The International Organization for Migration (IOM) has been providing essential health services to people on the move and hard-to-reach populations in Afghanistan for three decades, and has stood on the front lines of the UN's COVID-19 response in the country, with presence currently across four border provinces: Herat, Nimroz, Kandahar and Nangarhar. Since the beginning of the year, almost half a million people have received essential health assistance from IOM. IOM’s health teams now are rapidly preparing to increase capacity and adapt support to fill urgent gaps to help ensure that the Afghan health-care system does not collapse in the medium term.
More than 40 years of conflict have shaped Afghanistan into a country with one of the lowest scores in the Human Development Index. Its population faces a life expectancy of only 50 years, and a high percentage suffers from severe health conditions. The country is burdened by the effects of environmental pollution and is one of only two in the world where polio remains endemic.
Conflict, natural disasters and the COVID-19 pandemic have forced nearly half of Afghanistan's 40 million people to seek urgent humanitarian assistance in 2021. This number has also been forecast to dramatically increase. Among other factors, a collapsing economy, difficulty obtaining health services, rising food insecurity, and shrinking access to safe drinking water dramatically increase the pressure on the population’s physical and mental health.
In 2021, the number of people with physical trauma increased by at least one third, 54 per cent of Afghans report limiting their meal sizes, and half of all children under five are expected to face acute malnutrition.
Providing life-saving health care
IOM is currently providing health-care services in eight provinces in Afghanistan. One way is through IOM’s mobile health teams (MHTs), that offer services to communities in border regions, mostly to returnees, refugees, and internally displaced persons (IDPs) who typically have very limited access to or are underserved by the country's established health facilities. MHT services include basic health care and referrals for specialized care, as well as reproductive health services, health promotion, routine immunizations, and nutrition support – and will soon expand to include COVID-19 vaccination services. Additionally, mental health and basic trauma care is offered. Before 15 August, when the Taliban took control in Kabul, seven MHTs were active with 60 staff in 93 villages in coordination with the Ministry of Public Health.
Despite the recent upheaval, currently, seven of IOM's MHTs are operational in four border provinces. Assistance is also planned to be expanded imminently to Kabul, the western province of Ghor, and the northern provinces of Balk, Badakhshan and Badghis. In these northern provinces, IOM is scaling up to further support the Provincial Public Health Department with MHTs, rapid response teams (RRTs) for COVID-19 and additional vaccinators.
Mitigating the health impact of COVID-19
The COVID-19 pandemic has hit Afghanistan from various sides: low testing capacity, limited clinical infrastructure to treat severe COVID-19 cases, and lack of vaccines and trained health staff. To limit the pandemic’s impact on the population, IOM’s RRTs, composed of 100 health staff, offer COVID-19 screening, contact tracing, vaccination, health education, risk communication and community engagement, as well as training of community health workers and other medical personnel to help build capacity within the national health system.
After a two-week interruption in services following the Taliban taking power in Kabul, IOM has resumed its COVID-19-related assistance in all four border provinces and is also in the process of expanding the RRT response to the northern provinces of Balkh, Badakhshan and Badghis.
In Afghanistan, the recent freezing and subsequent restructuring of the system-wide funding for critical health infrastructure has only further compounded existing difficulties to accessing health care and delivering vaccines. On 3 October, IOM facilitated vaccination campaigns in migrant and IDP communities in Balkh and Badakhshan, and COVID-19 vaccination is also underway in Nimroz with IOM's support.
Tackling tuberculosis (TB)
Today, pervasive cultural barriers and stigma remain around tuberculosis (TB), which are worsened by a deteriorating security situation that hinders access to services. COVID-19 further limited TB services due to movement restrictions and a re-allocation of resources. Inadequate human capacity in health facilities and lack of proper quality control processes in public laboratories also compound the situation. Further, treatments for many were interrupted or stopped, which has sharply increased the risk of negative health outcomes for those infected with TB, alongside increasing the risks of drug resistance.
IOM enables these critical TB services to continue in border communities by actively seeking cases, utilizing its diagnostic capacity, facilitating laboratory testing and providing support (including referral support) to people who are TB positive.