Around 70 doctors and nurses from 361 employees at Kunduz Regional Hospital – the main health facility in several troubled provinces in northeastern Afghanistan – are either infected with the corona virus or quarantined if they are suspected of being infected. But there is nothing left to do but keep the doors open, said Dr. Naeem Mangal, the hospital director. Doctors cannot refuse the dozens of war casualties that arrive every day, as fighting rages every night within earshot of the hospital.
“The hospital has to be quarantined, but what alternative do we have?” said Dr. Mangal. “We were so concerned that we are all afraid of each other in the hospital because we don’t know who is infected and who isn’t.”
Afghanistan’s weak health care system – dependent on foreign donations, even for the $ 5 a capita the country spends on health annually, and dependent on non-governmental organizations to provide its most basic services – was tested by the pandemic’s spread at a time, as the The war with the Taliban continues nationwide.
The tests remain extremely limited here, but by Thursday the country had registered just over 2,100 cases, with at least 160 among medical professionals, and 64 deaths. There is a risk that hospital visits will actually promote the spread of the virus.
Officials from several provinces said the infections are unlikely to have peaked. But the number of confirmed cases, along with concerns about undiscovered cases, is already putting a strain on healthcare facilities, forcing hospitals, protocols, and rations between war victims and virus-infected people to improvise.
Dr. Mangal said his Kunduz hospital, where 23 out of 37 confirmed cases are medical personnel, asked people to visit the hospital only for serious emergencies.
Every night the fight rages within two to three miles around Kunduz city center and they cannot refuse the wounded war. For other patients, about half of the hospital turns away. (Between 100 and 150 new patients are still being treated every day, about half of whom are injured by violence, said Dr. Mangal.)
On Thursday, Afghan Minister of Health Ferozuddin Feroz said the spread of the virus had continued, as reported by W.H.O. Models that indicated that more than half of the population could be infected.
“We had 500 tests yesterday and about 232 were positive,” said Feroz, an emergency surgeon during the country’s bloody civil war in the 1990s. “That would indicate that the infection is really circulating in society.”
Citing the Spanish flu, which lasted three years, Mr. Feroz feared that an impoverished place like Afghanistan could not fight coronavirus for months, but for years.
The government’s ban on large gatherings and the enforcement of some level of blockage in major cities slowed the spread, he said, but too many people disregarded these measures.
Some Afghans have been influenced by religious leaders who disregard advice and continue to pray hundreds and sometimes thousands of people. Even the country’s senate refuses to cancel meetings and respect the government ban on large indoor gatherings.
In a broader sense, the deep poverty of the country, where people depend on the wages they earn every day, has made it impossible to enforce barriers. A western official who spoke anonymously to inform a reporter estimated that approximately 80 percent of the population was already living on less than $ 1.25 a day – just 25 cents more than the poverty line.
Food shortages are widespread across the country. In Kabul, the government started on Wednesday to distribute bread to over 250,000 families across 1,200 bakeries across the city. Depending on the number of family members, each family receives 4 to 10 loaves of bread once a day. It is an immediate measure to prevent starvation deaths and will expand to other cities in the coming days. However, the crowds outside the bakeries on the first day of the spread raised concerns that the measure will also promote the spread of the virus.
In several provinces, medical workers and hospitals bear the brunt of the virus.
A hospital in the northern province of Faryab, where fighting continues in several districts, could be forced to change the I.C.U. to quarantine. Section of their only hospital, said the governor, Naqibullah Faiq. He said it had “become a source of the virus’s spread” after a nurse there tested positive and another patient died of the virus.
In Kandahar, the director of public health, Dr. Tawus Naderi that the main regional hospital serving multiple neighboring provinces plans to hire 300 new health workers. In the meantime, the slightly sick, with 41 doctors and nurses who are infected with the coronavirus, will help care for the seriously ill.
“We have delivered the infected healthcare workers to the Covid-19 hospital and created a mechanism whereby healthier patients care for the heavier Covid-19 patients to fill the gap,” said Dr. Naderi.
A major factor limiting the country’s response to the virus is the raging war. The Taliban have declined a ceasefire request for humanitarian reasons, despite highlighting the virus threat by demanding that their prisoners be released immediately from prisons where the virus has spread. The head of the Taliban The health commission in Kunduz province has also been infected and is self-isolating, local insurgents confirmed.
Health Minister Feroz said his employees across the country are facing a challenge that the impoverished nation is unprepared for. When planning the worst-case scenario, they created a database of 10,000 new healthcare workers as a backup, which they can use when hiring new staff if the current staff is infected or needs additional assistance.
Mr. Feroz said he was optimistic about how low the country’s coronavirus deaths have been – something he said could be partly attributed to the fact that Afghanistan is a young country where about 60 percent of the population is younger than Are 25 years.
“It is possible that we have more deaths that are not reported to us,” said Feroz. “But we didn’t see any mass deaths.”
Reporting was contributed by Taimoor Shah, Asadullah Timory, Fahim Abed, Fatima Faizi, Farooq Mangal and Zabihullah Ghazi.