The Silent Suffering: Afghanistan's Battle With Covid-19

Afghanistan has been severely affected by the COVID-19 pandemic. The country has reported over 200,000 confirmed cases and nearly 8,000 deaths. The pandemic has exacerbated existing issues in the country, such as poverty, food shortages, and a weak healthcare system. There is also a lack of testing and a low vaccination rate, with only about 7.8% of the population having received a vaccine as of May 2024. The pandemic has also disrupted education, with schools and universities closing for extended periods. The economic downturn caused by COVID-19 has had a significant impact, with rising unemployment and business closures.

The impact of COVID-19 on Afghanistan's healthcare system

Afghanistan's healthcare system was already weak before the COVID-19 pandemic, with the government and its allies struggling to provide high-quality health services due to inadequate facilities, insecurity, and ongoing conflicts. The pandemic exacerbated these issues, overwhelming the healthcare system and leading to an increase in cases across the country. The influx of migrants from Iran, a country badly hit by COVID-19, contributed to community transmission. Additionally, there was a series of deadly attacks on civilians and healthcare workers, severely weakening the healthcare infrastructure.

The first case of COVID-19 in Afghanistan was confirmed on February 24, 2020, in Herat. As of May 3, 2024, there have been 233,472 confirmed positive cases and 7,985 deaths. Kabul Province has had the highest number of cases, followed by Herat and Balkh. The pandemic has had a significant impact on the country's healthcare system, with limited testing capacity and insufficient resources to handle the surge in cases. Afghanistan had 11 COVID-19 testing laboratories as of August 13, 2020, which were inadequate to understand the extent of community spread.

The pandemic has also disrupted routine medical appointments and vaccinations, leading to surges in preventable diseases. Healthcare workers have been at high risk of infection due to a lack of personal protective equipment. The conflict and violence in the country have further hampered containment efforts and have had a devastating impact on the healthcare system. Bombings and attacks on healthcare facilities have resulted in the closure of hospitals and the displacement of healthcare workers and patients.

The withdrawal of foreign aid and the fall of the Afghan government to the Taliban have also contributed to the collapse of the healthcare system. The loss of international support has left the system ill-equipped to handle the pandemic and other health crises. The Taliban's restrictions on women's education and employment have further impacted the healthcare workforce, as many female healthcare workers have fled the country or been unable to continue their jobs.

Overall, the COVID-19 pandemic has severely affected Afghanistan's healthcare system, exacerbating existing issues and highlighting the need for international support and sustainable solutions.

The economic impact of COVID-19 in Afghanistan

Afghanistan's economic system was already critically weak before the pandemic, and the situation has only worsened since then. The country's COVID-19 response has been hindered by low testing capacity, a lack of medical equipment, and a struggling healthcare system.

The pandemic has also exacerbated existing issues of poverty and unemployment in the country. In Herat Province, more than 35,000 shops and factories were closed by 16 April 2020, leading to a loss of profits and unemployment. Construction also stopped in the province. Shopkeepers and street vendors across Kabul announced that their incomes had been affected by the lockdown. Breadwinners of families and low-wage vendors have been particularly affected in poor communities. According to the World Food Program (WFP) in Afghanistan, "44% of all Afghans – more than 16 million people – rely on unsustainable livelihoods that will be disrupted by the shocks due to the outbreak of Covid-19."

The World Bank predicts that Afghanistan will experience an economic contraction of 5.5% of GDP in 2020 due to the pandemic. The country's power company, Da Afghanistan Breshna Sherkat (DABS), lost 60% of its revenue due to the outbreak and requested a $50 million loan from the government. If the imported electricity from Uzbekistan is not paid, Afghanistan could face power cuts.

The pandemic has also disrupted international trade and travel. In March 2020, the Ministry of Transport and Civil Aviation restricted most international flights by Afghan airlines. On 1 April, the Government of Afghanistan suspended flights between Kabul and Herat. On 24 June, Afghanistan resumed international air travel.

The pandemic has also impacted education in Afghanistan, with all educational institutes in the country closed until 21 April 2020. From 11 April, lessons were taught online via television and radio. In June 2020, it was announced that all Afghan schools and universities would remain closed until September.

The social impact of COVID-19 in Afghanistan

The COVID-19 pandemic has had a profound impact on Afghanistan, affecting various aspects of social life in the country. Here is an overview of the social impact of COVID-19 in Afghanistan:

Healthcare Challenges:

The pandemic has strained Afghanistan's already weak healthcare system. With limited resources and infrastructure, the country struggled to cope with the influx of COVID-19 patients. There was a shortage of ventilators, with only 300 available countrywide, and even those went unused due to staff lacking the necessary training. The lack of testing capacity and medical supplies further exacerbated the situation.

Mental Health:

The pandemic has taken a toll on the mental and emotional health of Afghans. 77% of Afghans surveyed reported that the pandemic negatively impacted their emotional and mental health. Longer wait times at doctors, difficulty accessing medical care, and reduced access to medical supplies and food have all contributed to the decline in mental health.

Gender Disparities:

Women and girls in Afghanistan have been disproportionately affected by the pandemic, especially in employment and healthcare. 63% of women surveyed who work in the informal sector lost their jobs since the pandemic began. Additionally, women face unique challenges and discrimination in accessing healthcare due to the lack of female health practitioners and cultural barriers restricting their travel, particularly in rural areas.

Economic Downturn:

The pandemic has had severe economic consequences for Afghanistan. In 2020, the economy contracted by 1.9%, and poverty levels rose significantly, with more than half of the population living below the poverty line. This increase in poverty has led to a rise in food insecurity as suppliers raised prices due to trade restrictions. The early closing of borders, particularly with Pakistan, a primary source of food imports and exports, disrupted supply chains and contributed to food shortages.

Loss of Jobs:

Many Afghans lost their jobs or faced reduced income due to lockdowns and economic downturns. This was particularly evident in the informal sector, where women are predominantly employed. The loss of livelihoods left many struggling to meet their basic needs, such as food and medical treatment.

Education Disruptions:

Schools and universities were closed for extended periods, disrupting the education of Afghan children and youth. While online learning initiatives were implemented, the lack of access to technology and internet connectivity in some areas likely exacerbated existing inequalities.

Behavioural Changes:

The pandemic led to behavioural changes among Afghans, although these were often out of necessity rather than choice. Many could not afford to follow public health guidelines due to widespread poverty and the absence of a welfare system. Religious beliefs and cultural fatalism also influenced how people responded to the pandemic, with many adopting a pragmatic or submissive approach.

Containment Measures:

The Afghan government implemented containment measures early on in the pandemic. In late March 2020, schools, universities, non-essential businesses, and government offices were shut down, domestic travel was restricted, and road travel was limited. However, the effectiveness of these measures waned over time as people could not afford to stop working, and early containment efforts were largely forgotten by June.

International aid to Afghanistan during the pandemic

Afghanistan has faced a challenging situation with the COVID-19 pandemic, and the international community has provided significant support to address the crisis. Here is an overview of the international aid efforts during the pandemic:

International Aid Efforts:

• USAID and State Department Assistance: The United States Agency for International Development (USAID) and the US State Department have played a crucial role in providing humanitarian assistance to Afghanistan. Since August 2021, the US has contributed over $1.1 billion in humanitarian aid, making it the largest donor. This aid addresses the needs of vulnerable Afghans within the country and those who have fled to neighbouring nations.
• World Health Organization (WHO): The WHO has been actively involved in Afghanistan's COVID-19 response. They supported the development of the National Emergency Response Plan and provided essential guidance and training to combat the spread of the virus. The organisation also conducted media campaigns and oriented community and religious leaders to combat misinformation.
• International Rescue Committee (IRC): The IRC has provided vital support to Afghans affected by the pandemic, natural disasters, and violent conflict. They welcomed the World Bank's decision to utilise International Development Association (IDA) funds to expand programmes supporting Afghanistan.
• World Bank: The World Bank has been instrumental in providing financial assistance to Afghanistan. In April 2020, they approved $100.4 million in aid. Additionally, they decided to use IDA funds to scale up support and expand the scope of their programmes in the country.
• Other International Donors: Various countries and organisations have contributed to Afghanistan's COVID-19 response. Germany pledged $510 million in civilian assistance, the UK offered $227 million in civilian and food aid, Norway committed $72 million in development and humanitarian aid, and Qatar provided medical equipment worth over $2 million.
• COVAX and Vaccine Support: Afghanistan received support for its vaccination efforts through the COVAX programme. The US donated three million doses of the Johnson and Johnson vaccine, and India provided 1.6 metric tonnes of life-saving medicines.
• United Nations (UN) Agencies: The UN played a significant role in coordinating humanitarian assistance. In 2021, donors contributed $1.67 billion for Afghanistan humanitarian programmes, with the US as the largest contributor. The UN also launched a $5 billion funding appeal in 2022, the largest single-country aid appeal in its history.

While these international aid efforts have been substantial, it is important to note that Afghanistan continues to face significant challenges in addressing the COVID-19 pandemic and its broader economic and social consequences.

The Afghan government's response to COVID-19

National Interventions

Cross-border screenings at points of entry were implemented due to the surge of returnees from Iran, which was a hotspot for COVID-19 cases. Presidential decrees to avoid large crowds and encourage hand hygiene were issued, and the Ministry of Interior Affairs banned large gatherings, sporting and entertainment events. Quarantine and lockdown were implemented throughout the country.

Role of Media and Communication

Collaboration with media and religious leaders was essential in assuaging panic in communities, combatting misinformation on the virus’ spread, and growing stigma against the overburdened health system. The Ministry of Public Health and Ministry of Communication and Technology Affairs jointly developed a mobile application providing updates on COVID-19. The WHO emergency team launched a media campaign, conducted month-long roundtables, and oriented 55,256 community and religious leaders in all 34 provinces. Information, Education and Communication (IEC) materials were developed from an Islamic perspective and distributed by the Ministry of Religious Affairs and WHO.

Health Systems Interventions

The Afghan-Japan hospital in Kabul was designated as an immediate COVID-19 treatment facility. Isolation wards were identified for the treatment of COVID-19 patients in all provinces. By March 2020, there were 300 ICU beds available for quarantine throughout the country. The government also converted dormitories and palaces into isolation facilities.

Testing Capacity

Despite the increasing cases, Afghanistan had one of the lowest national testing capacities in the region. This challenge was exacerbated by the shortages of testing kits, high costs of testing, insecurity in transporting tests, and the need to export samples abroad for confirmation and verification. By May 2020, there were a total of 9 certified laboratories with the capacity of 1790 tests per day. Afghanistan also decentralised its testing capacity to include laboratories in Herat, Nangarhar, Paktya, Kandahar, and Balkh provinces.

Recommendations to Improve the COVID-19 Response

• Increasing budget allocation towards the healthcare sector to improve hospital facilities, staffing, and procurement of medical equipment.
• Scaling up capacity-building for healthcare professionals for the use of PPE, rapid detection, case management, and critical care services.
• Recruiting additional health workers and engaging community health workers and actors in COVID-19 surveillance.
• Expanding the use of telehealth care and helpline services to support service delivery while maintaining quarantine.
• Continuing health promotion activities, particularly for illiterate and hard-to-reach populations.
• Raising awareness to reduce myths and stigma associated with COVID-19 through media campaigns and engagement of religious and community leaders.
• Focusing on internally displaced populations and returnees to ensure adequate screening, health education, and access to health services.
• Engaging with the private sector to expand and optimise service delivery, surveillance, laboratory capacity, and prevention.

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