Pakistan's Afghan Repatriation Is Undermining Its Own Polio Fight

At the Torkham border, a mother from Kandahar is turned back into Afghanistan with her two-year-old son. Neither of them has a vaccination card. Neither has completed a full round of polio drops. She does not know where to register her son in a country where clinics have been bombed and health workers have been shot. On the Pakistani side, in Peshawar and Quetta, a frontline polio worker watches buses like hers turn back every week, aware that a child sent across the line without paperwork usually disappears from the immunisation map for good.

Pakistan's Illegal Foreigners' Repatriation Plan is defended in Islamabad as a matter of security and sovereignty. Those are real state interests, and no country is obliged to leave its borders open indefinitely. But the way this plan has been carried out, in mass raids, rushed deportations and detentions with little regard for documentation status, is colliding directly with a public health campaign that Pakistan itself has spent three decades and billions of rupees trying to win.

Islamabad is entitled to control its borders. It is not entitled to pretend that how it does so has no bearing on whether Pakistani children get paralysed by a virus that does not carry a passport.

The Scale and Method of the Repatriation Plan

The mechanics of the plan are straightforward. Since November 2023, any Afghan without complete documentation has faced detention, deportation or coerced "voluntary" return. Within about a year, close to half a million people had been pushed back, and many more were living under the threat of the next raid. Human Rights Watch and Amnesty International have documented mass detentions, seized property, abusive policing and communities driven underground out of fear.

Supporters of the plan argue that Pakistan has hosted Afghan refugees for over four decades, that its security services have linked some recent attacks to individuals crossing from Afghanistan, and that no state can be expected to absorb an open-ended refugee population indefinitely, especially one straining housing, water and school capacity in cities like Peshawar and Quetta. These are legitimate grievances, and dismissing them as bigotry, as some critics of the plan do, is neither fair nor persuasive to the officials who actually have to weigh them.

The trouble is that polio eradication does not run on sovereignty arguments. It runs on three things: trust, access and data. Health workers need to know where children are, they need to be able to reach them, and families need to believe that a vaccinator is not a scout for a deportation raid. A repatriation drive built on unannounced raids and detention makes all three harder to sustain, even if the underlying security logic is sound. When families fear being registered anywhere, they stop registering for anything, including vaccination.

WHO's Polio IHR Emergency Committee has said as much in its own language, noting that the continued return of undocumented migrants from Pakistan to Afghanistan compounds the difficulties the programme already faces. VOA has reported that WHO has directly connected forced repatriation to the resurgence of the virus, pointing to large, unregistered population flows across the border that its surveillance systems cannot track. That is not an activist's talking point. It is the assessment of the body Pakistan itself relies on to certify progress toward eradication.

The Counterargument, and Its Limits

It is worth being honest here: Pakistan is not the only actor responsible for the region's polio failure, and it is not even the primary one. Afghanistan's own Taliban authorities have at various points banned door-to-door vaccination, restricted female health workers, and suspended campaigns in entire provinces, choices Islamabad has no control over. If the case against the IFRP implies that Pakistan alone can fix a two-country epidemic, that case overreaches.

But that caveat cuts against, not for, mass repatriation. If vaccinators inside Afghanistan already have reduced access, then pushing more unvaccinated, untraceable children into that same constrained system does not neutralise the problem, it adds to it. Pakistan cannot control what the Taliban does inside Afghan territory. It can control how many additional unvaccinated children it deposits into that territory, and how it treats the ones still inside its own borders.

Afghanistan and Pakistan remain the only two countries where wild poliovirus is endemic. Both reported dozens of cases in 2024 alone. Regional think tank commentary points out that many of the Afghans now being deported have lived in Pakistan for decades, since the Soviet invasion of 1979, and are shopkeepers, labourers and students rather than a security bloc.

Treating that entire population as suspect does not make the country safer. It makes its polio surveillance blind in exactly the border districts where blindness is most dangerous.

The Costs on Both Sides of the Border

Inside Pakistan, the atmosphere of fear has turned parts of Peshawar and Quetta into no-go zones for vaccinators. Parents who once let health workers into their homes now refuse, worried that any list with their name on it could end in a deportation notice. Community elders who once vouched for campaigns are now cautious about being seen cooperating with anything resembling a government register.

Across the border, UN agencies report that returnees are struggling to access basic services, schooling and health care once they arrive. Children who were in school in Pakistan are now out of school. Children who were receiving routine immunisation are now in districts the programme cannot reliably reach. Every one of those children is a potential link in a transmission chain that, sooner or later, points back toward Pakistan, because the virus moves with the same buses and trucks that cross the Durand Line every day.

None of this means Pakistan has no right to manage its border or its refugee population. It has both. What it does not have is the option of pretending the manner of that management is a polio-neutral choice. It is not.

Toward a More Coherent Policy

A policy that took both security and health seriously would look different from the current one. It would regularise and document Afghans already inside Pakistan rather than driving them underground, so the state can see who is there instead of losing track of them. It would fold refugee populations into routine polio and primary health services instead of treating their presence purely as a threat to be managed. And it would coordinate deportations, where they are unavoidable, with WHO, UNHCR and Afghan health authorities, so that every crossing is met with a vaccination team rather than only a checkpoint.

This is not a soft or sentimental position. It is the harder-headed one. If polio remains endemic on both sides of this border, Pakistan pays first, in paralysed children, in travel restrictions on its own citizens, and in its credibility as a partner in global health. A security policy that produces a public health failure is not a success by any honest measure, whatever it accomplishes on paper.

The mother turned back at Torkham with an unvaccinated child is not just a humanitarian image. She is a policy outcome with a date attached to it. Pakistan can keep treating Afghans primarily as a problem to be expelled and accept that polio will keep finding room in the gaps that approach creates. Or it can run a border policy and a health policy that do not actively work against each other. The virus will not wait for Islamabad to decide which argument it prefers.