As coronavirus spreads in Afghanistan, cracks in the country’s healthcare system begin to appear, which have already been weakened by decades of war. The BBC correspondent in Pakistan and Afghanistan, Secunder Kermani, reports on the exacerbation of the Covid-19 crisis in the country.
When the wife of Ahmad Shah had symptoms of a coronavirus, he tried to take her to one of the state hospitals in Kabul. But there are not enough free beds in the city, and resources are desperately dragging on. Although she had breathing problems, doctors advised Shah to treat her at home.
“One of them told me:“ If you really love her, please take her home and have her treatment there, ”Shah BBC said.
He bought his supply of oxygen and a mask. During the pandemic, demand was so high that cylinder prices have doubled in recent weeks. Now they cost about $ 200 ($ 162).
“It is very difficult to find oxygen now,” Shah said. “It’s not just expensive, but you need to know someone at the company selling it in order to be able to buy it.”
Doctors say the already weak healthcare system in a war-torn country is struggling to cope with Covid-19 pressure. Concerns were expressed about the supply of oxygen and other resources to public hospitals.
A doctor in Kabul said that families of patients had to “fight for oxygen” when the cylinders arrived before delivering it to the intensive care unit.
There are problems with testing too. Low test levels suggest that there are “significantly” more Covid-19 cases than official data, according to Dr. Rick Piperkorn, representative of the World Health Organization (WHO) for Afghanistan.
To date, about 31,000 infections have been reported. Almost half of all tests performed to date have been positive, which is one of the highest rates in the world.
Dr. Piperkorn told the BBC that the number of “test labs” would be increased from 11 to 21 in the “coming months,” and called for greater “global solidarity” to ensure regular supplies of necessary equipment.
One doctor who wished to remain anonymous spoke of a serious staff shortage in the intensive care unit, in which he worked in a large public hospital in Kabul.
“One night many patients died because there was no staff to look after them,” the doctor said. He said that the relatives of the patients were furious and in anger broke the windows in the hospital.
The doctor, who is now working in a private hospital, added that many families do not want to seek treatment in state institutions.
“They don’t trust the quality of the treatment,” the doctor said. “They say:” Take as much money as you want, but accept our patient. ”
But private hospitals also, he added, are usually forced to turn patients away due to lack of beds.
Another doctor told the BBC that even members of his private hospital could not treat his family members.
“The doctor called and said:” One of my relatives has breathing problems, we are sending it to you, please accept it. ” I apologized to him … We could not keep an eye on his relative, so think about what happens to ordinary people who come here? “
Prior to the pandemic, Afghanistan’s health system was not well provided — those who needed medical care often came to neighboring Pakistan or India for treatment if they could afford it. Many doctors who spoke with the BBC blamed corruption for a lack of staff and equipment in public hospitals.
One described the situation as “disappointing and depressing.”
Over the past few weeks, there have been many investigative reports in local media and public anger is growing. Officials are investigating the Pajkhwok Afghan News story, which alleges that 32 ventilation devices were stolen from the Ministry of Health and smuggled to Pakistan for sale.
In another case, a health department employee was arrested on charges of receiving a bribe of $ 80,000 to contract with a company producing protective equipment for medical personnel.
Lotfulla Najafizada, head of Tolo News, told the BBC that corruption was a “huge problem” in the government, but in particular at the moment in the ministry of health because of the additional resources that were recently allocated to fight Covid-19.
“The ministry has never managed this amount of money in the past,” he said, adding that urgency meant: “You cannot create an effective oversight process.”
It is difficult to assess the true extent of coronavirus in Afghanistan.
A doctor in Kabul suggested that the healthcare system could be heavily overloaded because “the potential is so low.” However, unofficial reports from cemeteries suggest that they saw a significant increase in the number of burials.
The stigma associated with this disease means that many families do not want to acknowledge deaths from coronavirus. One doctor from the southern city of Kandahar told the BBC that even from his own circle of friends it became clear that a large number of people were dying.
“If you look at Facebook, the number of deaths increases daily,” he said.
He said that in most cases, death was said to be the result of “typhoid fever” – a bacterial infection – or “unknown causes”, but he was “100% sure that this was due to Covid-19.”
The doctor, who usually treats victims of the war in Afghanistan, says the years of conflict and tragedy have reduced the sensitivity of some residents to deaths, which they called the “will of God.”
Meanwhile, violence in the country continues: Taliban attacks and killings of unknown militants in the capital of Kabul have become more frequent. Health professionals are sometimes directly affected. Earlier this month, MSF charity announced its withdrawal from Kabul maternity ward attacked by militants in Maykilling sixteen expectant mothers, including.
The UN also recorded a dozen other violent incidents, including the Taliban’s repeated abduction of medical personnel and one case of government security forces robbing drugs.
There is also growing concern about the impact of coronavirus on poverty in the country and efforts to combat other diseases. Afghanistan is one of two countries in the world that has yet to eradicate wild polio, but vaccination campaigns have been suspended. In recent weeks, cases of polio have been discovered in provinces that were previously considered polio-free.
Dr Peeperkorn of WHO told the BBC that it was imperative that the “fragile” progress made over the past decade – for example, in reducing infant mortality – was not reversed as a result of growing public distrust of the health system. or lack of investment due to economic pressure.
For frontline doctors, the first priority is to get the support needed to care for patients with coronavirus. According to WHO, currently purchased medicines worth more than $ 5 million. USA, and equipment worth $ 17 million. The US should appear in the coming weeks. It is very necessary.
“It’s very bad to see our people die before us,” one doctor from the western city of Herat said wearily, where an outbreak in the country began.
“We are the same doctors as everywhere else in the world, but we do not have beds, staff or resources,” he said.