Pakistan is paying the price for its inability to inoculate its children, with measles killing 310 in Sindh province over the past year and with health officials and analysts saying more deaths are likely. The World Health Organization said the 2012 death toll was more than 300 nationwide. Eight deaths were recorded in the first 10 days of the new year.

The country's primitive health care system, lack of education and malnutrition all contribute to the problems of dealing with infectious diseases. Many families oppose vaccination, especially by outsiders, believing that inoculation is an international plot to harm them.

The story has been complicated in recent months, however, in the wake of publicity over a widely criticized US Central Intelligence Agency plan to use a fake hepatitis B vaccination scheme program in the city of Abbottabad as a ruse to gain access to the compound where Osama bin Laden was living and to extract DNA samples from family members in an effort to identify him.

An alliance of 200 US aid groups has protested to the CIA against the use of a Pakistani doctor, Shakil Afridi, in the plan. Afridi has since been jailed for 33 years by Pakistani authorities for taking part.

Partly as a result of publication of the plan, religious extremists have declared war on inoculation teams. In December, nine women working to immunize Pakistanis against polio were shot dead by militants. In addition, at least five international NGO workers, including a British doctor, have been kidnapped by presumed Islamic extremists. That led the United Nations Children's Fund and the World Health Organization to suspend their anti-polio vaccination campaign after the workers were killed.

The turn of events is particularly tragic because Pakistan has the highest incidence of polio on the planet and is one of three countries where the disease is endemic. It is also one of the leading countries in the world for measles deaths. It has been called a health catastrophe that is threatening to spiral out of control. Pakistan is one of the priority countries targeted by WHO and UNICEF for accelerating attempts to control the disease.

"The CIA's use of the cover of humanitarian activity for this purpose casts doubt on the intentions and integrity of all humanitarian actors in Pakistan, thereby undermining the international humanitarian community's efforts to eradicate polio, provide critical health services, and extend life-saving assistance during times of crisis like the floods seen in Pakistan over the last two years," the InterAction coalition wrote.

In addition, Doctors Without Borders denounced both the CIA and Afridi for what they termed their "grave manipulation of the medical act" that could be expected to cause "vulnerable communities – anywhere – needing access to essential health services to understandably question the true motivation of medical workers and humanitarian aid."

Although globally the number of measles cases has continued to decreased significantly, Pakistan remains a problem area. Although the government claims that 82 percent of children under the age of 5 have been inoculated in Sindh, aid officials say the figure is probably around 50 percent at best. Low routine coverage of inoculations and booster shots are being blamed for the outbreak.

Heavy rains and flooding have cut into the ability of health workers to reach outlying areas has also contributed, along with malnutrition that made rural children particularly susceptible. The World Health Organization termed the significant difference of routine immunization coverage between provinces, districts and cities a major cause of the outbreaks.

The government last Friday ordered a crash program to vaccinate nearly 3 million children in the worst-hit districts in Sindh, seeking to register no less than 95 percent of children.

Provincial health minister Saghir Ahmed told IRIN, the reporting service for the United Nations Office for the Coordination of Humanitarian Affairs, that 100 children died in Sindh province in December alone, mostly in areas where many people were not vaccinated. He urged parents to get their children vaccinated.

"The intensity of the outbreak as well the cases of measles have been five times more this year compared to 2011 and it is very much under-reported," Iqbal Memon, president of the Pakistan Pediatricians' Association, told IRIN. He said he had warned the government last March about the risks of an outbreak given the low levels of vaccination in the province.

Although measles is largely regarded in the west as a childhood rite of passage that earns a few days off from school, it is an extremely infectious disease spread by coughing and sneezing or personal contact, causing a fever, cough and full-body rash. For those suffering from severe malnutrition, complications can include blindness, an infection that causes brain swelling, dehydration and diarrhea, and pneumonia.