The Current Healthcare Situation in Afghanistan

Based on information gathered by a group for a government article entitled "Challenges and Opportunities for Humanitarian Relief in Afghanistan " we have compiled the following facts about the healthcare situation in Afghanistan .

"Virtually all medical care is supplied by international relief agencies. The health budget under the Taliban was judged to be ~US$700,000 per year, or only a few cents per person, on average [21]. According to one analysis, the number of expected health facilities for a population of 25 million is 6522, including health posts, basic health centers, and district, provincial, regional, and national hospitals. However, the total number of health facilities in Afghanistan is currently 823. In 1996, 8 of 14 hospitals in Kabul were not functioning because of damaged infrastructure and a lack of critical supplies and staff [22]. The situation has since deteriorated. The few indigenous doctors remaining in Afghanistan are paid almost nothing (US$4-$6 per month) and have virtually no supplies. Sterile supplies are reused, and there is no running water [23]. With respect to the limited health services in Afghanistan , rural areas are particularly underserved compared with urban settings.

Afghanistan has an infant mortality rate of ~165 per 1000 live births and a maternal mortality rate of 1700 per 10,000 live births, both among the worst in the world. Only 8% of women receive prenatal care, and only 8% of births are attended by trained personnel. Three-fourths of the population have no access to obstetrical care, and there are <50% of the needed midwives and 30% of needed traditional birth attendants [5, 18]. Only 35% of the 330 districts have any maternal and child health clinics. For each maternal death in the United States , there are >5000 in Afghanistan , and the mortality rate for those <5 years old is reported to be 257 per 1000 live births. One-quarter of children do not reach their 5th birthday [5, 18].

The percentage of those with access to clean water is only 19% in urban areas and 11% in rural areas. Access to any form of sanitation shows similar statistics. Immunization coverage is generally low. Overall, only 35% of children have had measles immunization, and 11% have had polio vaccine [5, 18]. An estimated 10% of children are acutely malnourished and 50% are chronically malnourished [5, 18]."

"An estimated 85,000 Afghan children die each year from diarrheal disease [42]. In previous conflict situations, diarrhea has accounted for 25%-40% of all deaths and as much as 80% of deaths among children <2 years old. Common pathogens include viruses such as rotavirus and enteric bacteria such as Esherichia coli and Shigella species. Outbreaks of cholera have occurred throughout Afghanistan for the past 5 years. In June 2001, for example, 4500 cases and 114 deaths were reported from Samangan and Baghland provinces. Although the risk of cholera generally declines in winter months, the risk may remain very high in camps for refugees and IDP's. Poor sanitation, lack of access to water, contaminated water supplies in camps, and areas with limited health resources create a formula that results in high morbidity and mortality from diarrheal disease."

" Measles. Measles has been a leading cause of morbidity in those <5 years old in complex emergencies. More that one-third of the country has had no routine immunization programs, and immunization coverage rates are estimated are estimated to be well below 50% among most children [5, 41, 42]. A number of outbreaks have been reported from numerous locations in the country [43]. Measles accounts for up to 35,000 deaths among children each year in Afghanistan . More inaccessible areas such as Hazarajat and Nuristan have been particularly affected. In a recent survey, in the remote Kohistan district of the Faryab province, measles was responsible for 15.7% of all deaths [44]. Recent epidemics have occurred, particularly in war affected areas and where health services were destroyed. Measles is easily spread in overcrowded conditions. Complications of measles, such as pneumonia and meningoencephalitis, are especially likely in malnourished children and particularly those with vitamin A deficiency."

" Malaria. Malaria is endemic in the country below 1500 m of elevation, including urban areas but particularly in the rice growing regions of the north and east of the country [40, 41]. Most malaria in Afghanistan (90%) has been due to Plasmodium vivax, but the incidence of Plasmodium falciparum malaria, which predominates from September to November, rose by >20% between 1998 and 1999, with an estimated 300,000-450,000 cases of P. falciparum malaria per year [45, 46]. In 1995, in 6 eastern provinces >67,000 microscopically confirmed cases occurred, with an overall slide positivity rate of 19%…"

"Undernutrition. As with other health indicators, sound data on nutritional status are limited. Various surveys have demonstrated rates of acute malnutrition of <10%, but as many as 52% of children have moderate to severe stunting and 25% exhibit wasting [5, 6, 18, 44, 49]. Most data are from accessible areas, and the prevalence of undernutrition is expected to be higher in areas of poor security. In the Faryab province, where indicators of food shortage occurred well before the war on terrorism began, >60% of children were stunted as determined by anthropomorphic measures, even though only 7% demonstrated wasting [49]. Although in this survey the prevalence of severe wasting was not high, higher levels of wasting are usually a late indicator of serious food shortage and famine."

"Physical Trauma. In addition to communicable diseases, traumatic injuries are an important concern. In 1994, the most common cause of death (33%-44%) in Kabul were war-related weapons injuries, land mine injuries, and unexploded ordinance. These injuries occurred primarily to young adults, a resource vital to any future social and economic recovery. Injuries and permanent disabilities from amputations, burns, and vision or hearing loss remain high throughout the country [49]. Among Afghan women surveyed in 1996, 16% reported that land mines killed = 1 family member, and 23% reported land mine injuries. In 1996, after a 6-month period of peace in Nangarhar, 51% of hospital admissions occurred from non-combat weapons-related injuries."

"Tuberculosis has been estimated to be responsible for 70,000-80,000 new infections and 16,000 deaths per year, often affecting the economically most productive age group. In 1997, only 30 clinics in the country provided tuberculosis treatment services, and most of these were in large cities. Even in these locations, supplies were erratic and management of cases poor. As many as 70% of patients with active tuberculosis have no access to directly observed therapy [53]. As with other conditions, women in Afghanistan are affected the most. The WHO reports that there are no female tuberculosis specialists, yet 70% of tuberculosis is among women. Because effective treatment requires multiple drugs for at least 6 months, effective management of the disease is almost impossible at this time."

Sources: HARVARD NOTEBOOK
Sharp, Burkle, Vaughn, Chotani and Brennan