ISTANBUL A measles vaccination program in northern Syria has stalled amid disagreement over who should coordinate it, highlighting the challenges of establishing basic healthcare services in opposition-held parts of the country.
Syrian and international agencies are struggling to combat the extremely contagious and sometimes deadly disease 18 months into an outbreak, even though hundreds of thousands of vaccine doses are ready in southeastern Turkey, earmarked for high-risk refugee camps just over the border.
The provision of basic medical care in northern Syria, including universal immunization, collapsed as an uprising against President Bashar al-Assad three years ago turned into a civil war which has left some 9.3 million people in need of aid.
Opposition groups as well as Syrian and international non-governmental organizations are working out of Turkey to try to restore critical health services, but continued fighting, including aerial bombardment, and difficulties in coordinating dozens of humanitarian agencies have slowed progress.
The interim government of the Syrian National Coalition, the opposition body officially recognized by the United States and Western allies, has its own health ministry and has been pushing to run immunization campaigns itself.
But some international aid organizations and donors see the coalition as too political and fear they will appear partisan by working too closely with it, preferring to stick with a separate body, the Assistance and Coordination Unit (ACU), already leading a polio vaccination drive in the area.
"The interim Ministry of Health want to be involved," said Khaled Almilaji, health department manager at the ACU, saying that 250,000 measles vaccines have been waiting in Turkey for up to a month to be despatched to camps near the border.
"We were waiting for them to figure out what their contribution to the project is without causing discomfort for some governments and NGOs who cannot deal directly with them."
Eventually the program aims to vaccinate 1.3 million people.
A measles outbreak started in Syria in early 2013. Since the start of this year alone an estimated 4,000 cases have been reported, although wide-scale laboratory testing in the country is not easily available to confirm those figures, said Bachir Tajaldin, primary health coordinator at the ACU.
The disease is highly contagious and is spread by bodily fluids - drops of saliva from the mouth, mucus from the nose, coughing or sneezing, and tears from the eyes.
Measles can cause serious complications like meningitis and pneumonia, becoming much deadlier in difficult humanitarian conditions. In rich countries it kills only 1 or 2 out of 1,000 patients, but according to the World Health Organization it can kill as many as 10 percent of those infected in countries with high malnutrition and poor health care access.
Tajaldin said it was so far killing about 1-2 percent of patients in Syria. Typically a childhood disease, it has spread to those older than five in 40 percent of the cases.
Aid workers said they were growing increasingly frustrated with the deadlock between the interim government and the ACU.
"They claim to work for the same side but are risking the vaccination campaign over internal political fights," one Western aid official based in Turkey said.
In government-held areas, by contrast, a measles vaccination campaign of 1.3 million doses commenced on June 15, running alongside a polio campaign, U.N. children's agency UNICEF said.
UNICEF's Damascus spokesman Kumar Tiku said by email that the U.N. body is providing vaccines, syringes and other equipment as well as covering staff costs.
Mohammed Saad, manager of the opposition interim government's healthcare directorate, denied that disputes with the ACU were solely to blame for the delays in northern Syria, saying other agencies were also in disagreement about how best to manage the campaign.
The ACU and the interim government had managed to agree respective roles in the measles campaign but had yet to formulate a detailed plan on how it would work in practice, the ACU's Almilaji said.
One aid worker in Turkey lamented that the lack of coordination was symptomatic of the overall breakdown in health services in Syria's opposition-held areas.
"We would like to work towards routine immunization but to do this children's health must be de-politicized," she said, speaking on condition of anonymity.
"We can do little to protect children from violence but we can try to protect them from disease."
(Editing by Nick Tattersall, Kate Kelland and Peter Graff)