After four decades at the epicentre of conflict and natural disasters, Afghanistan today is teetering on the brink of a public health catastrophe, facing the collapse of an economy whose most marginalized are heavily reliant on remittances at a time when traditional donor countries are increasingly focused on domestic economic recovery efforts, and the spectre of a resurgent Taliban.
The failure to aggressively support the country’s efforts to combat and contain the spread of COVID-19 is deeply alarming for the health and safety of its citizens, provides those whose agenda is to roll back the fragile success stories wrought by nearly two decades of international investment a virulent new propaganda tool, and threatens many more years of regional instability.
The first confirmed cases of COVID-19 here were reported in February. Since then, the country has witnessed over 34,000 confirmed infections based on roughly 80,000 tests indicating a much more substantial number of undetected cases including daily new cases among frontline health staff from the International Organization for Migration (IOM).
COVID-19 is having a wide-ranging impact on mobility between Afghanistan and the Islamic Republic of Iran - a global coronavirus hotspot and destination for hundreds of thousands of Afghan migrant workers - which reopened its economy in late April. Since that time, the number of new infections has spiked from roughly 2,000 per day to nearly 3,600 new daily infections on 5 June.
In the month of March alone, over 160,000 undocumented migrants returned home to Afghanistan from cities across Iran; a dangerous narrative that the returnees brought COVID-19 home with them is unsupported by evidence, yet the resulting anti-migrant stigma has been widespread, influencing government policy and driving local communities to isolate and in some cases prevent the return home of Afghans from Iran.
Despite a recently concluded power sharing agreement on 17 May and a peace deal between the United States and the Taliban in February, the IDMC reports nearly three million people are internally displaced due to conflict, violence is escalating around the country, and humanitarian spaces remain targets, a situation underlined by the shocking attack on the Médecins Sans Frontières (MSF) maternity hospital in Kabul on 13 May.
Faced with these stark realities, many Afghans have no choice but to re-migrate in search of stability and peace.
COVID-19 induced lockdowns have amplified the effects of the conflict, rendering tens of thousands of working Afghans suddenly jobless, compelling over 376,000 to return from Pakistan and Iran since January. Despite this counterflow there has been a major downturn in remittances - the World Bank estimated remittances amounted to nearly USD 868m in 2019 - a significant revenue stream for the rural poor.
Given ongoing challenges and a determination to break community-level spread of the disease, IOM and our partners are placing an emphasis on community-level engagement to ensure local people are taking the right actions to keep themselves safe throughout the outbreak.
As the number of cases continues to soar due to the questionable effectiveness of lockdown measures which have been met by protests across the country; the demand to restart economic activities by reopening shops, offices and local services and perceived inequities in the distribution of food and other humanitarian support. The targeting of civilians by combatants has further exacerbated the situation.
A key constraint hindering a meaningful response to the pandemic is the low capacity for testing. Afghanistan’s 10 labs established since January 2020 have a daily testing capacity of 1,790 tests with a call by the national government for private clinics to extend testing capacity.
Afghanistan has very limited infrastructure to treat severe cases; has a life expectancy of only 50 years for both genders and a high percentage of the population suffers from pre-existing health conditions such as TB, HIV-AIDS, malnutrition, cancer, heart and lung disease, and environmental pollution. This lack of testing and treatment capacity has been further exacerbated by attacks on healthcare facilities by armed groups.
According to a UN Assistance Mission in Afghanistan (UNAMA) report published on 21 June, between 11 March and 23 May 2020 there were 15 incidents affecting healthcare facilities including 12 deliberate attacks.
“At a time when an urgent humanitarian response was required to protect every life in Afghanistan, both the Taliban and Afghan national security forces carried out deliberate acts of violence that undermined healthcare operations,” said Deborah Lyons, the Secretary-General’s Special Representative for Afghanistan and head of UNAMA. “There is no excuse for such actions; the safety and well-being of the civilian population must be a priority.”
So, what is being done to prevent the pandemic?
Despite these seemingly insurmountable challenges, IOM – under the leadership of the Government of Afghanistan and the Ministry of Public Health, and in close partnership with the World Health Organization (WHO), UNHCR and others – is actively supporting Afghanistan’s COVID-19 response.
Our seven mobile health teams and over 200 health staff are assisting the Ministry of Public Health in testing, surveillance screening, arranging awareness and hygiene sessions in over 12,000 communities, and ensuring the continuity of basic essential health care to underserved populations including IDPs and returnees. IOM has served over 170,000 vulnerable Afghans with critical basic health care interventions in 2020.
Accurate information is a key element of successful public health responses yet recent community perception surveys show as many as 60 per cent of residents were uninformed about COVID-19. For this reason we are carrying out awareness sessions for Community Health Workers in five provinces to build community-level awareness and referral capacity.
Training continues on COVID-19 awareness, screening, reporting and contact tracing methods to enable early detection of cases, and the use of ambulances for the transportation of suspected cases to quarantine facilities. Personal Protection Equipment is being provided to medical personnel, border police, the Directorates of Refugees and others.
Data is critical to targeted, effective humanitarian assistance. IOM’s Displacement Tracking Matrix (DTM) is delivering data on cross border and provincial migration flows and community-level needs to inform wider response planning and preparedness actions. DTM will contribute data from all 34 provinces and over 12,000 communities by year-end while providing hygiene sessions and COVID-19 awareness to all the communities where it is deployed.
IOM is also actively engaged in the socio-economic recovery of Afghanistan with programming to support the sustainable reintegration of returnees. Entrepreneurs among returnees receive financial assistance to open businesses and pay rent. Community support projects in high return areas also build up local infrastructure to ensure access to functional markets, clean drinking water and livelihoods opportunities while keeping communities safe from seasonal flooding.
In recent weeks, IOM has already begun to witness a significant return movement back into Iran, with thousands of Afghan migrants entering Iran every day in search of stable employment to sustain themselves and their families.
To overcome COVID-19 transmission, the Government of Afghanistan, IOM and partners are scaling up response efforts by deploying hundreds of new staff and resources around the country. However, without a negotiated ceasefire to end the fighting and enable successful health interventions and much greater engagement from the international community over the short to medium term, the unfolding catastrophe will deepen and act as a further driver of migration and instability in the region.
As wealthier economies make positive strides to stop transmission and flatten the curve, more focus must be urgently devoted to low resource environments with compromised public health systems to ensure countries like Afghanistan can protect the most vulnerable inclusive of the elderly, infirm and persons suffering from pre-existing health conditions.
Each day of inaction will have a profound impact on the ability to make progress against this deadly disease.