Afghan health crisis defies aid efforts so far

by Cesar Chelala

NEW YORK — Afghanistan is going through a serious public health emergency, exacerbated by the unstable political situation in the region. Food shortages could leave 8 million Afghans — 30 percent of the population — on the brink of starvation, unless more effective aid is provided soon. Lack of food is an actual threat not just in the remote regions of Afghanistan but also in its urban areas.

Price increases in basic foods, particularly wheat, have adversely affected millions of Afghans, primarily in rural areas where domestic production cannot satisfy people’ needs. For example, in 2005 an average household was spending 56 percent of their income on food. Now that figure has risen to 85 percent, according to Susannah Nicol, a spokeswoman for the World Food Program (WFP).

More than 1.6 million children under the age of 5 and thousands of women could die in 2009 as a result of the lack of food and medical care, according to the Afghan Ministry of Health. These are troubling figures not only because of the human suffering involved, but because they indicate that the millions of dollars poured into the country to date have not reached its most vulnerable citizens.

Children are not only affected by lack of food, but diarrhea, acute respiratory infections and vaccine-preventable diseases. Diarrhea and acute respiratory infections account for approximately 41 percent of all child deaths in this desperately poor nation of 26 million people, while vaccine-preventable diseases — such as measles, polio and diphtheria — account for another 21 percent, according to UNICEF.

Eighty to 85 percent of these diseases can be avoided by implementing preventive measures and appropriate and timely health care.

Afghanistan rates low in practically all health indicators. As a result, it has one of the world’s highest infant and maternal mortality rates. Hospitals in most of the country are in deplorable condition, and lack enough trained doctors or medical equipment for even the most basic surgeries. Life expectancy is 42 years, according to figures from the World Health Organization (WHO).

A survey of 800 Afghan households, led by Dr. Barbara Lopes Cardozo of the U.S. Centers for Disease Control (CDC), shows that a majority of Afghans, including children, suffer from depression and anxiety, and almost half from posttraumatic stress disorder.

The researchers also found that although violence and war were important factors in the Afghans’ deteriorating mental health situation, so were the daily stresses of dealing with shortages of food, water, shelter and lack of medical care.

In spite of this evidence, mental health remains one of the most neglected public health areas in the country. WHO’s Project ATLAS showed that in 2001 there were only eight psychiatrists for the entire country.

The number of disabilities caused by failing medical conditions must also include those injuries caused by millions of land mines and unexploded ordnance that contaminate the country. During continuing hostilities, several previously de-mined areas have been re-mined. In addition, the dumping of industrial and medical waste in the Kabul River is raising concerns about its impact on the population, most notably children, who swim in it.

Although health care has been one of the main focal points for much of the humanitarian aid in Afghanistan, the country’s health situation remains serious. Women and children, particularly, have seen a dramatic deterioration of their psychological, social and family life for the past two decades. Despite the government’s avowed interest in improving the maternal health situation in the country, the maternal mortality rate (1,600 per 100,000 live births) is one of the highest in the world. It is estimated that every 20 to 30 minutes a woman dies because of pregnancy-related complications.

Since the U.S. invasion in 2001, the U.S., Japan, Britain and Germany have invested billions of dollars in Afghanistan’s reconstruction, including the country’s health system. In spite of that, the health situation in the country remains dire. Improving the Afghans’ health situation remains one of the most serious and unresolved issues confronting the new Afghan government and international aid agencies.

Cesar Chelala, M.D., Ph.D., is an international public health consultant and a cowinner of an Overseas Press Club of America award.