key: cord-0881782-6ksnksc8
authors: Yasmin, Farah; Najeeb, Hala
title: Access to healthcare services for Afghan refugees and deepening medical crises due to war amidst COVID‐19 pandemic
date: 2021-10-20
journal: Int J Health Plann Manage
DOI: 10.1002/hpm.3372
sha: 509ebea694e31cffde23e3a469422dc7f64ae59d
doc_id: 881782
cord_uid: 6ksnksc8

nan

During the pandemic, economic instability across the globe led to an influx of refugees from European Unions, Pakistan and Iran back to Afghanistan. Additionally, Internally Displaced People (IDP) from remote Afghanistan have fled to bigger cities like Kabul, 2 cramping refugee camps and burdening the available sanitation facilities. The increasing incidence of COVID-19-like symptoms amongst the Afghans is a result of a lack of social distancing. Conflict and unemployment have led to malnutrition, while unsanitary conditions have emancipated GI-related conditions in the local population. 3 With little attention to the social needs, the prospect of a crumbling healthcare system will be evident if the polio-endemic re-emerges in the country. 4 WHO recommends 22.8 skilled healthcare professionals per 10,000 individuals; Afghanistan only has 9.4 skilled healthcare professionals. 5 The shortage of healthcare workers is predicted to increase as financial insecurity and fear of political unrest drives many out of Afghanistan. 6 The attack on Dasht-e-Barchi in 2020, a government-run maternity hospital in Kabul, took the lives of healthcare professionals and patients, jeopardizing women's access to basic health care. 5 Since then, non-profit organizations like Médecins Sans Frontières (Doctors Without Borders) have withdrawn from serving the country, jeopardizing all contributions to health care made in the past 17 years. In the six months preceding the invasion of the Taliban, armed attacks on healthcare workers killed 12 and damaged 26 medical facilities. 3 Between August 1st and 6th, MSF has reported having treated over 150 patients with war-inflected traumas. 7 Scattered hospitals and clinics make patient transfers from remote areas difficult, delaying treatment. Adding to this is the issue of inadequate diagnostic facilities which has affected coronavirus testing. 8 The B.1.617.2 (delta) variant, with higher morbidity and mortality has been detected in 60% of the cases in Afghanistan. 7 With a majority of Afghans earning only USD 1 per day, living below the poverty line has made treatment, COVID-19 tests and vaccines unaffordable. Under the COVAX agreement, the Afghanistan Ministry of Public Health received initial doses of COVID-19 vaccines. However, as war affects trade routes, the rate of COVID-19 vaccination has seen a decline, with many awaiting their second dose. 7 Afghans seeking asylum under these conditions risk the spread of coronavirus infection in countries of immigration.

Although developed nations such as Germany have raised 17 million euros for healthcare and other projects in Afghanistan, 9 a strategic policy change is required to sustain Afghanistan. UNDP and Aid Community collaboration has allowed the home-based provision of healthcare to IDP which has highly benefitted women and children. 2 Ministry of Health Policy had previously introduced a pay-for-performance 'Sehatmandi' project, funded by the World Bank. This was able to sustain the burden of caesarean deliveries, surgeries, and outpatient visits for vaccinations. In current times of political instability, this model is necessary for a successful healthcare delivery system. 10 

152,497 cases and 7,065 deaths. Worldometer. Accessed 20

Mobile Healthcare Teams Continue to Provide Essential Services in Afghanistan

Protect Patients, Health Workers and Facilities: WHO to All Parties in Afghanistan

Polio in Afghanistan: the current situation amid COVID-19

Conflict and COVID-19: a double burden for Afghanistan's healthcare system

Addressing health workforce shortages and maldistribution in Afghanistan

WHO warns of increasing disease including Covid-19 in Afghanistan. The Independent. Accessed 20

COVID-19: the current situation in Afghanistan

Forgotten crises: healthcare for refugees in Afghanistan -Afghanistan

Improving health service delivery in conflict-affected settings: lessons from a nationwide strategic purchasing mechanism in Afghanistan

Vietnam's success story against COVID-19

Medical needs as urgent as ever in Afghanistan after Taliban takeover

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Hala Najeeb https://orcid.org/0000-0001-7075-4674