Laraib Nisar
The COVID-19 pandemic proved to be increasingly threatening to Afghanistan due to its weak economy and poor health care system. Since February 24, when Afghanistan in a pandemic, and reported its first confirmed case of COVID-19, the number of Afghans who have tested positive for the coronavirus has increased. According to the Strategic Situation Report published by the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), as of September 24, 2020, the Ministry of Public Health reported around 39,170 people across all 34 provinces in Afghanistan to be tested positive for COVID-19. Some 32,619 people had recovered, and 1,451 people died – 76 of whom were healthcare workers. Almost 10 percent of the total confirmed COVID-19 cases were among healthcare staff. 109,469 people out of a population of 37.6 million were tested, out of which nearly 70 percent were males. Due to limited public health resources and testing capacity, the absence of a national death register, along with a lack of proper health infrastructure the number of confirmed cases of and deaths from COVID-19 were probably under-reported overall in Afghanistan in a pandemic. In general, the urban parts of the country including cities like Kabul, Herat, and Kandahar, etc. were more affected by the pandemic as compared to the rural parts, this could be due to the fact that testing centers were centered in urban areas and rural areas were neglected.
With the recent warning of a potential second wave of the pandemic by the World Health Organization (WHO) due to widespread complacency and failure to follow public health advice, grave risks will be generated in the community as people are generally not observing the social distancing practices. According to a model developed by the Centre for Humanitarian Data in collaboration with Johns Hopkins Applied Physics Laboratory released on 9 September, cases and deaths are likely to continue increasing over the coming weeks. It further suggested a major increase in severe cases if the preventive measures are lifted, with grave risks for Afghanistan’s economy and people’s well-being.
As reported by the local media, an increase in the number of people infected by COVID-19 has been observed in Herat during recent weeks. Doctors in the region have cautioned the second wave of COVID-19 to be more lethal than the first one if people continue to ignore the health guidance. The Minister for Public Health has also indicated that factors like cold weather, air pollution, and seasonal diseases as winter approaches could lead to an increase in the severity of a second wave of the disease. Similarly, according to recent figures gathered by WHO Rapid Response Teams, the west of the country (Herat and Ghor) is observing a rise in COVID-19 cases, and a change is seen in the gender balance among cases with an increase in the number of females being infected by the coronavirus. Chances are that school re-opening is playing a role in the spread of the virus to mothers.
A WHO comparison of Health Management Information System (HMIS) health data for the year 2019 with 2020 shows a dramatic decline in the utilization of health services during the pandemic. The comparison report observed the non-COVID hospital admissions to drop by 24 percent along with a 32 percent drop in total surgical interventions including 39.6 percent drop in gynecology related surgeries, 37.5 percent drop in eye surgeries, and 39 percent drop in ear, nose, and throat (ENT) surgeries.
According to the figures, many of the critical medical cases that required immediate hospital care have been unable to obtain treatment during the COVID-19 pandemic as a result of different factors including health staff getting infected with COVID-19, overwhelmed health facilities concentrated on COVID-19 response, patients’ reluctance to attend health services, movement limitations. These unaddressed medical conditions are likely to result in increased mortality and increased needs in the second half of the year and into 2021. WHO has stressed upon the need to balance the demands of responding directly to COVID-19, along with increased strategic planning and coordinated action to maintain crucial health service delivery, in order to mitigate the risk of system breakdown. Additionally, WHO emphasized on the improvement in infection prevention and control to encourage people to return to health services safely, along with the assurance of proper personal protective equipment for the healthcare workers to carry on their duties effectively and safely.
Along with the grave consequences posed to the healthcare system, the pandemic had several socio-economic consequences as well. According to a report by the United Nations Development Program (UNDP), COVID-19 has brought the deepest global economic recession since World War II, and the broadest collapse in per capita incomes since 1870. The World Bank’s outlook for Afghanistan suggested that both per capita and real GDP were likely to decline sharply and were expected to remain below pre-COVID-19 levels over the medium term. Moreover, the real GDP was expected to reduce between 5.5 and 7.4 percent, and remittances to Afghanistan were expected to drop by 40 percent from the 2019 levels. In the meanwhile, the average prices for key commodities were largely elevated above pre-COVID levels while purchasing power had reduced.
The Inter-Agency Standing Committee reported that the COVID-19 pandemic has aggravated protection concerns in humanitarian crises and exposed vulnerable people to new threats. Protection groups have reported an increase in cases of violence, including a ‘shadow pandemic’ of Gender-Based Violence (GBV), forced displacement, a rise in xenophobia and stigmatization, along with discrimination in access to health, food, water, education, and legal services for vulnerable and marginalized groups. In the face of the biggest economic shock the world has witnessed in decades, some of the most vulnerable communities are now forced to resort to adverse survival strategies, with limited safe alternatives. Afghanistan in pandemic also created problems for people engaged in cross border trade and economic activities. According to UNHCR’s latest border monitoring report, 33 percent of returnees interviewed at the Islam Qala and Milak border crossing points and 31 percent of returnees interviewed at the Torkham and Spin Boldak border crossing points said they met problems during the COVID-19 outbreak in neighboring countries, such as lost work/wages, discrimination/stigmatization by local communities, reduced access to markets, pressure from authorities to return to Afghanistan, movement restrictions due to the lockdown, and lack of access to medical facilities.
Afghanistan in the pandemic, the Afghan government should take the necessary actions to prevent the second wave of the virus outbreak and for strengthening the health sector, along with the economic sector. The government should ensure that the necessary preventive measures are being taken and the SOPs are being followed by all and sundry across the country. Effective and accurate risk communication activities must be practiced to reassure people that it is safe to seek treatment at hospitals and health centers and that health centers are carrying out proper infection prevention and control measures. Moreover, the government should reach out to the regional countries and seek help from them in order to tackle this grave health emergency.
The author Laraib Nisar is a Defense and Strategic Studies’ graduate, working as a research intern at CRSS.
