On 28 Oct 2013, the Minister of Health of the Syrian Arab Republic announced that, after a 15-year absence, polio had returned to the Middle East. Thirteen cases were confirmed from Syria's Deir Al Zour province. The occurrence of an outbreak reflects declining immunization rates due to the severe interruption of public health services and to the conditions in which the people are living. A comprehensive outbreak response will need to be implemented across the region, with seven countries and territories to conduct mass polio vaccination campaigns targeting more than 22 million children aged under 5 years. (Strategic Plan for Polio Outbreak Response in the Middle East)
As of 8 Feb 2014, 17 confirmed polio cases had been reported from Syria's Deir ez-Zour Governorate, three from Aleppo Governorate, one from Al. Hasakeh Governorate and two from Idleb Governorate (WHO/UNICEF, 8 Feb 2014).
By 20 Mar, a total of 37 cases had been reported: 25 cases by the Syrian Arab Republic Ministry of Health, and 12 cases from contested areas (Aleppo, Edleb and Deir Al Zour) not yet reflected in official figures. The most recent case had onset of paralysis on 17 Dec 2013. Further evidence of regional spread was confirmed by notification of a case from Iraq, the first polio case in the country since 2000. The case, a six-month old boy from Baghdad who had not been immunized, developed paralysis on 10 Feb 2014. Genetic sequencing indicates the virus is most closely related to virus detected in the Syrian Arab Republic. (WHO, 21 Mar 2014)
By 8 Oct, three cases had been reported in the Middle East with onset of paralysis in 2014 - two in Iraq and one in Syria. The most recent case reported from Iraq occurred in Mada'in district, Baghdad-Resafa province, with onset of paralysis on 7 Apr. Syria’s most recent case had onset of paralysis on 21 Jan. The fact that six months had passed with no new cases being reported indicates that transmission of the virus has been interrupted. (Global Polio Eradication Initiative, 8 Oct 2014)