Afghanistan Flash Update | COVID-19 | Strategic Situation Report No. 84 | 19 November 2020
Afghanistan Flash Update | COVID-19 | Strategic Situation Report No. 84 | 19 November 2020
Situation Overview: UPDATED
Global Update: According to John Hopkins University, the number of people worldwide who have died with COVID-19 has passed 1.3 million, with many regions still reporting surging numbers of new infections. The pandemic has spread to 191 countries with over 56 million confirmed cases, as of 19 November. In the eight months since the humanitarian community published its COVID-19 Global Humanitarian Response Plan (GHRP), the virus has severely impacted entire economies and societies. Millions of people have been pushed to the brink of survival with the situation still unfolding. As of 16 November, there were more than 15.7 million confirmed cases of COVID-19 in GHRP countries and 518,000 deaths. This represents more than 31 per cent of global cases and more than 41 per cent of global deaths. The number of reported cases and deaths have been lower than originally feared in many of the countries with humanitarian needs (as far as data is available), but it is the secondary impacts that have been – and will continue to be – devastating for many of the people living in these countries. For more information, please see the final GHRP progress report for 2020 which was published on 18 November.
MOPH Figures: MoPH data shows that 44,133 people across all 34 provinces in Afghanistan are now confirmed to have COVID-19. Some 35,339 people have recovered, and 1,650 people have died - 79 of whom are healthcare workers. Only 133,691 people out of a population of 36.7 million have been tested. Afghanistan has a test-positivity-rate – positive tests as a percentage of total tests – of more than 33 per cent, suggesting overall under-testing of potential cases. The majority of recorded deaths were men between the ages of 50 and 79. Men account for more than 69 per cent of the total COVID-19 confirmed cases in the MOPH data, although this may be the result of over-representation of men in testing. Due to limited public health resources and testing capacity, lack of people coming forward for testing, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely to be under-reported overall in Afghanistan. Stigma is considered a major factor in people choosing not to get tests and risk communications work is critical to turning this around. WHO notes that the official numbers reported by MoPH are unlikely to be capturing the full scale of the situation since testing remains limited to only the most severe cases. WHO warns that widespread complacency and failure to follow public health advice is creating grave risks in the community with people generally not observing physical distancing or mask wearing protocols.
Second Wave: The MoPH confirmed on Thursday, 19 November, that Afghanistan is in the second wave of the COVID-19 pandemic. Moreover, following two months of consistently lower confirmed COVID-19 cases, MoPH tracking data is beginning to reflect anecdotal reports of a recent uptick in cases, with 209 new COVID-19 cases recorded over the past 24 hours and 1,338 cases over the past week. While the official numbers are not yet at the same level as the May/June peak, when taken together with reports of increased hospitalisations for COVID-19-like symptoms, the need for vigilance should be reinforced. The rollout of the annual influenza vaccination across Afghanistan will be more important than ever to help the health system manage the rise in COVID-19 cases. Increasing influenza vaccine coverage can reduce the strain on the health care system and free-up limited health resources to focus on treating more severe cases of COVID-19. Public health experts strongly urge the public to follow health advice on physical distancing, mask wearing, good hygiene, hand washing and other proven strategies that mitigate the risk of COVID-19 transmission amid this second wave.
Ongoing Needs: The operating context continues to be impacted by worsening insecurity, on top of the risks associated with COVID-19. While responding to COVID-19, humanitarian partners are also mobilising to respond to needs in southern Afghanistan where tens of thousands of people have been displaced by conflict placing them at greater COVID-19 risk and where there has been a surge in trauma cases. Ongoing fighting has also forced the closure of a number of health facilities, interrupting access to critical health services and directly impacting more than 130,000 people. Assessment teams are currently verifying the immediate needs of affected families and organising assistance. COVID-19 awareness raising and community engagement work is being incorporated into this response due to the increased risks facing people who are displaced and living in crowded conditions without proper access to hygiene facilities. For more information, please see the latest OCHA Flash Update.
Attacks on Health Care: Despite the heightened pressure on the healthcare system and increased need for its services due to the COVID-19 pandemic, health facilities and workers continue to suffer harm from attacks, as well as acts of intimidation by parties to the conflict. Since the start of the pandemic, there have been direct attacks on hospitals, abductions of healthcare workers, acts of intimidation, harassment and interference, looting of medical supplies, and indirect harm from the ongoing armed conflict. Between 1 January and 31 October, WHO reports there were 67 incidents in 17 provinces across 40 districts. Direct, targeted attacks on health facilities and health workers now account for 78 per cent of all incidents. During this period, Afghanistan has witnessed the closure of 38 health facilities across four provinces, with threats of additional closures. WHO fears the gap in COVID-19 surveillance due to the closure of health facilities, as well as the negative impact on maintaining essential health service during the pandemic, will have serious implications for the people of Afghanistan.
Health Services: 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, especially in areas of active conflict. 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.
Almost 9 per cent of the total confirmed COVID-19 cases are among healthcare staff. Health facilities across the country continue to report shortfalls in PPE, medical supplies and equipment, further challenging their capacity to treat COVID-19 patients. In support of the Government, humanitarian partners have provided hundreds of thousands of pieces of PPE and several thousand items of life-saving medical equipment to MoPH. Additionally, frontline NGO workers have recently received new deliveries of PPE – including both surgical and N95 masks, face shields and shoe covers – from WHO. In total, since the start of the pandemic, almost 1.3 million PPE items have been delivered by humanitarian partners to both MoPH and frontline NGO workers in Afghanistan. With a second wave of the gathering pace globally, there is an urgent need to ensure a rapid distribution of medical and protective equipment to all corners of the country.
While 14 laboratories are now operating in Afghanistan, the capacity of these facilities remains limited and stocks of supplies have periodically run out. National capacity for COVID-19 testing has topped 5,500 a day, but according to WHO, lack of demand means that fewer than 400 tests are actually being conducted daily. Humanitarian partners urge the Government to ensure laboratories are appropriately equipped, staff receive timely renumeration 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. There are also reports that staff at the regional reference laboratory – which is currently a dedicated COVID-19 facility – in Hirat province are striking in response to the non-payment of salaries for the last five months.
Socio-economic impacts: The socio-economic impacts of COVID-19 are translating into a dramatic impact on food insecurity with levels now similar to those seen during the 2018 drought. An estimated 16.9 million people are in crisis or emergency food insecurity through until March 2021, 5.5 million of whom are in ‘emergency’ level food insecurity (IPC 4). According to WFP’s market monitoring, the average wheat flour price (low price and high price) increased by 11 per cent between 14 March and 18 November, while the cost of pulses, sugar, cooking oil and rice (low quality) increased by 20 per cent, 18 per cent, 32 per cent, and 20 per cent, respectively, over the same period. This price increase is accompanied by a declining purchasing power of casual labourers and pastoralists – which has deteriorated by over 10 per cent and 14 per cent respectively (compared to 14 March). These factors, combined with COVID-19 related interruptions to informal employment and decrease in remittances, are driving people into crippling debt. Data from the Whole of Afghanistan Assessment shows that household debt is rapidly escalating in terms of both the number of people in debt and the scale of that debt. Average household debt is now 46,299 AFS/US$602, up from 9,813 AFS/US$128 in 2019. Of displaced households in debt, the primary reason for taking on this debt was to pay for food (53 per cent).
Given this situation, there is an urgent need for additional funding for winterisation support to help struggling households survive the harsh weather ahead. 4.8 million people are in urgent need of support to survive the winter season. The ICCT’s $138m Winterisation Plan remains woefully underfunded with only $64m received. Support from the Government towards this plan is urgently needed.
In a recently published report on COVID-19 and the Child Protection Crisis in Afghanistan, World Vision reports that the children of Afghanistan, especially those already suffering from poverty and inequity, are among the most vulnerable to the harsh socioeconomic impact of COVID-19. Child mortality, malnutrition, forced marriages, sexual abuse, child labour and other forms of violence and exploitation and are all common challenges now facing children. With the addition of COVID-19 and its related impacts, children are now more anxious and worried than ever before and at greater risk of facing physical, sexual and emotional violence, especially as the economic impacts of the crisis set in.
The World Bank reports that Afghanistan's economy is set to contract by between 5.5 percent and 7.4 percent in 2020 because of COVID-19, exacerbating poverty, and leading to a sharp decline in government revenues. Economic activity plummeted in the first half of 2020 as COVID-19 negatively impacted the industry and service sectors. Despite continued robust growth in agriculture following the recovery from the 2018 drought, lower outputs in industry and services, as well as declining revenues due to trade disruptions and weaker tax compliance, have put government finances under pressure. Higher food and consumer prices combined with lower incomes are expected to harm household welfare and increase humanitarian pressures. The official Government poverty rate is expected to increase dramatically as a result. Small, informal businesses are most vulnerable and have limited access to resources to mitigate against the impacts of the COVID-19 crisis. As a result, impacts on employment, both formal and informal, are expected to be severe in Afghanistan, according to another recently published report by the World Bank. According to the report, 38 per cent of the surveyed Afghan businesses marked the closure of international borders as the most significant driver of disruption to business operations and their value chains, limiting access to raw materials, immediate inputs, and finished goods needed for trade or production. While vulnerability is felt by Afghan businesses of all sizes, it is considerably higher among businesses with at least one female shareholder, exporting businesses, and businesses with a larger share of female workers.