Narathiwat, Thailand – Suraiya first noticed something was wrong with her two-year-old son, Atfan Kuning, when he couldn’t eat or keep any food down.
The possibility of measles came to mind early as she remembered the warning postings about the vaccine-preventable disease on TV and radio, as well as on billboards plastered around Narathiwat and throughout the southern Thai province.
“At first, I tried to think positively, I thought, maybe it’s not measles, maybe it’s something else,” says Suraiya, 26. “I thought, he got the first vaccine, so this can’t happen to him.”
But it did.
A local doctor diagnosed Atfan with measles – while rare, children can still become infected even after receiving the first of two injections.
Even though it’s widely accepted that the disease is close to being eradicated, here in Thailand‘s deep south, the virus has spread rapidly since September, affecting some 3,000 people out of the 4,000 reported cases nationwide and causing the deaths of at least 22 children.
Hearing that her son was infected shook Suraiya to the core. And later, when she learned that the disease was possibly deadly, it almost sent her into a panic.
“I was terrified,” she says. “My husband and I were in disbelief because we got him the first injection already, so we thought how could this be happening to us? I needed to know the worst-case scenario, and if it happens, then I needed to prepare myself.”
The biggest risk for the young boy was for the disease to spread to his lungs. But luckily for the family, this didn’t happen. Instead, Atfan started improving because of the first vaccine.
Many others, however, have not been as fortunate, with doctors warning that the measles outbreak has gone off the rails in the country’s south.
The region borders Malaysia in a cluster of provinces – Narathiwat, Pattani, Yala and Songkla – where tensions have been raging for years amid an ongoing conflict between separatists fighting for independence and the Thai military. Unsurprisingly, the area, albeit naturally beautiful, rarely sees tourists.
Experts say the recent measles outbreak is the result of a lack of adequate health education, high levels of child malnourishment and dangerous anti-vaccination narratives that have long plagued the area.
Measles, a contagious disease, killed an estimated 110,000 people in 2017, according to the World Health Organization (WHO). The vast majority were children under five.
The disease starts out like a common cold, then it progresses into high fever along with worsening symptoms. It’s contagious through direct contact and through the air. Once it infects the respiratory tract, it then rapidly spreads throughout the whole body. Within days, rashes appear on the face and neck until fully covering the infected.
WHO says that deaths occur because of complications with the disease, such as encephalitis (an infection that causes brain swelling), diarrhea, dehydration, ear infections or severe respiratory infections. Research from WHO found that Southeast Asia suffers from more cases of Measles than anywhere else in the world.
In 2017, there were 107,292 suspected cases in Southeast Asia. The figure dropped to some 83,000 suspected cases the following year.
“Right now, the situation is really bad,” says Muhammadfahmee Talek, a local epidemiologist and lecturer at Prince of Songkla University Pattani campus, noting that the majority of those affected are children under the age of four.
Talek attributes the growing number of cases to the deep south’s high levels malnutrition – affecting, in some areas, up to 30 percent of children, according to UNICEF – and low vaccination coverage.
“The low vaccine rates are for a couple of reasons: one is that there’s a religious element that makes locals misunderstand vaccines. Some of it has to do with misinformation from religious leaders,” says Talek, who has been following the outbreak closely.
“Then there’s a second issue that there’s a ‘Zionist conspiracy‘, or that vaccines are somehow a ‘Western invention’ that are dangerous.”
The predominant religion in Thailand’s deep south is Islam, and local adherents are mostly conservative. Although the vast majority have no issue with vaccines, some fundamentalist leaders have grievances with the fact that some vaccinations contain gelatin derived from pork. This is problematic because consuming any kind of pork conflicts with Islamic teachings.
Al Jazeera repeatedly contacted two prominent local Muslim leaders who are currently promoting anti-vaccination narratives. Both refused to speak.
But other Muslim leaders and local doctors are promoting a more enlightened approach and are working together to fight the outbreak.
|A poster in Narathiwat urging residents to vaccinate their children [Caleb Quinley/Al Jazeera]|
According to Talek, the locals’ vaccination fears began in 2010-2011, when a diphtheria outbreak killed 27 people. All of the deaths occurred within the most conflict-prone areas, leading many to believe that the disease was somehow weaponised by the military through the use of vaccinations.
Human Rights Watch (HRW) says it’s imperative that children have access to vaccinations and that children’s rights to health should be prioritised.
“The cause of this outbreak is because certain local Islamic teachers are preaching the vaccine is un-Islamic. With such disinformation, many parents decided not to bring their children to receive vaccination,” says Sunai Pasuk, Thailand researcher for HRW.
“Since the surge of armed insurgency in 2004, the separatist BRN movement has targeted the Thai government’s public healthcare services as symbolic of what they consider to be the Thai Buddhist state’s occupation of their homeland. Separatists burned down public health centres, murdered public health volunteers and hospital staff, and used a hospital for military purposes. Separatists and their supporters have also used false teaching to spread misperception among Muslims that public healthcare services, including vaccinations, are un-Islamic.”
But for Talek, the problem all comes down to the importance of health awareness and education.
“We need to improve the nutrition status of the kids here, and we also need to encourage the education of the parents. This is so important for the kids because immunisation saves countless lives,” he says, calling for the crisis to be contained.
“If our kids aren’t generally healthy, then they will be more susceptible to other illnesses in the future.”
There’s no doubt that vaccinations have made global progress. Research indicates that immunisations have resulted in an 80 percent drop in measles-related deaths between 2000 and 2017, and within that period, measles vaccinations thwarted an estimated 21.1 million deaths.
Yet for the families situated in the centre of the affected region, uplifting statistics aren’t too comforting. And with nearly two dozen confirmed deaths, not all families have been as lucky as Atfan’s.
“I’m so glad that he’s not in any danger any more,” Suraiya says, smiling. “I’m so overjoyed that he’s going to be OK. I’m just so happy.”