01 November 2001

Text: World Health Organization Describes Afghan Health Threats

In a special report issued October 29, the World Health Organization (WHO) is raising an alarm about the serious health risks now threatening the population of Afghanistan. Starvation and exposure are problems that have drawn significant attention as an international humanitarian effort has been launched to prepare the population for winter, but WHO reports that disease heightens the peril for the Afghan people.

"In Afghanistan, with mass population movement, potential overcrowding in camps over the border and insufficient health services, the population is highly vulnerable to communicable diseases," says Dr. Mohamed Jama, WHO's regional coordinator for the Afghan crisis.

Diarrheal diseases, respiratory infections and measles are the greatest risks for the weakened population, the WHO report finds.

Few villages have access to clean water, a situation that has been exacerbated as wells have dried up in the three-year drought. The lack of clean water and sanitation creates conditions for cholera and dysentery, which can kill as many as 10 percent of children affected.

In the long period of war and internal strife that has troubled Afghanistan, vaccination programs have largely lapsed, a trend that now leaves children under five years of age highly susceptible to measles.

The U.N. News Service reports that WHO is now planning a widescale vaccination program to protect Afghan children from both polio and measles.

Following is the text of the special report:

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WORLD HEALTH ORGANIZATION

WHO SPECIAL REPORT

A Population at Risk: Communicable Diseases in the Afghan Crisis A population on the move through rugged mountains and windswept deserts, high rates of malnutrition with limited clean water and barely more than dried bread to eat, the onset of winter as temperatures drop and snow begins to clog the passes.... these are all factors in the Afghan crisis leading to deep concern over the spread of communicable diseases in the region in the months ahead.

"In Afghanistan, with mass population movement, potential overcrowding in camps over the border and insufficient health services, the population is highly vulnerable to communicable diseases. In fact, many mountainous and desert areas have no access to health services. " says Dr. Mohamed Jama, Regional Coordinator of the World Health Organization for the Afghan crisis.

The greatest threats faced by the displaced population include diarrhoeal diseases, acute respiratory infections and measles. But it is malnutrition that lowers the resistance of the population, especially children, and makes them susceptible to these diseases. Malnutrition also leads to greatly increased mortality and morbidity rates.

Diarrhoeal diseases pose a serious threat, particularly for young children. Increased population movement is linked to poor sanitation and unsafe food preparation and storage. Without proper treatment, one in ten children under the age of ten who develop bloody diarrhea known as dysentery will die. Few villages have access to clean drinking water, particularly in the drought areas where regular water supplies, including ground water wells, have dried up. Many people often drink from irrigation canals, which are also contaminated by human and animal refuse.

The risk of cholera epidemics is currently declining as winter sets in, but outbreaks have occurred throughout the country in the past five years. In June 2001, cholera in the Samangan and Baghland provinces of Afghanistan led to 4499 reported cases, including 114 deaths. The risk of cholera outbreaks is extremely high in refugee camps because of poor sanitation. In the northern areas of Afghanistan affected by the drought, numerous displaced families have congregated along the sides of canals or rivulets along the Amu Darya, or Oxus River, which also serve as sewage disposal points.

The onset of winter, which leads to bitterly cold nights in the northern mountainous areas of the Hindu Kush with its 3,000-5,000 metre-high passes or in the lower, more arid parts of western Afghanistan, means that acute respiratory infections will increase their toll on the Afghan population. Pneumonia is one of the leading causes of death of children under five throughout the region, and there is a higher incidence during the cold season. Pneumonia can be fatal in up to 20% of the cases if not treated appropriately. Adequate food to avoid malnutrition, and protection from the cold are two preventive steps, but both are quite challenging in the current crisis in Afghanistan.

Measles is a major killer under the age of five. In many parts of the world, children are immunised against measles at an early age. Despite international efforts to thwart the disease's deadly impact on the children of Afghanistan, over one third of the country has no routine immunisation programmes with more inaccessible areas such as Hazarajat in the central highlands or Nuristan in the north-east particularly affected. The risk of large outbreaks is very high during the crisis as vaccination coverage rates are estimated to be less than 50% among Afghan children. It is likely that over one in ten children who get measles will die.

Besides causing death from pneumonia, diarrhoea and acute malnutrition, measles can also lead to life-long disabilities, including blindness, brain damage and deafness. Measles can be avoided by immunisation and plans are underway to immunise all refugee children from 6 months to 5 years. Inside Afghanistan, however, it is far more difficult to reach local populations. Health workers may often have to walk for days to reach isolated population groups. The spread of the disease is increased in over-crowded areas and children under the age of one year are particularly at risk.

An estimated 50% of children in Afghanistan are underweight, increasing their susceptibility to measles and other communicable diseases. Devastated by more than 23 years of war compounded by three years of drought in the northern and western parts of the country, Afghanistan is a country where countless children simply have no longer any access to balanced diets. Many, particularly internally displaced families, now live on little more than bread and rice, occasionally supplemented by seasonal vegetables, fruit, and meat broth.

Poor nutritional status also increases vulnerability to tuberculosis, a disease which affects an estimated 325 of every 100,000 Afghans. There is also increased spread due to over-crowding. The great challenge with TB is that it requires supervised treatment for six months. With hundreds of thousands of Afghans on the move within the country, treatment possibilities are severely limited. More than 50% of those infected will die from TB if left untreated.

Earlier this month media reports focused on new cases of Crimean Congo Haemorraghic Fever (CCHF) in Pakistan and Iran. This tick-born disease is, in fact, endemic to the region and the new cases were typical for this time of year. The latest figures regarding CCHF in Iran indicate there were 36 cases in the past six months, including 4 deaths. In Pakistan, there have been 3 positive cases of CCHF reported in October and 4 confirmed cases in September. With cooler weather approaching, virus transmission is expected to end within several weeks.

Malaria, transmitted by mosquito bites, is endemic throughout Afghanistan in all areas below 1500m putting large numbers of people at risk, particularly in the rice-growing areas in the northern and eastern parts of the countries. Malaria peaks in October-November. There are an estimated 300,000-450,000 cases of potentially fatal falciparum malaria in Afghanistan annually, including in urban areas such as Kabul and Jalalabad. Mobile populations with low resistance are even more vulnerable.

Afghanistan: Essential Health Facts and Figures

Population 23,457,385

Life Expectancy: 46 years (European average: 78 years)

Infant Mortality Rate: 165 per 1000 live births

Maternal Mortality Rate: 1700 per 100,000 live births (2nd highest in world)

Probability of dying between Birth and 5 years: 257 per 1000

Availability of medical services: one physician for every 50,000 people; 50 of 330 districts have no health centre or access to immunistions

The WHO is working with its partners, including national health ministries in the region, M��ecins sans Fronti��es, M��ecins du Monde, UNICEF, Healthnet International, and others, to provide essential medicines and supplies to Afghanistan and neighbouring countries. WHO has released a profile for each communicable disease found in the region, including information on treatment protocols.

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