A History of the World Since 9/11

by Dominic Streatfeild

  Each year, roughly 3 million people congregate in Mecca, half of them from abroad, to participate in the Haj, the largest regularly scheduled mass movement of people on the planet. At the end of the pilgrimage, having mingled with travellers from all over the world, they return home. Modern transport, heavy overcrowding and close contact with individuals from other countries: if an infectious disease makes it to the Haj, odds are high that it will be dispersed globally the moment the pilgrimage is over. In 2004-5, two cases of polio showed up in Saudi Arabia: one in Jeddah, the other in Mecca. From there, the virus travelled onwards: the Indonesian case in spring 2005, for example, was traced back to the Mecca strain.

  Saudi Arabia might have been part of the problem. It proved to be part of the solution. The kingdom, which had been polio-free since 1995, had been one of the keenest of the Islamic nations to embrace polio vaccination. Following CDC/WHO intervention, clerics in Saudi announced publicly that OPV was not part of a Western plot, and advised that all Muslims make sure their children received it. They also warned that any child under the age of fifteen who arrived for the next Haj would be forcibly vaccinated unless they could provide proof of previous inoculation.

  With some of the most senior and respected clerics in the world now supporting polio vaccination, it became harder for Nigerian hardliners to maintain their stance regarding the ‘contaminated’ OPV. The way was clear to start cleaning up the damage created by the Nigerian incident.

  And yet commentators noted an alarming trend. Disregarding the recent reinfections from Nigeria, polio was endemic in four countries: Nigeria, Afghanistan, Pakistan and India. Two of the four were overwhelmingly Islamic, and the regions most affected in the other two were those most densely populated by Muslims. Routes taken by Muslims, either on the Haj or in search of work, were the routes the virus was following. The result was that children paralysed by polio were now predominantly Muslim. Poliomyelitis, largely eradicated from the rest of the world, appeared to be becoming a disease that targeted Muslims.

  But it wasn’t only the virus that was contagious. The African rumour was, too.

  Rumours about the safety of OPV appear to have arrived in India in 2004. Like the strains of polio virus multiplying across Africa and the Middle East at the time, these rumours originated in Nigeria – spread, presumably, by the Internet.

  For vaccinators, India had represented one of the major challenges to the GPEI. Poverty, a vast population, a hot climate, heavy overcrowding and poor sanitation combined to make the country a perfect environment for poliovirus. In 1988, at the start of the eradication campaign, the country was facing 25,000 cases each year. The ensuing WHO operation was immense: 150,000 vaccination sub-centres were established and fitted with refrigerators to keep the vaccine cold. Hundreds of thousands of volunteers were trained to administer it.

  Immunization days were advertised by town criers, on posters and flags, on television and radio, and in newspapers and public transport hubs. Vaccinators travelled on trains, inoculating passengers. Indians’ love of cinema was also harnessed: vaccination was plugged in the lobbies of movie theatres, on the stage before films began and in the films themselves. Bollywood stars, cricketers and pop singers publicly endorsed vaccination. The result was a heavy vaccine uptake as India embraced the GPEI. The country would end up administering a billion doses of OPV every year to an estimated 150 million children under five.

  Signs of the programme’s success were not long in coming. In 1997, thirty-three Indian states were entirely free of polio and by 2000 cases of the disease had dropped more than 99 per cent, from the tens of thousands to 300. In 2001, the entire country reported just 268 cases, most of them concentrated around two ‘hot zones’: India’s northern states, Bihar and Uttar Pradesh.

  There was a reason for this. India’s highest-intensity transmission areas were among the biggest, most overcrowded and least-developed regions in the country. Bihar and Uttar Pradesh had a combined population of more than 250 million people. Five million children were born each year in Uttar Pradesh alone, a fact which made vaccination more difficult: each time eradicators returned, another 600,000 children had to be traced.

  The states were poor, too. More than 60 per cent of Uttar Pradesh’s inhabitants had no access to sanitation. Malnutrition and diarrhoea – factors that not only assist polio infection, but also hinder the efficacy of OPV – were common: 52 per cent of the state’s children were malnourished. Problems with logistics and poor local education meant that coverage in these areas, where vaccination was most crucial, was patchy. In richer, southern states, an estimated 90 per cent of children under five received at least three doses of OPV; in Bihar the figure was closer to 10 per cent.

  It was thus no great surprise when, shortly after the millennium, Uttar Pradesh experienced a resurgence of the disease. In 2002, the state reported 1,500 new polio cases: 66 per cent of all infections globally that year. Vaccinators stepped in and resolutions were made to improve coverage. Shortly afterwards, however, other problems emerged.

  One of the issues that complicated polio eradication in the two northern states was the fact that the majority of their populations was Muslim. Women tended not to leave their homes; there were problems with male vaccinators coming into contact with females. Unlike the southern states, the populations of Bihar and Uttar Pradesh did not come forward to public vaccination booths. The last thing the region needed was a series of community leaders instructing people not to co-operate with vaccinators. But this was what happened.

  In 2004 – hot on the trail of an erroneous rumour that children had been killed by the vaccine – came the Nigerian story: OPV contained birth-control agents. The inhabitants of Uttar Pradesh were reminded that India had been one of the thirteen countries targeted for ‘actions to reduce fertility’ by the secret US memo, NSSM-200. Flags and banners went up instructing Indians not to accept health visitors, who were peddling a mysterious medicine that made Muslim children sterile. In an area already suspicious of foreign medical intervention, this was bad news.

  Results were as tragic as they were predictable. By 2006, Uttar Pradesh and Bihar were responsible for nearly 90 per cent of all Indian polio cases. Polio from the two states spread to other regions previously free of the disease. When Nepal and Bangladesh were also reinfected, UN Secretary-General Kofi Annan wrote to the Indian Prime Minister warning of the dangers of not controlling the disease in the region. That year, although Muslims made up just 13 per cent of India’s population, they accounted for 70 per cent of the country’s polio victims.

  If eradicating polio from India’s northern states was a struggle, there was one area that presented even more problems. India was at least peaceful. A thousand kilometres to the north-east, the border between Pakistan and Afghanistan was anything but. The area was so politically complicated, so ridden with tribal feuds, that even the British, when they had ruled India, had not known what to do with it.

  In 1893, an attempt had been made to pacify the region. The territory had been divided by the Durand Line, creating a border between then British India and Afghanistan. Once the line was in place, instead of trying to rule the region’s numerous Pashtun tribes, control had been ceded to autonomous agencies: in return for stability, the area was left well alone. A century later, the 1,500-mile-long border was still disputed and still inconceivably messy. It was also the nexus between two of the remaining four countries harbouring endemic poliovirus.

  Conditions that allowed polio to thrive in India and Nigeria – poverty, climate, poor education, poor governance, poor sanitation – were prevalent all along the Pakistan-Afghan border. Rural areas were inaccessible, urban ones overcrowded. Inhabitants of Pakistan’s Federally Administered Tribal Areas (FATA) and North-West Frontier Province (NWFP) slipped across into Afghanistan with impunity, then returned just as easily. This was possibly the most porous border in the world: most inhabitants didn’t even recognize it existed. The poliovirus certainly didn’t. So convoluted w
ere its movements that CDC and WHO staff were unable to work out whether Afghanistan was reinfecting Pakistan with polio, or vice versa.

  Perhaps ironically, prior to 9/11, in Afghanistan the Taliban had been willing participants in the GPEI. During the civil war in the 1990s, both the Taliban and their opponents, the Northern Alliance, had ceased hostilities on Days of Tranquillity so that children could receive vaccine. In some areas, vaccination was actually easier on the Afghan side of the border than it was on the Pakistani side. As a result, much of the vaccination in Pakistan’s mountainous tribal areas was conducted by Afghan teams, criss-crossing the border and vaccinating at will. Even a diplomatic spat – rumours of Afghan eradica-tors entering Pakistan to conduct operations without permission – led only to wrist-slapping: officially, they promised to stay on their side of the border. Unofficially, they crossed over and continued to vaccinate anyway.

  Results were impressive. ‘Nowhere is the achievement of humbling polio more remarkable than in Afghanistan,’ wrote UNICEF author Siddarth Dube in a book highlighting the successes of the GPEI in 2003. ‘Afghanistan is on the verge of conquering polio . . . its complete defeat in the near-term is almost a certainty.’

  Dube’s prediction turned out to be premature.

  9/11 saw to that.

  In 2001, three out of five NIDs were complete before 11 September. The fourth, scheduled for late September, went ahead – bombing had not yet begun – but the fifth, in November, was more problematic. Afghans were fleeing the country in huge numbers. The border areas were unsafe. Nevertheless, 33,000 NID volunteers went ahead with the vaccination plan anyway, immunizing more than 5 million children. It was a testament to the dedication of GPEI staff that such a programme was conducted at all. But the success was not to last.

  As the situation in Afghanistan became increasingly chaotic, refugees, desperate to avoid the fighting, flocked across the border. The best connected and best resourced made it into the cities, or sometimes even to foreign countries such as Australia. The rest ended up marooned in Pakistan’s border areas, making the already difficult task of tracking down and inoculating children there even harder. The WHO set up vaccination points in refugee camps and at border crossings, but it was impossible to ensure children were not missed. It was also impossible to predict what might happen on this most unstable border.

  Vaccination in the autonomous tribal regions was already a tricky business anyway. For a start, there was the issue of accessibility: many of the agencies were so remote that vaccine had to be transported by donkey, packed in blocks of ice. Then there was the culture. Pashtun tribes were among the most conservative of all Islamic societies. Women seldom ventured outside the home at all. As had been the case in Uttar Pradesh and Bihar, they often refused to attend public vaccination booths. Vaccinators were forced to make the rounds door-to-door, asking parents whether they wished to have their children inoculated, marking each house with chalk to record the number of children inside that had received a dose. But this also created problems.

  A Pashtun woman would never allow a strange man into her house. When female health workers teamed up with men, the issue was not resolved: what kind of woman would be seen in public with a man who was not her husband or brother? Sending two women together was little better: females brazen enough to travel around knocking on strangers’ doors were often unwelcome.

  Because the border regions were off limits to the Pakistani government, asking for assistance there was not likely to help: Pashtun communities didn’t trust the Government. They certainly didn’t trust foreigners. In these areas, where fighting was common and centuries-old feuds lingered on, a stranger knocking on the door and announcing that he was from any official organization was a reason to reach for the guns – and the one thing there was no shortage of in FATA was guns.

  The Pakistani government’s schizophrenic policy towards the region made the situation a great deal more difficult. For decades, the military had been supporting the Taliban in Afghanistan. Post-9/11, US pressure to close the door on both Taliban and al-Qaeda fighters achieved little: billions of US dollars supplied to Pakistan went astray, while requests to sweep up insurgents fell on deaf ears. Occasionally, al-Qaeda fighters were handed over, but no senior Taliban members were caught: a clear sign that there was no real interest in neutralizing the organization.

  Simply, Pakistan did not believe the Taliban was a threat. The result, as more and more refugees fled Afghanistan for Pakistan, was a series of border regions teeming with civilians, insurgents, foreign fighters, Taliban leaders and al-Qaeda cells. Insurgents fired rockets from Pakistan at US bases in Afghanistan or sneaked across the border, attacked, then retreated back into FATA where they were untouchable. Privately, American intelligence officials wondered whether the invasion of Afghanistan had achieved anything other than shifting Taliban and al-Qaeda a few miles to the south-east.

  Despite US exhortations to clean up the area, Pakistan’s government alternated between feigned ignorance of the problem and peace deals with local militia leaders: no violence in Pakistan in return for autonomy, no interference from central government in return for peace. Often Pakistan’s Inter-Services Intelligence (ISI) actively assisted insurgents in their cross-border operations. The result was the creeping Talibanization of the border provinces.

  Girls’ schools were shut down. Barbers were warned not to shave their customers. Sharia was instituted and madrasas opened by the dozen. By the time the militants turned against the Pakistani government itself and started bombing city centres, they had gained so much power it was too late to rein them in. Troops were sent and beaten back. Towns were destroyed. More refugees fled their homes, further complicating issues: now the area wasn’t just dealing with displaced Afghans, but displaced Pakistanis, too. Further peace deals were negotiated and disregarded. The bombings went on. Al-Qaeda strikes around the world were planned here: Bali, London, Madrid. According to Pakistani commentator Ahmed Rashid, all al-Qaeda operations worldwide came with FATA fingerprints on them.

  Periodically, when US patience wore thin, the Americans staged cross-border operations themselves, firing missiles at suspected al-Qaeda hideouts. Civilian casualties led to popular outrage: Pakistan was already fighting America’s war for it, now the country was being bombed. Even when strikes were accurate, there was rage. In the border areas, mistrust of US and international organizations was such that polio vaccinators were forced to repaint their vehicles. Originally, they had UN stickers on, but when ‘UN’ came to be read as ‘US’ this was replaced with ‘WHO’. This soon became synonymous with the Americans, too, and was replaced with ‘NOPOLIO’.

  Still there were problems.

  The Afghan Taliban may have accepted Days of Tranquillity in the 1990s, but its modern descendants did not. Travel in the border regions became too dangerous for all foreigners.

  The deteriorating situation along the Afghan-Pakistan border made it a perfect hiding place for the poliovirus. Pathogens tend to thrive during war: water systems are wrecked, sanitary infrastructures destroyed. Violence causes health workers to flee. Roads and bridges are destroyed. Transport systems go down. Waves of refugees disperse in all directions, carrying their infections with them. Keeping track of them, let alone offering healthcare, becomes impossible.

  Dr Abdul Ghani saw all of this. In the latter part of 2003, looking for a new role, and perhaps a higher salary, he contacted a friend, local politician Abdullatif Bacha.

  ‘He came and requested me to use my influence to transfer him from Nowshera to Bajaur,’ Bacha recalls.

  The transfer presented a few complications. In Nowshera, Ghani had been the employee of the NWFP administration; in Bajaur, he would be employed by the federal government. But Ghani was a talented, hard-working doctor and the Government wasn’t turning away applicants. Bacha called a friend, who arranged the paperwork and on 22 December Dr Ghani was formally transferred. It was to be his last promotion.

  At first the doctor was de
lighted with his new post, inviting former colleagues to visit. Bajaur was beautiful, he told them, with high mountains all around, historic passes into Afghanistan to the west and the Swat Valley – the site of his family’s hiking holidays – to the east. It wasn’t long before he changed his mind.

  The smallest and northernmost of the Federally Administered Tribal Areas, Bajaur was also one of the least secure. Home to a large number of Afghan refugees, mostly Salafists loyal to Gulbuddin Hekmatyar (the warlord who later claimed to have smuggled Bin Laden out of Afghanistan in December 2001), the area was ideally situated for running cross-border operations. In the 1980s, the CIA had used it to equip mujahedin fighters before they attacked Soviet troops in Afghanistan. Twenty years later, Islamic militants used it for the same thing; only this time the targets were American, not Russian, military outposts.

  Mountainous, sparsely populated and almost entirely inaccessible to both American and Pakistani militaries, Bajaur was a perfect hiding place for foreign fighters and al-Qaeda operatives – and one in particular.

  ‘Bin Laden loved Bajaur,’ says Michael Scheuer, head of the CIAs Bin Laden Unit. ‘It was the place he intended to move his family and organization in May of 1997, before he was invited by the Taliban to go to Kandahar.’ Ousted from Afghanistan immediately after 9/11, it was highly probable that the sheikh and his acolytes had returned for sanctuary. ‘I think, without question, that’s the most likely place along the border for them to be,’ says Scheuer. This fact did not go unnoticed in US intelligence circles.

  On 13 January 2006, two years after Dr Ghani’s arrival in Bajaur, the CIA struck a housing complex in one of the agency’s main towns, Damadola. Four Predator drones launched Hellfire missiles into the compound. Intelligence sources later explained that there was ‘good reporting’ that Bin Laden’s deputy Ayman al Zawahiri was attending a party in one of the houses. If he was, he was gone by the time the missiles hit. Three homes were razed to the ground, eighteen civilians killed.