INSECURITY, FLU THREATS ADD TO AFGHANISTAN HUMANITARIAN CRISIS

With winter descending on Afghanistan, a new threat is putting the health of war-weary Afghans at risk. A sharp rise in the number of respiratory infections, in part linked to the emergence of the pandemic H1N1 2009 influenza virus, is adding to the humanitarian crisis that is already well established in the country.

PAUL GARWOOD, WHO

This additional health challenge for the Afghan people, and their country’s weak health system, has been highlighted by the international humanitarian community within the Consolidated Appeals Process (CAP) for 2010. “Increasing numbers of cases of the pandemic (H1N1) 2009 influenza virus compound the country’s already precarious health status,” states the main CAP 2010 document which was launched last month in Geneva.

In December 2009, health authorities had recorded a 60% increase in the number of acute respiratory infections across Afghanistan compared to the same period in 2008. Among these had been at least 850 cases of the H1N1 virus, with transmission of the new influenza recorded in at least fifteen provinces.

While H1N1 has been shown to have mild affects on many people who contract it, people with underlying health conditions and pregnant women are at much greater risk. Afghanistan is home to one of the world’s most serious humanitarian crises, where infants, children aged under five years and mothers are more at risk of dying than almost anywhere else in the world.

Afghanistan is one of twelve countries identifi ed in the CAP 2010 as needing financial support to respond to its multiple humanitarian emergencies. Health providers in Afghanistan have requested US$ 10 million as part of the CAP to conduct a range of life-saving health interventions.

Although insecurity remains the biggest threat to the delivery of basic health care in Afghanistan, severe weather conditions, widespread poverty and the emergence of new diseases, including H1N1 influenza, are adding additional pressure to the country’s health system. Despite progress made since 2001, Afghanistan continues to have some of the most alarming health indicators in the world as a result of decades of isolation and conflict. Due to the insecurity, approximately 15% of the population has no access to the most basic health services, leaving four to five million people extremely vulnerable.

And as Afghanistan is prone to natural disasters, such as earthquakes, drought, floods and disease outbreaks, the Health Cluster is working to develop the health sector’s capacity for coordinated response and postdisaster recovery.

“Maternal, infant and under-five mortality, polio and malnutrition are among just a few of the key health challenges that threaten Afghans and require intensive support for health authorities and international and local health providers,” said WHO Country Representative Peter Graaff.

“Every hour at least two Afghan women die from obstetric complications due in part to the lack of health services. Of every thousand live births, at least 125 infants die, and one in five children die from mostly preventable diseases before their fifth birthday.”

“Now we see rising numbers of influenza cases across the country. Instead of letting the health system succumb to these multiple threats, we need to react to the obvious health challenges facing Afghanistan and support those trying to save lives and reduce sickness across the country.”

WHO is leading the Health Cluster response to the emergency, which has brought UN and NGO health providers together to better assess and respond to the health needs of Afghans. The cluster has been a critical link between humanitarian aid providers and Afghan authorities in their efforts to bring relief to those in greatest need.

WHO is supporting efforts by Afghanistan’s Ministry of Public Health to respond to the H1N1 pandemic. WHO is providing vaccines to the country while at the same time providing information and guidance on ways to reduce the spread of the disease. Also, WHO helped Afghan authorities develop a proposal that aims to secure international financial support to improve the country’s ability to respond to the outbreak. The Government of Norway in December provided US$1.2 million to support efforts to respond to the H1N1 pandemic.

The Afghanistan Health Cluster is coordinating emergency health activities and pooling the resources of many health providers in order to support the Ministry of Public Health’s response to the crisis. One person who is playing a crucial role in the overall health response is Dr Maria Luiza Galer, the Health Cluster Coordinator in Afghanistan. “As Health Cluster lead agency, WHO is mobilizing health supplies to respond to the harsh winter conditions and the continuing conflict,” Dr Galer said. “The Health Cluster and WHO have a crucial role to play in advocating for the protection of health workers and patients from the consequences of military operations.”

There is a clear link between the intensifi cation of the conflict in Afghanistan and a worsening health situation. Decreasing accessibility to basic healthcare, especially for women and children, has led to an increase in easily preventable diseases like polio (with confirmed cases rising from 17 in 2007 to 31 in 2008). Diarrhoea and acute respiratory infections increased by 25% and 16% respectively in the two years ending in March 2009. Emergency medical teams often have difficulty accessing insecure areas, while patients struggle to reach the nearest health facility.

Insecurity directly affects the willingness of qualified health workers to work in remote and rural areas. Additionally, there is a chronic shortage of local health workers in southern Afghanistan where much of the violence is centered. In the southern provinces, roughly 80% of health workers are recruited from other regions or abroad.

To respond to these health challenges, the Health Cluster has identified key areas where humanitarians will focus. Key goals include improving access to quality health services for vulnerable people in insecure and underserved areas, particularly in primary health care, vaccination and reproductive health services.

“Above all, the main driver of the humanitarian crisis is the ongoing climate of insecurity,” said WHO’s Peter Graaff. “We need to keep promoting humanitarian principles, including the neutrality and impartiality of health facilities and workers. To do this, we must use outreach and advocacy that is based on evidence that shows the direct link between insecurity and the health and welfare of Afghans.”

For further information

• WHO Afghanistan:
  http://www.emro.who.int/afghanistan/
• Consolidated Appeals Process 2010:
  http://ochaonline.un.org/humanitarianappeal/webpage.asp?Page=1820