Afghanistan: Strategic Situation Report: COVID-19, No. 71 (27 August 2020)

Key Messages:

• People confirmed to have COVID-19: 38,126 (as of 2pm, 27 August. Source: Afghanistan Ministry of Public Health - MoPH)

• Deaths from COVID-19: 1,401 - Samples tested: 102,110

Key concerns: Border crossing areas, in-country testing capacity, protective equipment for frontline workers, maintaining essential health services, public complacency, sustained prevention and mitigation measures, messaging and rumour management

Situation Overview:

MoPH data shows that 38,126 people across all 34 provinces in Afghanistan are now confirmed to have COVID19. Some 29,046 people have recovered, and 1,401 people have died (69 of whom are healthcare workers). 102,110 people out of a population of 37.6 million have been tested. Almost 10 per cent of the total confirmed COVID-19 cases are among healthcare staff. The majority of the deaths were people between the ages of 50 and 79. Men in this age group represent 50 per cent of all COVID-19-related deaths. Moreover, men account for 70.4 per cent of the total COVID-19 confirmed cases although this may be the result of over-representation of men in testing. Due to limited public health resources and testing capacity, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely under-reported overall in Afghanistan. Kabul remains the most affected part of the country in terms of confirmed cases, followed by Hirat, Balkh, Kandahar and Nangarhar provinces.

Complacency and failure to follow public health advice is creating grave risks in the community, with people generally not observing physical distancing protocols. Recent modelling on COVID-19 projections, developed by the Centre for Humanitarian Data in collaboration with the Johns Hopkins Applied Physics Laboratory and released on 12 August, suggests cases and deaths will continue to rise over the coming weeks. Modelling further suggests a significant increase in severe cases (potentially up to 4x the number) should current preventative measures be lifted, creating grave implications for Afghanistan’s economy and people’s well-being. Recent conflict in the north-east and flooding in the centre and east of the country has displaced thousands of households. Compliance with COVID-19 preventative measures is challenging for the majority of those affected, exposing them to heightened risk of COVID-19 infection and transmission. Risk communications messaging to these groups is critical.

Hospitals and clinics continue to report challenges maintaining or expanding their facilities’ capacity to treat patients with COVID-19 as well as maintaining essential health services. WHO notes that it is important to ensure healthcare workers have the proper personal protection to carry out services. In addition, effective and accurate risk communication activities are needed to re-assure people that it is safe to seek treatment at hospitals and health centres and that health centres are carrying out proper infection prevention and control measures. Current laboratory capacity in Afghanistan remains limited. Humanitarian partners urge the Government of Afghanistan to ensure laboratories are appropriately equipped and that procured supplies go to under-resourced health centres in a transparent manner, so that life-saving support can be delivered to those most in need.

WHO notes that when health systems are overwhelmed, as is being seen in Afghanistan, both direct mortality from the outbreak and indirect mortality from vaccine-preventable and treatable conditions increase dramatically. WHO stresses the need to balance the demands of responding directly to COVID-19, with simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery, mitigating against the risk of system collapse.

According to a new assessment by World Vision, the COVID-19 pandemic has gravely impacted people’s ability to meet basic household needs. The assessment, carried out in Hirat, Badghis and Ghor provinces, found that due to the outbreak, the vulnerability of the households further increased, leading to dangerous coping strategies such as child labour, child marriage and decrease of food consumption. Moreover, more than 91 per cent of the 409 families surveyed indicated that their debt has increased since the COVID-19 outbreak, and more than 47 per cent of the respondents reported that they have lost their jobs or income revenue due to the pandemic. Reported loss of income has resulted in more than 48 per cent of the respondents sending children to work; more than 19 per cent engaging in high risk jobs; 8 per cent sending children to other relatives for food; almost 11 per cent have resorted to begging; almost 6 per cent have been forced to sell girls into early marriage; and more than 48 per cent have engaged in illegal activities.