Humanitarian diplomacy offers the olive branch needed in today's violent world

Syrian children who arrive at a refugee camp in Iraq are given polio and measles vaccinations. In war zones and areas of humanitarian crisis, creative negotiations have facilitated crucial vaccination campaigns to reach vulnerable civilians. Photo by: Caroline Gluck / ECHO / CC BY-NC-ND
Our world has become more violent. Trends show that more countries are involved in conflicts and last year 180,000 people were killed in internal conflicts, a number 3.5 times higher than in 2010. The latest Office of the United Nations High Commissioner for Refugees statistics estimate that almost 60 million people are now either refugees or internally displaced because of conflict and violence, the highest number since the end of World War II.
In this context, the achievement of the ambitious new Sustainable Development Goals becomes even more important. Despite the many challenges, the pursuit of these goals is possible and provides crucial opportunities for peaceful conflict resolution.
Humanitarian diplomacy — which advocates on behalf of the needs of vulnerable populations, while upholding humanitarian principles — can open small windows of opportunity that can lead to peace, and at the very least dramatically improve the situation. 
Even in the bloodiest conflicts, when there seems no end in sight, creative negotiations have facilitated crucial vaccination campaigns and interventions to reach desperate civilians. This diplomacy takes place not just at a governmental level, but also through grass-roots advocates who engage community and religious leaders to create a dialogue and enable health professionals to do their work.
From Sri Lanka to Syria and Nigeria, this quiet diplomacy — as practiced by members of the Global Polio Eradication Initiative and its partners, which has reduced polio cases by 99.9 percent since its launch in 1988 —  is creating new models and tactics for humanitarian organizations.
The best practices of humanitarian diplomacy aim to achieve sustainable results by combining top-level negotiations with local peace initiatives. This is in stark contrast to the failing efforts in Syria. Although a report on peace initiatives there concluded that the April 2012 cease-fire brokered by Kofi Annan and other top-level attempts to negotiate cease-fires had “significant humanitarian impact,” the positive impact was short-lived. This is because local actors were not integrated successfully as part of the process.
So how do we actually combine high-level efforts with local initiatives to achieve sustainable humanitarian impact? Here are three principles:
1. Diplomacy is increasingly multilateral: involve as many players as possible.
During the Sri Lankan civil war, the government had originally planned to hold a polio National Immunization Day only in those areas that were not impacted by the war, with the result that only two-thirds of the country’s children would be vaccinated. However, after consultations between Rotary and United Nations Children’s Fund, the two organizations reached out to the rebel army and convinced its leader to agree to an immunization campaign and a cease-fire if the government would also stop the war for two days.
The parties came to an agreement and the subsequent immunization efforts reached approximately 95 percent of the country. By involving all of the relevant parties and utilizing the unique contributions of a nongovernmental organization such as Rotary (rather than just pursuing unilateral action by the government), immunization efforts were converted into an instrument of peace and negotiation.
This tactic — what became known as “days of tranquility” — was successfully used in other countries and demonstrated how creative diplomatic strategies can aid conflict resolution. 
One example saw Rotary work with its partners in the GPEI, as well as the International Committee of the Red Cross and the Catholic Church, to negotiate in El Salvador during the civil war. Allowing health workers to access isolated populations to carry out immunization efforts and the resulting lull in hostilities opened the door for mediators to initiate a dialogue between the warring parties that ultimately led to a lasting peace.
What is the Global Polio Eradication Initiative?
A successful model of cooperation between the public and private sectors, the GPEI is supported by national governments. The core partners are Rotary, the World Health Organization, the U.S. Centers for Disease Control and Prevention, and the United Nations Children’s Fund, joined more recently by the Bill & Melinda Gates Foundation. Today, Pakistan and Afghanistan are the last remaining polio-endemic countries.
But creating these opportunities depends on a strong and local grassroots presence, engaging with as many willing public and private partners as possible, and enlisting the support of internal social and institutional authorities. In this way, localized humanitarian diplomacy that integrates the resources of national and international players not only benefits public health, but complements the efforts of high-level negotiations when progress appears stagnant.
2. Use the strengths of neutrality, independence and principled action.
The importance of neutrality has long been a staple for NGOs and aid organizations, especially when operating in conflict areas or responding to natural disasters. However, the demands of humanitarian diplomacy in the field place ever-increasing pressures on these principles. 
To maintain credibility in a politicized environment, it is important to build trust and ensure local involvement. This can be time-consuming, but becomes crucial whenever tensions arise. For example, the recruitment and induction process for Lebanese Red Cross volunteers can take 9–12 months. This may seem lengthy, but a rigorous selection process to recruit and train professional, impartial, local members of international NGOs operating in volatile areas, ensures that they will be able to act more effectively with the support of the local population.  
Upholding independence is fundamental in peace as well as wartime, as the GPEI learned when embarking on delicate negotiations to reach populations where rejection of vaccines was at high levels. It was only by gaining the support of social and religious leaders that these barriers were overcome, leading to successful and sustainable vaccination efforts.
However, once trust and credibility as nonpartisan, principled actors is lost, it can be very hard to regain. The damaging revelations of ongoing sexual abuse perpetrated by U.N. peacekeepers in the Central African Republic, Liberia, Haiti and elsewhere “can destroy … in a flash” any hard-earned gains of a humanitarian mission, according to Jack Christofides, head of U.N. peacekeeping in Central Africa.
3. Maximize humanitarian opportunities by providing multiple interventions and services.
Using health as a bridge for peace in Sri Lanka and other countries not only created important informal channels of communication across political and ethnic divides, but it facilitated other vital interventions for vulnerable populations. These included the provision of vitamin A tablets, deworming treatments, the distribution of malaria nets and the provision of electricity. 
What this means is that NGOs must be ready to capitalize on opportunities once humanitarian diplomacy creates windows for action.
In summary, whether development professionals target the Syrian conflict and refugee crisis, disease prevention in the developing world, or gender equality, the coalition-building and agile engagement strategies of humanitarian diplomacy will be crucial in achieving many of the benchmarks of the Sustainable Development Goals.
Ending a Global Disease is a conversation hosted by Devex, in partnership with Rotary International, to explore successes in the fight against polio and identify lessons that can be applied to overcoming other global diseases. Visit the campaign site and join the conversation using #endpolio.

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The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno




A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left


What is that nature of the acute illness in infancy?
What is the nature of the subsequent deterioration?
What investigations should be performed?
What is the differential diagnosis of the cause of the progressive calf hypertrophy?



An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.


A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3


Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition


The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies



  • tumours

  • amyloidosis

  • cysticercosis

    Link here