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Afghanistan Flash Update | COVID-19 | Strategic Situation Report No. 78 | 24 September 2020

Situation Overview: UPDATED

MOPH Figures: MoPH data shows that 39,170 people across all 34 provinces in Afghanistan are now confirmed to have COVID-19. Some 32,619 people have recovered, and 1,451 people have died - 76 of whom are healthcare workers. Almost 10 per cent of the total confirmed COVID-19 cases are among healthcare staff. 109,469 people out of a population of 37.6 million have been tested. The majority of the recorded deaths were men between the ages of 50 and 79. Men account for more than 70 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, 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. Kabul remains the most affected part of the country in terms of confirmed cases, followed by Hirat, Balkh, Kandahar and Nangarhar provinces.

Prevention Measures: 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 protocols. Recent modelling on COVID-19 projections, developed by the Centre for Humanitarian Data in collaboration with Johns Hopkins Applied Physics Laboratory and released on 9 September, suggests cases and deaths will continue to rise over the next four weeks. Modelling further suggests a significant increase in severe cases (potentially up to 3x the number) should current preventative measures be lifted, with serious risks for Afghanistan’s economy and people’s well-being.

Trends in the country’s west: According to local media reports, officials in Hirat are already observing an increase in the number of people infected with COVID-19 in recent weeks. Doctors in the region are warning that the second wave of COVID-19 will be more deadly than the first if people do not follow health advice. The Minister for Public Health has also warned that cold weather, air pollution and seasonal diseases as winter approaches  could increase the severity of a second wave of the virus. Similarly, according to a recent figures collected by WHO Rapid Response Teams , the west of the country (Hirat and Ghor is witnessing a spike in COVID-19 cases. WHO also notes that health actors in the west are now starting to see a change in the gender balance among cases with more women now testing positive than was previously the case. Officials are monitoring whether school re-opening is playing a role in the spread of the virus to mothers. While data suggests that the first wave seemed to peak in June, the new rise in cases in the west is being closely monitored.

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. A WHO comparison of HMIS health data from Q2 2019 with Q2 2020 shows that the utilisation of health services has dramatically decreased during the pandemic. For example:

Non-COVID hospital admissions have dropped by 24 per cent; the number of referrals served has reduced by 24 per cent.

Total surgical interventions have dropped by 32 per cent – gynaecological related surgeries are down by 39.6 per cent, eye surgeries down by 37.5 per cent, and ear, nose and throat (ENT) surgeries by 39 per cent.
Women seeking first time antenatal care has dropped by 10.5 per cent and postnatal care by 5.2 per cent; home deliveries by health staff have fallen by 31.2 per cent, and referrals of complicated deliveries have risen by 3.1 per cent.

The figures demonstrate that many of the severe medical cases that required hospital care have been unable to receive treatment during the COVID-19 pandemic as a result of a variety of factors including health staff falling ill with COVID-19, overwhelmed health facilities focused on COVID-19 response, patients’ unwillingness to attend health facilities, movement restrictions. These unaddressed medical conditions will likely to result in increased mortality and increased needs in the second half of the year and into 2021. 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.

WHO emphasises that infection prevention and control need to be improved in health facilities to encourage people to return to health services safely. WHO reiterates the importance of ensuring healthcare workers have the proper personal protection to carry out services. Effective and accurate risk communication activities are needed to reassure 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.

While 13 laboratories are now operating in Afghanistan, 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.

Socio-economic impacts: The non-health impacts of COVID-19 continue mount. According to UNDP, COVID-19 has brought the deepest global recession since World War II, and the broadest collapse in per capita incomes since 1870. Globally, economies are likely to see a USD$9 trillion cost over the next two years and a global loss equivalent to 400 million jobs. An estimated 60 million more people will be pushed into extreme poverty, and hunger and famine will reach historic proportions. Two thirds of the SDGs are now under threat or may not be met. This is in line with the World Bank’s outlook for Afghanistan that suggests both per capita and real GDP are expected to sharply decline and are likely remain below pre-COVID-19 levels over the medium term. According to the World Bank real GDP is expected to contract between 5.5 and 7.4 per cent and remittances to Afghanistan are expected to decline by 40 per cent from 2019 levels. Preliminary data from multi-sector needs assessments in Afghanistan also paints a worrying picture about exponential increases in household debt.

In the immediate term, average prices for key commodities remain elevated above pre-COVID levels while purchasing power has diminished. According to WFP’s market monitoring, the average wheat flour price (low price and high price) increased by 9 per cent between 14 March and 23 September, while the cost of pulses, sugar, cooking oil and rice (low quality) increased by 26 per cent, 20 per cent, 26 per cent, and 17 per cent, respectively, over the same period. This price increase is accompanied by a declining purchasing power of casual labourers and pastoralists – which have deteriorated by 6 per cent and 10 per cent respectively (compared to 14 March).

Protection concerns: The Inter-Agency Standing Committee reports that the COVID-19 pandemic is exacerbating protection concerns in humanitarian crises and exposing vulnerable people to new threats. Protection clusters are reporting an increase in cases of violence, including a ‘shadow pandemic’ of Gender Based violence (GBV), forced displacement, a rise in xenophobia and stigmatisation, alongside discrimination in access to health, food, water, education and legal services for vulnerable and marginalised groups. In the face of the largest economic shock the world has experienced in decades, some of the most vulnerable communities are now forced to resort to adverse survival strategies, with limited safe alternatives. 

Operation(s)/ Webspace(s): 
United Nations Office for the Coordination of Humanitarian Affairs
World Health Organization
Original Publication Date: 
24 Sep 2020
Document type: 
Situation Report
Coordination hub(s): 
National Level Coordination