WHAT WE DO?
Afghanistan, with a population of 41.7 million, has been affected by political instability, overlapping health threats, natural disasters and conflict for over 40 years. It is widely regarded as one of the world’s largest and most complicated protracted humanitarian crises. Humanitarian needs continue to rise owing to the sharp economic decline and the devastating combination of decades of conflict, disasters such as recent earthquakes and recurrent natural drought and floods that exacerbated several outbreaks of infectious diseases.
Some 24.4 million people, or 59 per cent of the estimated population, have needed humanitarian assistance in 2022, up from 18.4 million at the beginning of 2021. As of year-end 2021, 5.5 million Afghans were displaced, either internally or outside the country.
WHO Health Emergencies Programme (WHE) has been working with multiple partners to serve the people of Afghanistan by tackling critical health emergencies. The Programme aims to reduce avoidable morbidities and mortalities due to the current crises through increased availability of life saving healthcare services.
WHO is following two strategic priorities in addressing the country’s health needs:
- Delivery of basic and essential health services at current health facilities while extending coverage and service delivery to underserved areas.
- Focus on most needed life-saving health service delivery such as trauma care, emergency maternal, neonatal and child health services including immunization so such services being expanded and scaled up all over the country.
The Health Cluster aims to relieve suffering and save lives in humanitarian emergencies while advancing the well-being and dignity of affected populations. The Health Cluster provides a valued platform for existing humanitarian partners to share information, coordinate and jointly plan for health service delivery, and bridge gaps, with the ultimate aim of maintaining and expanding health facilities and services.
The health cluster coordination mechanism exists at the national and seven sub-national levels, and it is carried out by a dedicated coordination team. The Health Cluster has more than 50 active partners delivering health services and assistance through static and mobile health facilities across 34 provinces of Afghanistan.
The Health Cluster, led by the WHO, ensures effective coordination and service delivery reaching 14.7 million of the 18.1 million people in need of health assistance in 2022.
WHO has been supporting the provision of quality healthcare for vulnerable populations in Afghanistan, including internally-displaced populations, returnees, refugees, and those affected by natural disasters and emergencies. According to the Health Resources and Services Availability Monitoring System (HeRAMS) baseline report (2022), among 4100 public health facilities, 86% were fully functional and the remaining 14% were partially functional, and 77% were stocked out with essential medicine and supplies.
Improving access to quality healthcare services is critical for people’s health. While the health system remains fragile, WHO and its partners continue to work to sustain and expand essential quality healthcare services at the community, primary, secondary, and tertiary care levels. WHO, through the implementing partners, supports the health service delivery in more than 200 primary health care centers across the country, as well as 17 secondary and tertiary hospitals to meet increased service demand.
Afghanistan remains vulnerable to the threat of epidemic- and pandemic-prone diseases and continues to face multiple disease outbreaks: the COVID-19 pandemic has significantly impacted the country. A significant surge of acute watery diarrhea (AWD) cases has been observed across the country in 2022. For measles, all provinces continue to report cases. Crimean-Congo haemorrhagic fever (CCHF) is endemic in the country, while new dengue fever cases have been reported in the country since June 2022. In addition, the rapid global spread of monkeypox is of concern.
WHO is committed to enhance the early warning and response (EWAR) function of the national disease surveillance and response (NDSR) system at national and sub-national levels. This includes building the capacities of the NDSR system at all levels, expanding laboratory capacities, and supporting infectious disease hospitals and wards to improve case management and reduce case fatality rare. WHO is also working with water, sanitation and hygiene (WASH) and other sectors to tackle cross-cutting issues to mitigate the risks of infectious diseases outbreaks.
In Afghanistan, women and children are still exposed to various health risks. Maternal and neonatal mortality and morbidity rates are particularly high in conflict settings due to limited, non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC). In 2019, the WHO-led UN Maternal Mortality Estimation Interagency Group (MMEIG) estimated a maternal mortality ratio of 638 per 100,000 live births. Under five mortality and newborn mortality rates were 58/1,000 and 35/1,000 in 2020, respectively.
WHO and its partners are working to ensure access of life-saving health interventions for safe motherhood through basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) care. WHO is working on functionalizing and strengthening BEmONC and CEmONC facilities by providing training and rehabilitating the buildings of the facilities and building capacities of healthcare workers and provision of needed medical equipment to health facilities at national and sub-national levels.
Gender-based violence (GBV) and sexual exploitation and abuse (SEA) often increase during emergencies. In Afghanistan, family violence, forced and early marriage are also contributing factors to GBV. GBV has severe consequences on the safety, dignity, and wellbeing of women and girls, negatively impacting their physical, sexual and reproductive and mental health as well as their social well-being.
WHO and its partners are striving to ensure access to safe, equitable and inclusive health and reproductive health care services and information to GBV survivors. WHO has continued to provide medical and non-medical supplies for treatment of GBV survivors through national advanced GBV referral center, as well as train healthcare providers on GBV treatment protocol including responding to GBV and GBV-related health and case management for survivors.
The UN and WHO have a zero-tolerance policy with regard to SEA and takes its responsibility to ensure its prevention very seriously. WHO and its partners provide training for their staff and healthcare providers on PSEA.
Logistical and operational capacities at national level underpin all emergency health responses in Afghanistan, and they are especially needed to sustain healthcare services for the most vulnerable, support outbreak, natural disaster and critical incident responses, WHO coordinates multiple-channel procurement and distribution through the identification and aggregation of demand, forecasting, certification, safe storage, sourcing, allocation and delivery of essential supplies to where they are needed most. Prepositioning supplies in preparation for emergencies is also critical, especially considering the country’s unstable setting.
WHO’s procurement and logistics operations capacity in Afghanistan has been scaled up to enable the country to meet the increasing demands for supplies and equipment, connecting eight warehouses across the. WHO manages charter flights with medical and non-medical supplies and equipment. Sea transport supplements air cargo transport of medicines and supplies, which will enable more predictable supply lines in the long term.
Quality health data and information further strengthens the health system, enabling decision-makers at all levels to identify problems and needs, make evidence-based decisions on health responses and optimally allocate resources. Under the Cluster approach, WHO’s health information management system provides high-quality, dynamic data and produces a wide range of information tools on health status, health partner operations and progress by collecting and analyzing data. WHO produces information products covering different type of response activities such as risk assessment, trauma and physical rehabilitation service, medical supplies, and capacity building.
Continued armed conflicts and frequent natural disasters have heavily burdened the country. Significant gaps in emergency and trauma care remain to meet high demand with occurring injuries. Based on WHO data on trauma presentations to hospitals with associated mortality in 2021, case fatality rates ranged as high as 10%, with large numbers of trauma victims of violence, road traffic, and occupational injuries.
To reduce morbidity and mortality due to trauma, WHO is enabling trauma and emergency care, as well as physical rehabilitation services, across the country. WHO established a standard emergency unit, supports physical rehabilitation centers and Kabul radiology institute, continues delivering medical supplies, kits, and equipment to critical trauma care hospitals and blood banks, including the Kabul National Blood Bank service. To provide pre-hospital emergency services for injuries, WHO established and maintaining an ambulance network in four provinces (Kabul, Wardak, Hirat, Parwan) with 60 ambulances. In addition, WHO continues its effort to strengthen national capacity of trauma care services by conducting several training programs for healthcare workforce, such as Basic Emergency Care and Mass Causality Management.
Based on the integrated food security phase classification (IPC) (Jun-Nov 2022), 18.9 million of the population (45%) face high levels of acute food insecurity which increases malnutrition among the most vulnerable population, including children and pregnant and lactating women (PLW). The Nutrition Cluster estimates that 27 out of 34 provinces are above the emergency threshold for acute malnutrition. At least 3.9 million people needed acute malnutrition treatment services in 2021, including one million children under five with severe acute malnutrition (SAM), 2.2 million children under five with moderate acute malnutrition (MAM), and 0.7 million PLW with acute malnutrition. Stunting already stands at a staggering 41% in Afghanistan,
WHO continuously supports the inpatient management of severe acute malnutrition services through 123 IPD-SAM centers across the country. WHO supports, promotes, and protects infant and young child feeding through, increasing awareness among people, counseling mothers on breastfeeding and complementary feeding, and implementing of breastmilk substitute code and baby-friendly hospital initiative (BFHI). WHO also supports health facility nutrition surveillance systems in the country to monitor the trend of nutritional status among children under five years of age and increase case finding and referral system.
Devastated by decades of war and political violence, virtually every household has been impacted by instability, poverty and/or mental health problems. With the ongoing crisis in Afghanistan, many people have become displaced, losing their homes, possessions and loved ones. Consequently, one in two people living in Afghanistan suffers from psychological distress.
Mental health services are scarce across the country. A survey in October 2021 showed that only 3% of people visiting health centers are there for their mental health. WHO estimates that Afghanistan has only 0.23 psychiatrists and 0.30 psychologists per 100,000 people. While the prevalence of mental health problems is high in the country: 4.86% of the population suffer from depression, 2.78% from General Anxiety Disorder (GAD), 5.34% from Post-Traumatic Stress Disorders (PTSD), and 48% of the population have High Psychological distress (National Mental Health survey 2018).
WHO works with partners to fill critical gaps in mental and psychosocial health treatment. These efforts include supporting the National Mental Referral Hospital in Kabul with the provision of medical kits, building capacity through training of medical doctors working at BPHS and EPHS facilities on diagnoses and case management in line with mental health Gap Actin Program (mhGAP), and offering training on Psychological First Aid and Stress Management for Community Health Workers and Supervisors across Afghanistan. Also, a strategic approach to drug addiction support is in progress.
Quality water, sanitation and hygiene in healthcare facilities are necessary for infection prevention control, reductions in antimicrobial resistance, and safe health services for all.WASH services in healthcare facilities are needed more than ever to protect both patients and healthcare workers. This includes insufficient basic water services, toilet, septic tanks, water supply networks, and handwash basins. In addition, healthcare waste management has been overlooked. Healthcare waste contains potentially hazardous materials that can infect hospital patients, healthcare workers and the general public.
Together with its partners, WHO is scaling up activities to improve WASH in healthcare facilities through establishing a water network, equipping facilities with toilets, and installing waste management containers and incinerators.
Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, respiratory diseases and diabetes, are the leading causes of deaths worldwide, resulting in more deaths than all other causes combined. In Afghanistan, almost 45% of deaths are due to NCDs and over 20% of deaths are caused by injuries. NCDs result in over half (52.3%) of deaths in women between 15 and 59 years while less than 38% in men of same age group.
NCDs have been driven by mainly unhealthy diets, tobacco use, and physical inactivity. And given the fragile health system in the country, NCDs pose devastating health consequences for the vulnerable population and can overwhelm health facilities, as NCDs often require long-term interventions.
Addressing the acute situation of chronic diseases in emergencies is an important priority in Afghanistan, especially in urban and remote rural areas where healthcare access is limited for displaced and elderly populations. WHO and its partners are working on health promotion for prevention of NCDs, as well as strengthening early detection and timely treatment.
To ensure proper oversight of health emergencies project implementation, WHO has conducted systematic and regular monitoring and evaluation (M&E) activities using specific tools based on the type of health interventions. This includes supervisory site visits by WHO M&E officers in each province to assess the progress of projects and initiate targeted follow up based on the findings. Furthermore, WHO assesses monthly self-reporting from implementation partners against a set of agreed indicators and regularly conducts programme meetings with its partners to review the findings through a structured action tracker Gantt Chart. This allows timely interventions and support as needed to ensure quality healthcare services for people in need and maximizes the impact on public health.