Central Asia Crisis
Health Status Update
October 26, 2001
The newly-appointed Regional Coordinator for the Central Asia crisis, Dr. Mohamed Jama, has arrived in Islamabad where he is meeting with partner agencies to develop a coordinated approach to health activities.
AFGHANISTAN
Health Situation
The WHO has received reports of probable new cases of falciparum malaria, one of the most dangerous forms of the mosquito-born disease. These cases of malaria in Nangrahar Province near Jalalabad are now being investigated by the NGO Healthnet International. During the month of September, 269 children were hospitalised in the pediatric ward of Jalalabad Public Health Hospital- more than half with severe conditions, including cerebral malaria. No deaths have been officially reported to date.
The already bad health situation in Afghanistan is expected to deteriorate rapidly in the weeks ahead. The onset of winter, lack of basic food and supplies, and population movements are leading to an increasingly desperate situation. Malnutrition is the greatest concern.
Rural medical centers are becoming over-burdened, due to population movements away from urban areas. There has been a 60% increase in cases treated in rural areas near Jalalabad over the past two weeks. Health supplies are urgently required for maternal and child care centers in Kabul.
WHO is paying close attention to the following areas:
- A further breakdown in preventive health services including immunisations, water quality control, and environmental sanitation;
- Increased risk of outbreaks of measles and other communicable diseases which are known to rise with displacement of the population and are often fatal for children;
- Spread of diarrhoeal conditions such as cholera and dysentery; (no outbreaks of cholera reported)
- Increase in maternal mortality due to lack of safe delivery services;
- Increased injuries arising from conflict, including mines, will further deplete low resources in hospitals.
According to Dr. Jama, mental distress continues to be the most widespread and enduring health problem in the country.
Response
Emphasis remains on controlling disease, reducing malnutrition and saving lives among those most at risk.
The current constraints in Afghanistan make it nearly impossible to move medical supplies to the districts and villages where the need is greatest.
Two 14 ton trucks from WHO, and one truck from UNICEF left Peshawar on October 22 containing 860 kilograms of medical supplies for 30,000 people. The convoy is expected to take ten days to reach its destination of Faizabad. The arduous route will entail travel by truck, jeep and donkey. The supplies also include 5000 mosquito nets, antiobiotics, sleeping bags, and other essential equipment.
In the meantime, eleven emergency kits have arrived in Kabul for distribution throughout the country. Each kit provides enough medicines and supplies to treat 10,000 people for three months.
The WHO has eight sub-offices within Afghanistan still in operation, although communication is becoming increasingly difficult.
PAKISTAN
Health Situation
According to the UN, there are now at least 60,000 new Afghan refugees in Pakistan.
The immediate health concerns facing these refugees are malnutrition, measles, malaria, and diarrhoeal disease (including cholera). There have been no reports of any epidemics in the camps. Viral haemorrhagic fever, meningitis, and acute respiratory infections pose additional threats, but they are being monitored and there are no reports of any epidemics. There is no confirmation of any typhoid cases in Quetta.
A limited number of wounded Afghans have been crossing into Pakistan seeking medical treatment. Provision of emergency trauma kits, containing surgical equipment, for front-line hospitals near Peshawar and Quetta have been requested and are en route.
Response
The WHO is prioritizing medical assistance for the most vulnerable members of the refugee populations, including the very young, the elderly, and those from the poorest households.
The response is focusing on ensuring that populations within camps and other displaced people can access health centers, and be provided with essential drugs and equipment. In particular, the WHO is providing measles vaccination of children under age 5 as soon as they cross the border. Other priorities include ensuring children are given polio drops as part of the on-going polio eradication programme. WHO is working with local and international partners to provide essential obstetric care, better access to safe water and sanitation and supplementary nutrition.
To ensure effective planning of the response, regular assessment and monitoring of the health situation amongst refugees is being undertaken and must be maintained in the future.
IRAN
Health Situation
The exact number of new Afghans refugees into Iran is not known, although the UNHCR has confirmed that refugees have been entering border cities and towns over the past two to three weeks.
There have been no reports of any epidemics along the border or within Iran.
The latest figures regarding Crimean Congo Haemorraghic Fever in Iran indicate that 46 cases have been reported throughout the country in the past three months. 22 have been confirmed, and 22 are under investigation (2 died before blood samples could be taken). There is not an increase caseload of CCHF at the border areas and there has been no outbreak. CCHF is endemic to Iran, as well as the region, including Afghanistan and Pakistan.
Response
Pre-positioning of health supplies continue, but for the time being, the situation remains stable.