QUETTA, Pakistan, (News Lens Pakistan) -- As hardline militants continue to gun down polio vaccine workers in Pakistan, health workers continue their efforts to protect children.
Pakistan's polio rate has quadrupled in the past year, according to the World Health Organization, with spokesman Oliver Rosenbauer telling News Lens that as of Nov. 19, 246 polio cases had been recorded this year in Pakistan, compared to 63 a year ago.
Militants have targeted health workers in Pakistan, charging they are spying for the West.
These militants have gunned down polio vaccination workers in western Pakistan three times in the past month, bringing the number of polio workers and accompanying guards killed since 2012 to more than 50.
On Nov. 26, four polio vaccination workers, including three women, were killed while working when their van was sprayed with bullets in the southwestern provincial capital of Quetta. Seven others were injured.
Commander Ahmed Marwat of the outlawed militant organization Jundullah, a splinter group of the Pakistani Taliban whose spokesman last month declared the group's allegiance to the Islamic State, claimed responsibility.
Three days earlier, a polio vaccination team in the Shabqadar area of the northwestern province of Khyber Pakhtunkhwa was attacked. The Tehreek e Pakistan Jamat ul Ahrar militant group, a faction of the Pakistani Taliban, claimed responsibility.
"We claim responsibility for the attack on the polio workers in Shabqadar. We will soon release our policy statement on polio vaccine," TTPJA spokesman Ehsanullah Ehsan stated on Twitter.
"In our policy statement, we will outline according to Islam and science how it is dangerous to health and how it is against Islam."
Over 50 health workers and law enforcement officers protecting them have been killed since the end of 2012, Rosenbauer said via email.
Despite the extremists' threats, grass-roots health workers such as 27-year-old Sabira Khan continue to attempt to protect children from the disease.
Khan, who works neighborhoods in Quetta, and her co-workers know that what they are doing is dangerous.
She believes she may one day become a target for killers and has already experienced intimidation on her daily rounds.
"Once I felt I was about to be shot by two men on a motorbike. They abused us verbally and blocked our way twice," Khan said, adding that they wore large coats, garments that could not only disguise them but conceal weapons, and they glared at her and her companions.
"My colleague and I ran to the nearest doorway and called our supervising doctor. When he and our security team came, the men on motorbike fled away," she said.
Khan and a colleague recently toured one of Quetta's calmer neighborhoods, administering oral polio vaccines.
The team often encounters families, like that of Muhammad Rahim, who refuse the vaccine.
Rahim, 25, has a 3-month-old son and opposes having him vaccinated for polio.
He says his brother was told by a doctor who is part of a conservative Islamic preaching group called Tableeghi Jummat that the polio vaccine contains monkey, donkey and lion meat and brains.
"Therefore, our family will never let our children vaccinated," Rahim said.
"The vaccination program may be a conspiracy by the infidels, so I don't believe in it," he said.
Tehreek e Taliban Pakistan, Pakistan's Taliban, came out against the polio vaccine after the U.S. raid on Abbottabad that killed al-Qaida leader Osama bin Laden. The insurgent groups have since branded the vaccination campaign a form of espionage because the CIA had used a hepatitis vaccination program to help it track down bin Laden.
Khan covers her head in a cloth wrap as she goes about her rounds, to avoid being identified as a polio vaccination team member. She also covers the vaccine.
"It is our own technique for staying safe," she says.
Khan encounters families on her rounds who refuse the vaccine immediately and even refuse to listen to the health workers.
"They only say 'no and never,' and then no one can convince them because they see us as immoral girls and as agents working for Western countries. They even hate listening to what we say as we attempt to convince them otherwise," Khan said.
Rahmato Bibi, 40, said she had been urged by other women to refuse polio vaccinations for her six children.
"Many women advise me to stop allowing the vaccinations, because the vaccine is actually a kind of family planning," she said.
Pakistan is the world's "greatest threat" to efforts to curb the spread of polio, "with the virus exported to Afghanistan and the Middle East in the past year" from Pakistan, Rosenbauer said.
More than 180,000 vaccinators work in mobile, fixed site and transit teams to immunize Pakistan's children, according to UNICEF's polio program.
"The target population of children below the age of 5 in Pakistan is 34.6 million during each national immunization campaign. So far this year, 71,131 caregivers have refused vaccination," said Ban Khalid Al-Dhayi, a spokesman for UNICEF.
WHO said in November that "the international spread of wild poliovirus has continued since 31 July 2014, with at least three new exportations from Pakistan into neighboring Afghanistan. There has been no other documented international spread of wild poliovirus since March 2014."
"I am scared before knocking because it could be anyone's home. It can be a willing family, a family who refuses, or even a family whose members are emotional and hate polio vaccinators," Khan said.
Bullets are not her only fear.
"These are dangerous men, they could throw acid in our faces," she said.
Opposition to the vaccines is not universal, though.
Abdul Aziz, 32, had initially been reluctant to vaccinate his two sons, ages 3 and 4, but changed his mind after religious scholars issued a verdict.
"Now, I get both my sons vaccinated," he said.