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Twenty-three years after it was eradicated in the United States, polio still stalks Pakistan, one of three countries left in the world where the devastating disease remains endemic. Prevention should be easy – all it takes is two drops of the vaccine, administered three different times, for a child to become immune. For years, polio has hovered on the brink of extinction in Pakistan, thanks in part to a 25-year effort by UNICEF, WHO, the CDC and Rotary International that has established a system of nationwide vaccinations that take place every six weeks. In 1988 there were 350,000 cases of polio in 125 different countries; today, that number is down to 176 cases in Pakistan, Afghanistan and Nigeria.

Hopes that polio could be knocked out for good in Pakistan faltered this summer when a pair of militant commanders in the ungoverned tribal areas along the border with Afghanistan banned the program, saying no vaccination teams should come to the area until the drone campaign against militants came to a halt — essentially holding the nation’s children hostage. The militant ban has spread amongst Pakistan’s Pashtun population, reaching as far as Karachi, in the country’s south.

There were 48 cases of paralytic polio last year in Pakistan, down from 154 in 2011. And while the cases are concentrated in the Pashtun speaking populations of Khyber Pakhhtunwa Province and the tribal areas, many of them have direct links to Gadap Town, Karachi’s biggest slum. Home to more than 400,000 people, of which 60,000 are children under the age of five, the tightly packed warren of concrete-block low-rise apartment buildings and small family compounds has become something of a black hole for government services. There is only one basic health clinic to serve the entire population, no sanitation services, no water treatment and a high likelihood that waste water is mixed with drinking water. For polio, it is the perfect storm, combining limited access, bad hygiene, low education levels and severe malnutrition: the polio virus has recently been found in water samples collected from the fetid stream that runs through the slum, a popular playground for area children. One polio worker recounts watching young children play tea party there, sipping stream water from the lids of water bottles scavenged among the heaps of rotting refuse lining the banks.

Pashtun-speaking migrants from the tribal areas dominate the area, and militant networks have made inroads among the population. Local officials call Gadap town “mini Waziristan,” in reference to an area near the Afghan border that is home to both the Pakistani Taliban and al-Qaeda linked militants. It’s not much of an exaggeration. In Gadap town, women, if they are seen at all, wear the trademark shuttlecock burqa of the Pashtun heartland. A recent survey conducted in Karachi by the World Health Organization noted that Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Pakistan will never be free of polio, concluded the report, until a way is found to persuade poor Pashtuns to vaccinate their children. The Pakistani government is working with local communities on an education campaign, and making sure that every child on a public bus coming into or out of Karachi gets the drops. Still, some families have had to learn about the value of the vaccine the hard way.

Not so long ago, every child in Muhib Banda, a Pashtun village not far from the provincial capital of Peshawar, was vaccinated each time the polio teams came through. Local shopkeeper Saiful Islam says that he made sure his sons were first in line. But in late May, rumors swept through the town, as vicious and quick as a virus. “Some people were saying that the polio vaccine was made of pig urine, or monkey urine,” says Islam. “They said that it was a conspiracy to make Muslim children infertile. I believed them.” When the vaccinators came through a few days later, he refused to answer their knock. He refused again in July. And then his six month-old daughter Sulaim came down with a fever. When she recovered, she could no longer move her legs. It’s likely that she will never be able to walk. “Our ignorance made her paralyzed,” says Islam. He has pledged to join the fight against the disease, praying that Sulaim will be its last victim.

Diego Ibarra Sánchez is a Spanish documentary photography based in Pakistan.

Aryn Baker is the Middle-East bureau chief for TIME.

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David R Arnott writes

GRAPHIC WARNING: This post contains graphic images which some viewers may find disturbing.

At the Beaconsfield Gallery in London last Friday, I sat in a darkened room and watched as dozens of images of death and destruction lit up the wall in front of me. Gruesome photos of mangled bodies and destroyed buildings, each accompanied by the name of a village and a date. The war they depict does not officially exist.

The photographs were taken by Noor Behram, a journalist from the North Waziristan region of Pakistan, and they document what he says are the civilian victims of unmanned aircraft 'drone' attacks carried out by U.S. forces.

Noor Behram via AP

In this Aug. 23, 2010 photo provided by Noor Behram, a man holds debris from a missile strike in North Waziristan, Pakistan. The Beaconsfield gallery in London is staging an exhibit of photographs taken by Behram allegedly showing innocent civilians killed by U.S. drone missile strikes in Pakistan's tribal region.

Over a three year period Behram was able to travel to around 60 attack sites in Waziristan, a region that is usually off-limits to the international media. His images, fuzzy, washed-out and often poorly composed, are an incongruous sight in an art gallery, but these are photographs taken as a form of documentation, rather than for their aesthetic value.

In this, Behram follows a path set out by the renowned French photographer Gilles Peress, who declared in a 1997 interview that "I don't care so much anymore about 'good photography'; I am gathering evidence for history." Peress' project A Village Destroyed, which documented a 1999 massacre in Kosovo, illustrated the important role that photography can play in human rights investigations.

Noor Behram via AP

The body of an eight-year-old boy killed by a missile strike in Makeen, South Waziristan, Pakistan, in a photo taken on Feb. 14, 2009.

Behram explained his own motivation in taking the pictures: "I have tried covering the important but uncovered and unreported truth about drone strikes in Pakistan: that far more civilians are being injured and killed than the Americans and Pakistanis admit," he told the AP's Sebastian Abbot last month.

As Abbot reported, U.S. officials do not publicly acknowledge the existence of the drone program, but they have said privately that the strikes harm very few innocents and are key to weakening al-Qaida and other militants.

Noor Behram via AP

A man stands next to a destroyed vehicle after a missile strike on a funeral in South Waziristan, Pakistan, on July 8, 2009.

Alongside Behram's pictures, the exhibition features The Ethical Governor, below, a satirical animation by the artist John Butler that draws on the parallels between drone technology and video games.

Butler Brothers

'The Ethical Governor', a fictional animation by the artist John Butler that satirizes Western imperialism and the use of drone technology.

The Beaconsfield exhibition, Gaming in Waziristan, is a collaboration with the NGO Reprieve, which has provided legal representation to prisoners on death row and Guantanamo Bay inmates. Reprieve has launched an initiative named "Bugsplat" - the term used by the CIA to describe a successful drone hit - which calls for an inquiry into the use of drones and says that some of the attacks may have constituted war crimes.

"We currently have a monopoly, or effective monopoly, on armed drones," John Nagl, president of the Center for a New American Security think tank, told Reuters last month. "This technology will spread, and it will be used against us in years to come."

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