The Afghanistan Humanitarian Crisis in Relation to Vaccine-Preventable Disease Spread

Introduction

            Undoubtedly, for many decades Afghanistan has experienced protracted civil and military conflicts- coupled with natural calamities- which have significantly affected the state of social and economic development. As such, the events have led to development of a massive humanitarian crisis in the Central-Asia nation (Narain et al., 2022). From a research perspective, a humanitarian crisis emerges as an event or a series of events that largely threatens (risks) the health, wellbeing, and safety of persons in large populations. Indeed, humanitarian crises results from the outbreak of famine, disease, natural disasters, and war (Lucero-Prisno III et al., 2020). Majorly, children and women comprise the most affected populations after the occurrence of a humanitarian crisis. In Afghanistan, the wars and conflicts have led to the development of over 0.5 million IDPs (internally-displaced-persons) who trek throughout the country in search of safe and conflict free zones.

            Certainly, the movement of IDPs creates a severe strain on the healthcare infrastructure in the country, Afghanistan. Moreover, a high percentage of Afghanistan’s population is majorly rural; however, the nation is highly urbanizing at a steady rate of 6% per annum (Martellucci et al., 2021). The statistic indicates that roughly five (5) million persons are presently residing in slums in their quest for urbanization; thus, introducing a new public healthcare menace due to poor sanitation in the slum dwellings. Afghanistan- as a result of the military and civil conflicts- faces numerous public healthcare challenges, especially in the management of infectious, and highly communicable diseases such as diarrhea and typhoid (Lucero-Prisno III et al., 2020). Further, Afghanistan experiences stumbling blocks in the pursuit to control the spread of vaccine-preventable diseases (VPDs) such as, polio, COVID-19, and MMR (Measles, Mumps, and Rubella) (Narain et al., 2022). From the backdrop, a review and critical analysis of the relationship between the humanitarian crisis in Afghanistan and the spread of vaccine-preventable diseases (VPDs) forms the foundation of the paper.

Background and Overview of VPDs in Afghanistan

            COVID-19, a highly contagious and infectious disease continues to cause havoc in Afghanistan due to the informal dwellings in slums and IDPs’ camps where proper sanitation lacks due to poor or no access to piped water (safe for drinking and cooking) and the limitation in access to private latrines that limit contamination with human waste. Indeed, the humanitarian crisis in Afghanistan adversely affects the vaccination efforts to limit the spread of COVID-19 since the war-torn zones are difficult to access by the health workers (Martellucci et al., 2021). As such, the spread of COVID-19 amidst the humanitarian crisis in Afghanistan has increased tremendously (Narain et al., 2022). Thus, international health and humanitarian organizations have advanced talks with the Taliban administration in a bid to reduce the spread of the disease and reduce mortality rates, especially among young children, women, and the elderly.

            Further, Polio- an extremely contagious, but vaccine-preventable disease- continues to affect the state of public healthcare in Afghanistan, largely due to the inherent challenges that arise from humanitarian crises (Martellucci et al., 2021). For instance, lack of proper sanitation leads to contamination of food and water sources- these are some of the major causes of Polio among children. During wars and protracted conflicts, it becomes increasingly hard healthcare professionals in Afghanistan to offer vaccination services against Polio to young children due to inaccessibility of the war-torn sections of the country (Martellucci et al., 2021). Wars in Afghanistan have resulted to the destruction of critical water sources such as community reservoirs where people access clean water; thus, when these sources are destroyed the spread of diseases such as Polio increases due to contamination of the food and water.

            MMR (measles, mumps, and rubella) vaccine plays a fundamental role in the management of the spread of the infectious and contagious infections presented in the discussion (Narain et al., 2022). Children in Afghanistan who are at the risk of contracting MMR fail to receive the vaccines on time due to the problems associated with humanitarian crises resulting from wars and conflicts.

How the Afghanistan Humanitarian Crisis Influences the Spread of VPDs such as, Polio, COVID-19, and MMR

Afghanistan Humanitarian Crisis and the Spread of COVID-19

            Agreeably, the multiple humanitarian crises in Afghanistan- over the years- has contributed immensely to the spread of COVID-19 in all the major provinces- 34 in number- including Kabul. The healthcare threat presented by COVID-19 coupled with the limited healthcare capacity and the protracted military and political advancement of the Taliban has promoted the spread of COVID-19 (Lucero-Prisno III et al., 2020). The number of COVID-19 cases in the year 2020 and 2021 rose steadily based on poor containment measures established by the state and the limited diagnostic capacity that has a detrimental effect on the strategies for accurate measurement of the disease. Moreover, the programs for vaccine distribution in an effort to reduce the infection rates have been affected by poor government policy and lack of strategic healthcare plans by the new Taliban administration (Martellucci et al., 2021). COVID-19 has presented a new (novel) health emergency to Afghanistan which has been compounded by the weak healthcare systems by the Taliban administration.

            COVID-19 is a highly infectious and vaccine preventable disease (VPD) that has brought untold suffering to the communities in Afghanistan since it affects all ages risks human health. The internal strife within Afghanistan and the incessant wars have caused massive internal displacements leading to the emergence of the IDPs (Shah et al., 2020). The movement patterns of the IDPs contributes to the spread of COVID-19 to the provinces in Afghanistan. The third (3^rd) wave of COVID-19 has greatly affected the state of public healthcare in Afghanistan largely to the onset of the devastating Delta variant whereby about 60% of the cases from the new variant have been reported in the Kabul province (Martellucci et al., 2021). The highest number of daily cases of COVID-19 were recorded on 16^th June, 2021 whereby 2321 persons were reported to have contracted the infectious disease (Lucero-Prisno III et al., 2020). Indeed, the case analysis reflected a high positivity rate of 48% which is indicative of the poor containment measures resulting from the challenges of the humanitarian crisis in Afghanistan.

            The activities of the Taliban forces have a direct and adverse impact on the humanitarian operations in the country that help to promote access to healthcare services and essential healthcare programs such as vaccines and crucial drugs. For instance, the Afghanistan government under the Taliban administration lacks the requisite capacity to undertake mass testing of the communities in the country (Lucero-Prisno III et al., 2020). The limited testing capacity translates to increased infections through the spread of the viral disease since surveillance measures are weak. Indeed, the Afghan government has only undertaken tests on 664, 045 persons against a staggering population of 40.40 million people (Lucero-Prisno III et al., 2020). The humanitarian crisis in the nation influences the spread of the virus, COVID-19, based on the weak (ineffective) health systems that would otherwise reduce the infection rate of the deadly respiratory-based disease. For instance, Afghan lacks an updated death register (national) and has only thirty-five (35) active medical laboratories in the entire nation (Shah et al., 2020). Thus, some provinces have limited capacity to undertake testing; hence, increasing the chances of infection.

            Further, the wars and conflicts that have characterized the life of residents in Afghanistan have led to the destruction of critical healthcare facilities and installations; thus, affecting the response rate towards the healthcare emergency caused by COVID-19. The limited healthcare capacity- due to the decades of conflict that led to a humanitarian crisis- in Afghanistan manifests in the following shortcomings; low (lack-of) oxygen supply in healthcare centers, limited bed capacity for COVID-19 patients, and reduced vaccination capacity (Lucero-Prisno III et al., 2020). The spread of COVID-19 in Afghanistan continues to skyrocket amidst the humanitarian crisis based on the reality that there are only a limited number of healthcare workers to serve the COVID-19 patients: for instance, at present the ratio of healthcare professionals to the population is 9.4: 10000 (Shah et al., 2020). Thus, one healthcare worker serves a thousand members of the community.

            From the analysis, it emerges that the cases of extreme fatigue among the workers are quite common; hence, their capacity to serve effectively in the fight against the spread of COVID-19 is compromised (Lucero-Prisno III et al., 2020). Moreover, the limitation in the access to PPE (personal-protective-equipment) by the healthcare professionals coupled with the limited access to proper (effective) training on the preparedness strategies for COVID-19 management have a positive influence on the rising cases of COVID-19 in the state of Afghanistan (Shah et al., 2020). Shockingly, the incidents of violence directed towards healthcare workers in Afghanistan, even before the onset of the COVID-19 pandemic, increased in the year 2019 to roughly 75 incidents.

            The causation of these violent attacks is largely due to political intolerance and anarchy; thus, the delivery of healthcare is compromised. When the COVID-19 pandemic hit Afghanistan, the challenges of healthcare- that caused humanitarian crises- compounded the response program to COVID-19 patients (Lucero-Prisno III et al., 2020). Hospitals in Kabul were attacked by violent militants and healthcare workers kidnapped; hence, these factors caused COVID-19 cases to soar across major provinces in Afghanistan since vaccination programs could hardly be delivered to the citizens (Shah et al., 2020). Without a doubt, the humanitarian crisis in Afghanistan had a massive and direct impact on the spread of VPDs such as COVID-19 in the nation.

Afghanistan Humanitarian Crisis and the Spread of Polio

            The Incidence and Prevalence (Spread) of Polio in Afghanistan

            A 2020 report from UNICEF (United-Nations-Children’s Fund) presents that Afghanistan and its neighboring country Pakistan are the only two prominent polio-endemic nations in the globe. As such, Afghanistan falls under the category of nations that record high prevalence rates of Polio (Ahmadi et al., 2020). From an epidemiological perspective, Polio or Poliomyelitis is a highly contagious and infectious disease- that causes disability- and originates from the polio virus and can be life-threatening (Lin, 2021). The disease can be easily prevented through the polio vaccine and it spreads through (transmitted) the contamination with food and water or through interactive contact with an infected individual.

            For the case of Afghanistan, in spite of the progressive and rigorous efforts to contain the spread of the infectious disease through strategic programs launched by the humanitarian authorities, the number of new polio cases among young children has skyrocketed in the period between 2016-2021 (Lin, 2021). Unfortunately, there is an appalling trend in the polio infection rates per region in Afghanistan since the provinces that had been declared polio-free have recorded increased infection rates. A WHO (World Health Organization) 2020 report indicates that 56 cases of the deadly type-1 of the World Polio Virus (WPV1) have been recorded in 16 provinces in Afghanistan (Ahmadi et al., 2020). Indeed, the southern section of the nation remains highly affected by the incidence of the virus (polio) since it accounts for about 66% of the total cases.

            How the Afghanistan Humanitarian Crisis Contributes to the Spread of Polio

            Certainly, the polio-prevention-program in Afghanistan encounters intense challenges that stifle the efforts to control the spread of the viral disease, especially in the polio-endemic regions of the South, East, and Southeast Afghanistan. A humanitarian crisis has emerged in the nation due to the prolonged conflicts and extensive political instability that have led to the damage of critical socio-economic amenities for the citizens (Lin, 2021). In this regard, weakened (ineffective) health systems, poor (impoverished) livelihoods, under-development (slowed economic growth) have had an adverse humanitarian outcome (Ahmadi et al., 2020). Further, massive (high) population movements have characterized the humanitarian challenge in the nation, Afghanistan.

            Indeed, vaccination programs have been constrained in both the rural and urban dwellings due to the protracted conflict thus exposing young children to the deadly incidence and impact of the fast-spreading disease. Medical professionals and public health officers in Afghanistan have developed fear and demotivation based on the increased cases of violence meted on the healthcare workers in the course of their duty (Lin, 2021). Therefore, the control and preventive programs through vaccination and immunization have been adversely affected leading to increased infection rates of the disease (Ahmadi et al., 2020). Further, the killing of pro-polio leaders in the state sent a message of fear and despondency to the many healthcare workers involved in the vaccination efforts across the provinces.

            The move by the AGE (Anti-Government-Elements) in 2018 (May) to scrap off the house-to-house polio-prevention campaigns negatively impacted the strategies to control the prevalence of polio among young children. As a result of the ill-intentioned action by AGE, the cases of Polio soared to extreme levels since about 3.4 million failed to receive their requisite immunization dosage- the prevalence rates grew steadily (Ahmadi et al., 2020). Indeed, the situation worsened in 2019 (April) when AGE instituted a nation-wide prohibition (ban) on all types of vaccination programs in Afghanistan thereby exposing about 10 million young children to the dangers of the deadly polio virus (Lin, 2021). Agreeably, the operations of the militant groups in Afghanistan significantly affected the measures to control the spread of polio in the communities.

            As such, the scenario presented above on the issue of the bans by AGE help to demonstrate the devastating impact of the humanitarian crisis on the control of endemic diseases such as polio in Afghanistan. In the year 2020, when the incidence of the COVID-19 infections hit the globe, Afghanistan experienced the adverse impact that the disease, COVID-19, had on the preventive measures related to other infectious diseases such as, Polio (Lin, 2021). Thus, the COVID-19 pandemic massively affected (disrupted) all the campaigns directed towards the containment of polio in Afghanistan for about five (5) consecutive months therefore causing a vast gap in the immunization schedules for children (Ahmadi et al., 2020). As a result, the number of polio infections per household in Afghanistan increased tremendously due to the clear disruption in the vaccination and immunization programs for the children. Hence, the humanitarian crisis in Afghanistan contributed to the escalation of the prevalence rates of polio.

Afghanistan Humanitarian Crisis and the Spread of MMR (Measles, Mumps, and Rubella)

            The humanitarian and public health initiatives to eradicate measles in Afghanistan have failed to bear much fruit due to the vast humanitarian crisis that the nation has experienced in the past two decades and recently the COVID-19 pandemic has dramatically led to the exacerbation of the situation (Islam et al., 2022). Indeed, Afghanistan has a weak (fragile) healthcare infrastructure that has deteriorated over the years due to the decade-long conflicts and internal strife (Martellucci et al., 2021). Hence, it has become increasingly difficult for the healthcare providers and humanitarian assistance to reach the masses- children- in the quest to offer vaccination services and immunization programs.       

            Without a doubt, the ever-growing political turmoil in Afghanistan has led to the surge in the prevalence rates of measles since the preventive actions are blocked by the hostile troops. For instance, the South, East, and South-East sections of the country have progressively recorded high infection rates of measles (Martellucci et al., 2021). It is due to the hostile nature of the regions characterized by insecurity, abduction and attacks on healthcare providers, and retrogressive policies that place a ban on the eradication campaigns through vaccinations. The movement of internally-displaced-persons (IDPs) within the borders of Afghanistan has contributed- to a great extent- the spread of measles in the nation (Islam et al., 2022). The aspect bases on the understanding that the deplorable living conditions of the IDPs and the contamination with disease-spreading contaminants such as fecal elements increase the susceptibility to the measles.

            The recent outbreaks of measles in Afghanistan have been occasioned by the growing supply chain problems that affect access to preventive medication whereas the issue of COVID-19 pandemic has affected the efficiency of the healthcare workers and the humanitarian organizations involved in the immunization programs of the disease (Martellucci et al., 2021). Further, high rates of transmission coupled with increased mortality rates among the IDPs in the state of Afghanistan have presented a challenge in public healthcare system in the nation. Actions have been undertaken to ensure that the vaccination measures to the urban and rural areas are executed in a bid to reduce the fast-rising cases of infection among the children (Islam et al., 2022). The humanitarian crisis in Afghanistan characterized by the damage to the healthcare infrastructure has exacerbated the challenge of increased prevalence rates of measles since the citizens have limited access to the healthcare (preventive) services within their locations.

            Thus, the access of the MMR vaccine is extremely limited due to the problems such as hostile neighborhoods, increased insecurity, and poor healthcare policies introduced by the inhumane militant groups operating in Afghanistan (Martellucci et al., 2021). The COVID-19 pandemic presented a twin challenge to the preventive strategies of measles based on the understanding that healthcare providers failed to access particular locations due to lockdowns and containment measures established for COVID-19 (Islam et al., 2022). Therefore, the humanitarian crisis in Afghanistan- as a whole- has significantly affected the control of infection rates for measles thus leading to increased cases of infection to the disease.

The Afghanistan Humanitarian Crisis (the prevalence of VPDs) and the Relevance to Humanitarian Operations in Afghanistan

            Fundamentally, humanitarian operations in Afghanistan have been severely affected by the ever-growing humanitarian crisis in the country. Indeed, the common and characteristic challenges of the humanitarian crisis include; food insecurity, displacement, violence, and the deterioration of essential (critical) services such as medical care (Shah et al., 2020). Human activities have been compromised by the operations of the Taliban forces. Certainly, the Taliban forces wage wars and fund internal conflicts with the aim of making the state ungovernable (Narain et al., 2022). Therefore, the programs (operations) of the humanitarian organizations are adversely interfered with as they seek to promote the well-being of the Afghanistan people.

            International humanitarian organizations have set base in Afghanistan as they strive to achieve the common good of the Afghanistan communities through the provision of basic and essential humanitarian support services such as, healthcare, food and nutritional services, sanitation support, and shelter support (Shah et al., 2020). Indeed, the humanitarian crisis results in the destruction of critical healthcare installations that help to promote the societal wellbeing through preventions of VPDs such as, Polio, MMR, and COVID-19.

            The operations of the humanitarian organizations including UNICEF, WHO, USAID, and United Nations are focused on ensuring that Afghanistan gets back on its feet and regains the capacity to provide for its people through institution of crucial services that touch on humanity (Narain et al., 2022). In that case, dialogues and multilateral talks (proceedings) are being conducted with the aim of softening the Taliban’s administration hardline positions on the issues that touch on the common wellbeing of the citizens (Shah et al., 2020). They include, provision of vaccination and immunization services to the young children in the rural and urban areas- including the children within the IDP camps.

Conclusion

            From the research, review and critical analysis, there is a concise and direct relationship between the humanitarian crisis in Afghanistan and the spread of vaccine-preventable diseases. Indeed, the wars and conflicts in Afghanistan have led to the development of about 0.5 million IDPs (internally-displaced-persons) who have tremendously contributed to the increased cases of the VPDs in the provinces of Afghanistan. For Afghanistan, the military and civil conflicts have affected the public healthcare delivery, especially in the control of infectious and highly communicable diseases such as, polio, MMR, and COVID-19. The humanitarian crisis cripples the operations of the humanitarian organizations such as, United Nation agencies and the USAID. Interventions between the international humanitarian bodies and the Taliban administration have helped to promote access to humanitarian aid, especially medical support to the people of Afghanistan.

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