When the first case of the coronavirus was confirmed in Afghanistan’s Herat province on Monday, the war-torn country was already taking precautions for a potentially larger outbreak.
Land borders in Herat, which borders Iran, have been closed to prevent the virus from spreading further. Two other provinces bordering Iran - Farah and Nimroz - have likewise shut their entry points. According to the National Security Council in Afghanistan, all travel - both by land and air - to and from Iran has been suspended. Food imports from Afghanistan’s western neighbour have also been halted.
At least 12 people have died of the virus in Iran and at least dozen others were infected, mainly in the city of Qom, Iranian state TV reported. But the country’s semi-official ILNA quoted an official in Qom saying the number of dead in the city was closer to 50.
Around 3,000 people usually cross the border between Iran and Afghanistan illegally every day, using unofficial border points, the WHO said.
One person has so far tested positive for coronavirus, now known as Covid-19. More suspected cases have been sent for testing from Herat.
All of the suspected cases returned from Iran’s Qom, where they attended a religious gathering. The virus has killed at least 12 people in the country.
Afghanistan’s minister of public health, Ferozuddin Feroz, said that preparations were already underway to respond to the virus. The ministry of public health, together with the World Health Organisation, have set up committees to handle surveillance, case management and risk communication, he said.
But the war-torn country, strapped for cash, is already facing a political crisis, with a potential health crisis adding to pre-existing issues. Last week, President Ashraf Ghani was reconfirmed in office for another five years, a result disputed by his main rival Dr Abdullah Abdullah. Afghanistan is also observing a seven day reduction in violence, followed by the signing of a peace deal between the US and the Taliban that could see large-scale US troop withdrawal.
At the central public health laboratory in the capital Kabul, Alimi Sahib is currently one of the project managers working to detect the virus. In a country of 35 million, he explained that adequate testing equipment is lacking. Right now, he said, it is not a problem, as few suspected cases have been detected, but it might become an issue in the future.
“We currently have three functional polymerase chain reaction machines here,” he explained, referring to the detection devices that test oral swabs for the virus.
“We need to decentralise to the regional level,” he added. Saliva swabs from Herat, about an hour’s flight from the capital, have so far been sent to Kabul for testing.
At the Afghan-Japan Communicable Disease Hospital in Kabul, doctors are preparing for a potential outbreak.
The clinic on the hilly outskirts of the city has been turned into a coronavirus treatment-only hospital. Prior to the outbreak in China’s Wuhan, HIV and tuberculosis patients received medical care here. Now the hospital is empty of patients. Bed frames sit outside in the sunny parking lot. The 60-bed clinic has already been expanded to 100 beds, but there’s room for more.
“We’re ready,” said Dr Hamid Sepass, who works in the outpatient department.
The clinic’s brand new visitor’s book lists the names of the few individuals who feared they had contracted the virus and came for testing.
“I’m not afraid. I’ve treated different diseases in the past and I know that we can stand up to the challenge,” Dr Sepass explained But he acknowledged the mood is different on the streets.
“Of course people fear the virus. Everyone is talking about it. People are starting to wear face masks,” he said.
Afghanistan’s national health budget currently allocates about $5 annually to each citizen for healthcare. The World Health Organisation said that at least $3.5 million was needed to adequately prepare for a virus outbreak - Kabul, a crammed city of at least 6 million people, is vulnerable.
“We’re already creating awareness through brochures, radio and television ads, and besides that, more than 700 coronavirus reporting sites throughout the country have been allocated,” said the World Health Organisation’s Dr Muntasir Elhassan Elnoor, adding that culture and tradition had to be considered. Many Afghans have big families and keep close contact with friends and relatives.
Back at the Afghan-Japan Communicable Disease Hospital, Dr Sepass counts the number of ventilation machines - used to supply oxygen in severe cases of respiratory illness - with his hands.
“We have just a few, and new ones come at $12,000,” he said. His voice echoed in the hospital’s hallways, eerily empty.
“We’ve prepared, but we hope this clinic will stay empty,” he said. “We already have a lot of suffering here in Afghanistan.”