Afghanistan’s Public Health Emergency

Afghanistan is going through a serious public health emergency, exacerbated by the unstable political situation in the region. This is the verdict of international aid agencies in the country, such as the World Food Programme (WFP), which last January had already recommended a sharp increase in food assistance.

More than 1.6 million Afghan children under the age of five and thousands of women could die in 2009 as a result of the lack of food and medical care, particularly in terms of proper services for women and children, according to the Afghan Ministry of Health.

These are troubling statistics 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.

Food shortages and inclement weather could leave eight million Afghans — 30% 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.

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

The security situation in Afghanistan continues to deteriorate, affecting the population's access to food and health aid. Attacks on food convoys in Afghanistan and Pakistan are making it more difficult to bring supplies to the people. It is estimated that 141 of 328 districts are high or extreme safety risk areas.

At the same time, the government, its partners and aid organizations have failed to meet the needs of millions of people returning from Iran and Pakistan, according to a new report by the Afghanistan Independent Human Rights Commission.

Children are particularly vulnerable. They are not only affected by lack of food, but diarrhea, acute respiratory infections and vaccine-preventable diseases are also significant threats to children's health. Diarrhea and acute respiratory infections account for approximately 41% 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%, according to UNICEF.

The tragedy is that 80-85 % 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 conditions 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 and Prevention (CDC), shows that a majority of Afghans, including children, suffer from depression and anxiety — and almost half from post-traumatic 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, and so do statistics on mental health problems. WHO's Project ATLAS showed that in 2001 there were only eight psychiatrists for the entire country of 25 million people.

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 20-30 minutes a woman dies because of pregnancy-related complications.

The Ministry of Public Health in Afghanistan has prepared a balanced scorecard to monitor the progress of its strategy to deliver a basic package of health services to the population.

The application of this system found serious deficiencies in counseling patients, health care during childbirth, monitoring tuberculosis treatment — a serious problem in the country — and establishing functional village health councils. The situation is even more serious because of the numerous aid agencies that have left the country for security reasons.

Despite billions of dollars poured into the country, the reconstruction of Afghanistan's health system is not meeting its goals, according to the U.S. Government Accountability Office (GAO), the investigative arm of Congress in charge of examining matters relating to the receipt and payment of public funds.

Since the U.S. invasion in 2001, the United States, Japan, Great Britain and Germany have invested billions of dollars in Afghanistan's reconstruction — including the country's health system. The GAO also noted that poor infrastructure and security concerns limit the ability to monitor projects effectively.

Improving Afghanistan's health crisis remains one of the most serious and unresolved issues confronting aid agencies. Addressing the health needs of children and women remains a priority. And so is the need to rebuild infrastructure, de-mining the country and creating a functional judicial system while simultaneously respecting Afghan customs and traditions.

This is a tall order for a country ravaged by violence and lawlessness — but not an impossible situation for the new U.S. administration, which can, and should, do much to remedy.