Coronavirus overloads war-torn hospitals in Afghanistan

As the coronavirus spreads in Afghanistan, cracks in the country’s health care system – already weakened by decades of war – are beginning to appear. BBC Pakistan and Afghanistan correspondent Secunder Kermani reports on the worsening Covid-19 crisis in the country.

When Ahmad Shah’s wife developed symptoms of coronavirus, he tried to take her to one of the government hospitals in Kabul. But free beds are scarce in the city and resources are desperately depleted. Even with breathing difficulties, doctors advised Shah to treat her at home.

“Someone said to me, ‘If you really love her, take her home and do the treatment there,” Shah told the Chillylife.

He bought his own oxygen supply and mask. Demand has been so high during the pandemic that the price of cylinders has doubled in recent weeks. They now cost about $ 200 ($ 162).

“It is very difficult to find oxygen today,” said Shah. “Not only is it expensive, but you need to know someone at the company that sells it in order to buy it.”

Doctors say the already weak health system in the war-torn country is struggling to cope with pressure from Covid-19. Concerns were raised about the supply of oxygen and other resources to government hospitals.

A doctor in Kabul described the families of the patients who had to “fight for oxygen” when the cylinders arrived, before taking him to the intensive care unit.

There are also problems with testing. Low levels of testing suggest that there are “substantially” more Covid-19 cases than official figures, according to the representative of the World Health Organization (WHO) for Afghanistan, Dr. Rik Peeperkorn.

About 31,000 infections have been reported to date. Almost half of all tests performed so far have been positive, one of the highest rates in the world.

A man is treated with oxygen in Afghanistan
Source: BBC

A doctor, who wanted to remain anonymous, described a worrying shortage of personnel in an intensive care unit where he worked in a large state hospital in Kabul.

“One night, many patients died because there were no staff to look after them,” said the doctor. He said the patients’ relatives were “furious” and broke the hospital windows in anger.

The doctor, now working in a private hospital, added that many families are reluctant to seek treatment in public institutions.

“They don’t trust the quality of the treatment,” said the doctor. “They say, ‘take the money you want, but get our patient admitted’.”

But private hospitals, too, he added, are routinely having to refuse patients due to a lack of beds.

Another doctor told the BBC that even employees at his private hospital were unable to treat his family members.

“A doctor called and said, ‘One of my relatives is having breathing problems, we are sending it to you, please admit it.’ I asked his forgiveness … We couldn’t take care of his relative, so think about what happens to ordinary people who come here? “

Afghanistan’s health system already had few resources before the pandemic – those in need of medical assistance used to travel to neighboring Pakistan or India for treatment, if they could afford it. Many of the doctors who spoke to the BBC blamed corruption for the current shortage of staff and equipment in government hospitals.

One described the situation as “frustrating and depressing”.

A Health Ministry official allegedly receiving a bribe
Source: BBC

There have been a number of investigative reports in the local media in recent weeks, and public anger is increasing. Authorities are investigating a story from the Pajhwok Afghan News, claiming that 32 fans were stolen from the Ministry of Health and smuggled into Pakistan for sale.

In another case, a health department official was arrested for allegedly demanding a $ 80,000 bribe to conclude a contract with a company that produces protective equipment for medical personnel.

Lotfullah Najafizada, head of Tolo News, told the BBC that corruption was “a big problem” across the government, but particularly at the moment at the Ministry of Health because of the extra resources recently allocated to combat Covid-19.

“The ministry has never managed that amount of money in the past,” he said, adding that urgency meant “you can’t implement an efficient oversight process”.

It is difficult to assess the true scale of the coronavirus in Afghanistan.

A doctor working in Kabul suggested that the health system may be overburdened mainly because “capacity is very low”. However, anecdotal reports from cemeteries suggest that they saw significant increases in the number of burials.

Afghan doctors help patients to breath through oxygen mask in Afghan-Japan special hospital for Covid-19 patients in Kabul, Afghanistan
Source: BBC

A sense of stigma associated with the disease means that many families are reluctant to acknowledge coronavirus deaths. A doctor in the southern city of Kandahar told the BBC that, even in his own social circle, it was clear that a large number of people were dying.

“If you look at Facebook, there are an increasing number of deaths every day,” he said.

He said that in most cases, the deaths were the result of “typhoid fever” – a bacterial infection – or “unknown causes”, but that he was “100% certain that it was due to Covid-19”.

The doctor, who usually treats victims of the Afghan war, said that years of conflict and tragedy have desensitized some of the city’s residents to deaths, which they described as “God’s will”.

UN condemns health attacks in Afghanistan amid pandemic
Meanwhile, violence in the country continues, with an increase in Taliban attacks and killings of unknown militants in the capital Kabul. Sometimes health professionals are directly affected. Earlier this month, the charity MSF announced it would withdraw from a maternity hospital in Kabul that was attacked by militants in May, killing sixteen pregnant women, among others.

A sense of stigma associated with the disease means that many families are reluctant to acknowledge coronavirus deaths. A doctor in the southern city of Kandahar told the BBC that, even in his own social circle, it was clear that a large number of people were dying.

“If you look at Facebook, there are an increasing number of deaths every day,” he said.

He said that in most cases, the deaths were the result of “typhoid fever” – a bacterial infection – or “unknown causes”, but that he was “100% certain that it was due to Covid-19”.

The doctor, who usually treats victims of the Afghan war, said that years of conflict and tragedy have desensitized some of the city’s residents to deaths, which they described as “God’s will”.

UN condemns health attacks in Afghanistan amid pandemic
Meanwhile, violence in the country continues, with an increase in Taliban attacks and killings of unknown militants in the capital Kabul. Sometimes health professionals are directly affected. Earlier this month, the charity MSF announced it would withdraw from a maternity hospital in Kabul that was attacked by militants in May, killing sixteen pregnant women, among others.

A sense of stigma associated with the disease means that many families are reluctant to acknowledge coronavirus deaths. A doctor in the southern city of Kandahar told the BBC that, even in his own social circle, it was clear that a large number of people were dying.

“If you look at Facebook, there are an increasing number of deaths every day,” he said.

He said that in most cases, the deaths were the result of “typhoid fever” – a bacterial infection – or “unknown causes”, but that he was “100% certain that it was due to Covid-19”.

The doctor, who usually treats victims of the Afghan war, said that years of conflict and tragedy have desensitized some of the city’s residents to deaths, which they described as “God’s will”.

Meanwhile, violence in the country continues, with an increase in Taliban attacks and killings of unknown militants in the capital Kabul. Sometimes health professionals are directly affected. Earlier this month, the charity MSF announced it would withdraw from a maternity hospital in Kabul that was attacked by militants in May, killing sixteen pregnant women, among others.

The UN has also documented a dozen other violent incidents, including the Taliban’s repeated kidnapping of medical teams, and an example of government security forces looting medical supplies.

Concerns are also emerging about the impact of the coronavirus on both levels of poverty in the country and efforts to combat other diseases. Afghanistan is one of only two countries in the world to eradicate wild polio, but vaccination campaigns have been suspended. In recent weeks, cases of polio have been discovered in provinces previously considered free of polio.

WHO Dr Peeperkorn told the Chillylife that it is crucial that the “fragile” progress made in the past decade – in reducing the infant mortality rate, for example – is not reversed as a result of increased public distrust of the health system or lack of investment due to economic pressures.

For doctors on the front lines, the immediate priority is to get the support needed to care for patients with coronavirus. According to WHO, more than $ 5 million in medical supplies have been purchased so far, with $ 17 million in equipment due in the coming weeks. It is very necessary.

“It is very bad to see our own people dying in front of us,” said a tired doctor from the western city of Herat, where the country’s outbreak began.

“We are just like doctors anywhere else in the world, but we don’t have beds, staff or resources,” he said.

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