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The World Health Organization has declared a polio emergency in Syria. The outbreak has spread to four cities there, including a war-torn suburb of the capital. The Syrian government has pledged to immunize all children under five, but wartime politics is getting in the way and the outbreak is expected to spread.

NPR's Deborah Amos reports from Gaziantep, on Turkey's southern border with Syria.

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DEBORAH AMOS, BYLINE: A polio task force gears up for a mass immunization campaign in Northern Syria, just a short drive away. The doctors are part of the Syrian opposition, a medical early warning team that monitors rebel-held areas. They raised the first alarm after discovering polio cases in the province of Deir ez-Zor. Dr. Mohammed al-Saad says there are now more than 60 suspected cases, with new ones reported every day.

Is this spreading quickly?

DR. MOHAMMED AL-SAAD: It is spreading quickly when you are looking to the age group; most of them less than two years old who didn't receive the routine vaccination in Syria.

AMOS: This workshop prepares volunteers to immunize children in rebel areas, communities decimated by shelling and bombs with no electricity, no clean water or functioning sewage treatment, where children under five are at greatest risk, says Dr. Bashir, head of the polio task force.

DR. BASHIR: Our target is to train about 8,000 people for the door-to-door polio campaign.

AMOS: Mass immunization is the only way to contain the outbreak. The fastest way to reach kid is to cross the border from Turkey. But that raises a political problem for U.N. agencies in charge of immunization. Dr. Bashir says a request for vaccines has been in vain.

BASHIR: Till now they didn't promise they can provide us with vaccine for our children.

AMOS: Delivery from any U.N. agency is not likely. The U.N. is only authorized to operate through sovereign states. That means it delivers all humanitarian aid through the central government in Damascus. And last month, the Syrian regime said no to a U.N. Security Council statement urging cross-border aid. UNICEF's vaccination program is based in Damascus. Reaching children in rebel areas is a challenge, says spokeswoman, Juliette Touma.

JULIETTE TOUMA: In the past couple of years, we were not able to reach more than half a million children because of access restrictions. And this could explain why we have polio cases inside Syria.

AMOS: Only after the outbreak was confirmed did the Syrian regime pledged to vaccinate all Syrian children. And some vaccines are getting to rebel areas. One hundred-eighty thousand doses have arrived in Deir ez-Zor where the outbreak began, says Touma, after negotiations with the regime and the rebels.

TOUMA: There is no other way to deliver humanitarian assistance than to deal with all parties of the conflict.

AMOS: And you've been able to do that in Deir ez-Zor?

TOUMA: Yes, we have.

AMOS: But it's not enough for all vulnerable children, says Dr. Khaled Almilaji, with the polio task force. The virus is spreading in rebel areas, he says, where there are millions of displaced living in dire conditions. Families are drinking directly from the rivers, he says, dependent on contaminated water, a carrier for the virus.

DR. KHALED ALMILAJI: We are sure that the people in Deir ez-Zor, some villages, they don't know about the polio actually.

AMOS: He says a door-to-door campaign is now key for families with children at risk.

ALMILAJI: This is a disease. This is not politics. So they can't pretend that they are - we are doing what is needed. And this is more important.

AMOS: International aid workers call for greater pressure on the Syrian regime, to allow a route from Turkey to northern Syria.

The polio cases are alarming, says Mary Ana McGlasson, a registered nurse who now works on aid to Syria.

MARY ANA MCGLASSON: Humanitarian aid in general, throughout large parts of Syria is not functioning. And I think that the polio epidemic and the vaccination campaign is one symptom of many.

AMOS: She says the return of this crippling disease and the response is a sign the international aid system is failing Syria's children.

MCGLASSON: My anger is directed at all parties to the conflict that are slowing down humanitarian aid, even by a fraction. And its children caught in the middle of that that are suffering and that's tragic to me.

SIEGEL: Polio does not stop at borders or military checkpoints. Without a comprehensive response, say aid workers, the outbreak could become a public health catastrophe. Deborah Amos, NPR News.

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