WARNING: GRAPHIC IMAGES BELOW

A dog being shot with a strychnine-laced dart. Photo: Allan Putra

Klungkung, Bali: Ketut Pujana is being dragged away from his dead dog.

His face is contorted in a mask of grief. The dog is lying on a strip of lawn, its black coat scattered with frangipani blossoms.

Within minutes they start convulsing until their legs stiffen and they die. The streets are littered with dead dogs. 

It's "dog elimination" day in the village of Aan in Klungkung regency and the streets are lined with their carcasses.

An emotional Ketut Pujana after his dog was killed in a dog elimination in Aan village, Klungkung as part of the battle against rabies. Photo: Allan Putra

Klungkung regency is famous for its paintings of the Sanskrit epics Ramayana and Mahabharata – the latter features a stray dog that turns into a deity.

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But these dogs have been shot with strychnine-laced darts.

This is the gruesome front line of Bali's battle to contain an outbreak of the deadly rabies virus. This year 15 people have died in Bali alone, up from one in 2013 and two last year. The virus is now found in more than 160 Balinese villages.

Strychnine-laced darts being prepared for the dog elimination. Photo: Allan Putra

"Last month four people in the village were bitten by a dog and later tested positive for rabies," says village head Anak Agung Gede Rai Ardika. "The rabid dog bit the owner, a neighbour and passers-by."

The villagers were given a post-exposure vaccine and survived. They were lucky – there is often a shortage of these life-saving vaccines.

But Anak says villagers were still concerned about the high number of strays after a previous "dog elimination" and vaccination last month. "Today's dog elimination is based on a request by the local community."

Dogs killed in a cull are loaded onto a truck. Photo: Allan Putra

Rabies is a disease transmitted from animals – usually through dog bites – that causes acute inflammation of the brain. It is almost always fatal once symptoms appear.

And although Indonesia has a target to eliminate rabies in humans by 2020, parts of the archipelago – including Bali, West Sumatra and Sukabumi in West Java – are struggling to control the virus.

Gusti Ngurah Dibya Prasasta from Gianyar Animal Husbandry says a man from Payangan village reported in the last few days that one of his cows had "gone crazy, banging its head several times".

Children walk past dogs killed in a cull. Photo: Allan Putra

"We went to the site, took a sample and the cow was tested positive for rabies," Gusti said. "One of his cows died earlier with the same symptoms."

Jakarta is rabies-free for now. However, Governor Basuki "Ahok" Tjahaja Purnama recently raised concerns about infected dogs being brought into the capital for human consumption.

Although dog meat is considered haram (prohibited) by Muslims, it is a popular dish among the Batak, Minahasa and Manado ethnic groups. Lapo (Batak restaurants) commonly offer a dish of dog cooked in its own blood known as B1. Jakartans are amongst the highest consumers of dog meat in Indonesia.

Dog corpses being thrown into a pit. Photo: Allan Putra

However, four animal rights organisations have formed the Dogs Are Not Food campaign to discourage the practice.

"Surprisingly the handlers don't understand that they have the biggest risk of getting rabies," says Jakarta Animal Aid Network co-founder Karin Franken. "They even do their job with bare hands. There is the possibility the handlers could get bitten by the dog with rabies when they unload them from trucks, or the dog could run away and bite someone in the area. That's the danger."

On World Rabies Day this year, on September 28, Indonesia's World Health Organisation representative, Khanchit Limpakamjanarat, expressed concern about the number of human deaths in Bali this year.

"Bali has been the model of rabies control," he wrote in The Jakarta Post. "The reasons for this recrudescence need to be studied and immediate correctives instituted."

The frustration of Janice Girardi, the co-founder of the Bali Animal Welfare Association, is palpable. When rabies first appeared on the island in 2008, she says, the government's immediate response was to start culling all dogs. "There were no dog vaccines or human vaccines, so they probably didn't have much choice."

Girardi was determined to show there was an effective way of eliminating rabies that didn't involve the mass slaughters of dogs, which had tourists aghast and was generating international headlines.

In 2009 the Bali Animal Welfare Association set up a pilot vaccination program in Gianyar regency.

To achieve herd immunity, they must vaccinate 70 per cent of a dog population. "We had to run down the streets with nets and catch dogs and vaccinate them. We vaccinated 48,000 dogs in six months," Girardi says.

The pilot was so successful the governor of Bali and the mayor of every regency except Klungkung signed up. Between October 2010 and May 2011 more than 75 per cent of dogs were vaccinated.

Under the memorandum of understanding, the program was then turned over to the provincial government in collaboration with the UN.

"Our island-wide program had effectively reduced canine rabies by 86 per cent, and then the government took over and went back to culling dogs," Girardi says. "Tens of thousands of vaccinated dogs were culled, losing the much-needed herd immunity we had established.

"It has been been years of stress and trauma because we had worked so hard and had almost succeeded in eliminating rabies, and now they have gone back to culling. Culling did not work before the vaccination program and it is not working now."

Ketut Suarjaya, the head of the health department in Bali, says the island takes a co-ordinated approach to eradicating rabies. "We vaccinate the dogs, we provide vaccinations for people who have been bitten and we have selected eliminations," he says.

Bali's deputy governor, Ketut Sudikerta, has even called for the Balinese to hold religious ceremonies in their traditional villages to dampen the spread of rabies.

But Ketut Suarjaya says that once an area has been identified as a "red zone" – where dogs have tested positive for rabies – they eliminate the wild dogs in the area. "We have to, for the safety of the people. Just the wild dogs, not house pets."

The village of Aan is one such red zone. At 8am on Tuesday, a team of 15 officials combed the streets on their motorcycles.

Stray dogs are shot with darts on the spot. Within minutes they start convulsing until their legs stiffen and they die. The streets are littered with dead dogs.

Children stare as they walk past on their way to school.

Pets that are caged or kept on leashes are exempt from the cull. But in Bali most pet dogs – recent research by Cambridge and Udayana universities found that 85 to 90 per cent of village dogs do have owners – are not kept inside but roam outside doorways to protect households from spirits and thieves.

The elimination team asks for permission before killing a dog in someone's yard. Owners who refuse must sign a statement saying they will be responsible for any costs incurred if their dog has rabies and bites someone.

Almost all owners in Aan acquiesce to their dogs being killed, albeit some with reluctance or, in the case of Ketut Pujana, great sadness. The corpses are piled onto the backs of trucks and dumped into pits.

The Australian government warns that there is a risk of rabies throughout Indonesia, in particular Bali and nearby islands, as well as Nias, off the coast of Sumatra. And it recommends a pre-exposure rabies vaccination for those staying any length of time.

On September 20, Kadek Dwi Antari, a 32-year-old housewife from Sawan, in north Bali, died from rabies. She had been bitten by a dog at a night market in July. Her husband had taken her to hospital in Buleleng and then a local clinic in Tejakula, but they had reportedly run out of the anti-rabies vaccine.

The Bali Animal Welfare Association says that for months, most major hospitals and private clinics were completely out of stock of the human vaccines in the major tourist areas surrounding Kuta.  "Many hospitals and clinics remain out of stock," Girardi says.

Every week she fields panicked calls from Australian tourists who have been bitten and can't find a human vaccine in Bali. "You don't have a lot of time," she says. "If it is a child it can only take several days for the virus to get into the central nervous system and travel to the brain. It's a disaster waiting to happen."

With Amilia Rosa and Karuni Rompies