are not targeted by militants; though the workers are outsiders, their killers are not.

Second, is what could be referred to as the ghost of bin Laden. Many within the ranks of the TTP suspect that health workers are used by the CIA as spied. Remember, Dr Shakil Afridi used the guise of a vaccination drive to locate Osama?

Third, even outside the TTP, a general suspicion about health workers prevails amongst civil society. There is always a larger conspiracy theory, starting from 9/11 being a CIA-Jewish conspiracy, which is accepted as a fact even amongst the educated.  In this context, consider the following suspicion: in Pakistan, the use of iodised salt is considered to lead to infertility and is believed to be a part of a conspiratorial family planning drive.

The Washington Post, in one of its reports, quoted a cleric in Lahore asking, “Why are the US and the West so worried about the health of Pakistanis, that they are forcing us to use iodine? .. They have an agenda.” The TTP is exploiting this very lack of awareness and general ignorance.

The State: Primary Culprit?
But why blame only the Taliban and the TTP?

Presently, most health workers engaged in humanitarian aid in adverse situations belong to multiple NGOs. But, is this not the primary duty of Pakistan’s health department? In the rest of South Asia, the State has been extremely proactive in vaccinating its children. The State in India, for example, has extensively used film actors and famous cricketers to create awareness in the first place, followed by an extensive campaign to eradicate polio.

Unfortunately, in Pakistan, both have been missing. Consider the following numbers relating to the country’s health sector. Pakistan, along with Nigeria and Afghanistan, is one of the three countries at the global level where polio is endemic. According to a WHO estimate, more than 300 children died in 2012 alone due to measles. While releasing the 2012 annual report- Health of the Nation, the President of Pakistan Medical Association (PMA) was reported to have said, “the existing situation is that a large number of newborns die in the first year of their life, whereas 30,000 – 35,000 women perish due to complications during pregnancies; while tuberculosis, cardiac diseases, diabetes, cancers, kidney diseases and hepatitis B and C are on the rise.”

If polio is endemic in Pakistan, so is corruption in its health department. Whilst health departments all over South Asia are facing a governance crisis, the lack of accountability further complicates the problem in Pakistan. More importantly, how much the State spends on the health of its citizens is of vital concern. Presently, the health sector gets less than 0.3 percent of the annual budget – both at the federal and provincial levels.

A larger problem in the future, therefore, could be in terms of international donors, led by the UN, deciding to stop these welfare activities. The UN, citing a lack of security, has already suspended the programme a few times. Given the prevalent sense of insecurity, international donors may be forced to re-think their strategy, which could severely affect the future of children in Pakistan.

Should We Thank the TTP For Creating Awareness?
Corruption, problems of governance in the health sector and low government spending on health, may pose a larger threat to Pakistan than attacks by the TTP. It is extremely unfortunate that what the State could not do as a part of its positive campaign to create awareness, the TTP could do with their negative campaign.