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28 June 2020, Herat – In western Afghanistan, Médecins Sans Frontières (MSF) is stepping up its COVID-19 response in Herat province, the second most affected province after Kabul. Today, the MSF COVID-19 treatment center in Gazer Ga Hospital will open its door to the first patients.
“We are opening a treatment unit to provide care for patients with severe conditions and to support the capacity of the Ministry of Health for the management of COVID-19 cases. After four decades of protracted conflict, the COVID-19 outbreak is further exacerbating an already dire situation in Afghanistan,” says Claire San Filippo, MSF Project Coordinator in Herat.
Since the first case of COVID-19 in Afghanistan was confirmed in Herat at the end of February, the number of cases has continuously increased. At the onset of the pandemic, a very high number of Afghans - more than 159 000 in March alone according to the International Organisation for Migration - returned from Iran, a country heavily affected by the pandemic. For this reason, Herat, used by many Afghans as a transit route back to their provinces, was the first epicentre of the outbreak in Afghanistan. Now, Herat is the second hotspot for COVID-19 with almost 4,500 confirmed cases on June 22.
However, these numbers do not provide an accurate picture of the overall situation. COVID-19 cases in Herat, similar to the situation across the country, remain largely undetected. As of June 22, only 64,585 people out of an estimated 37.7 million people in Afghanistan have been tested. There is a chronic shortage of testing capacity. The number of severe cases at Shaydahee Hospital in Herat increased from fifty in early May to 125 by early June. At the triage in Herat Regional Hospital, out of around one hundred patients seen per day, 5 to 10 are in a severe or critical condition - and it appears that the true scale of transmission among the community remains blatantly underestimated.
To respond to the pandemic in Herat at the onset of the outbreak, MSF teams had started implementing infection prevention and control measures in the health structures they were working in; a clinic for internally displaced people in the outskirts of Herat and the intensive therapeutic feeding centre in Herat Regional Hospital.
In April, they also set-up the triage of patients for COVID-19 screening in the clinic for displaced people and in Herat Regional Hospital to ensure early case detection and to create an effective referral system of suspected cases to relevant health facilities.
“Now with the opening of Gazer Ga Hospital, which has a 32-bed capacity, we plan to raise the level of care for severe COVID-19 patients who need oxygen and relieve the pressure on the two existing COVID-19 managements centres, Shaidayee and Liberty Hospitals, who are overwhelmed by patients,” notes Claire San Filippo.
In order to focus on the management of severe cases, Gazer Ga Hospital will not accept patients who arrive without a referral. All patients will be referred primarily from Herat Regional Hospital triage.
Four months after the first case was reported, the situation is not under control and preventing the spread of the virus remains challenging. Large households, overcrowded accommodation with poor access to water, sanitation and ventilation, high levels of social interactions and poverty make regular hand washing, home-isolation and social distancing almost impossible. Some people with COVID-19 related symptoms continue to be reluctant to seek health care.
Due to the spike in cases after Eid, a previously witnessed denial of COVID-19 existence by the community seems no longer possible, and people continue to be scared. There are widespread rumors about COVID-19 centers and some people are afraid that the appropriate religious and cultural burial rituals will not be respected if they die while seeking treatment – which is not the case. Yet, it is critical for patients not to wait to look for treatment. Arriving late at the hospital greatly reduces the chances of recovery.
For non-COVID-19 patients, the situation is also challenging. The high number of infected staff in health facilities limits their capacity to provide care. Since mid-May, a high number of malnourished babies have been admitted in the MSF inpatient therapeutic feeding centre at a time when MSF is struggling to maintain the full bed capacity due to infections amongst the staff.
MSF runs six projects in five provinces of Afghanistan, in Helmand, Kandahar, Herat, Khost and Kunduz. In Herat province, MSF is running a clinic for displaced people in Kadhestan/Shaidayee in the outskirts of Herat and is supporting the Ministry of Public Health in the malnutrition ward in Herat Regional Hospital. In 2019, MSF undertook a total of nearly 101,869 outpatient consultations, assisted 61,881 deliveries and performed over 9,953 surgical interventions. For its work in Afghanistan, MSF does not accept funding from any government and instead relies solely on donations from private individuals and foundations.
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