The Epidemic in Afghanlstan

According to the WHO Global Dashboard, as of 25 March 375,498 cases of COVID-19 have been confirmed and 16,362 deaths have been reported across 195 countries. On 11 March, WHO declared the COVID-19 outbreak as a global pandemic. Physical distancing measures can help to slow transmission of the virus and reduce the burden on the health system. But to suppress and control epidemics, countries must isolate, test, treat and trace. As the virus moves to lowincome countries, WHO is deeply concerned about the impact it could have among populations with high HIV prevalence, or among malnourished children – the latter being of particular concern in Afghanistan. Travel restrictions by countries are changing rapidly and should be monitored on daily basis. Wide commercial flight suspensions to Kabul are now coming into force and the United Nations Humanitarian Air Service (UNHAS) is investigating options for a possible international air-bridge service, although this would be dependent on funding and other considerations.   

A total of 75 people are now confirmed to have the virus in 12 provinces – Hirat, Samangan, Balkh, Daikundi, Farah, Kapisa, Badghis, Logar, Zabul, Kandahar, Ghazni and Kabul. Most people with the virus have a travel history outside Afghanistan. The cases are predominantly men, although one woman has now tested positive. Afghanistan has recorded its first fatality from the virus. A 40-year old man has died in Balkh Province. He had no prior travel history. Contact tracing for the people confirmed with COVID-19 is ongoing. To date, testing has been small scale which may account for the relatively low number of confirmed cases given the high number of border crossings with Iran where there are thousands of cases.   

Distancing yourself from others is the best protection against the further spread of the virus however there are concerns that is not being widely practiced around the country.   The Hirat Provincial Governor announced in a public statement a restriction on movement due to COVID-19 starting today (25 March) along with plans to disinfect Hirat city. Further details on accessing essential services will be shared shortly. The implications of these measures on humanitarian operations and cross border movements are being assessed. On 14 March, the Government of Afghanistan also announced that all schools would be closed for an initial period of four weeks – through to 18 April 2020. The Provincial Governor of Nimroz convened a meeting today in Nimroz to announce quarantine measures for the city of Zaranj including the closure of all non-essential businesses.

Response: UPDATED

The overall focus of the health response is now on preparedness, containment and mitigation. The outbreak is likely to spread to other provinces, beyond those already affected. WHO is working to provide reliable modelling on the evolution of the virus in the specific context of Afghanistan with its unique vulnerabilities including its porous borders, erratic borders openings/closures, weak health system, high malnutrition rates, significant displacement, poor water and sanitation infrastructure, the unequal access of women to health services and high rates of people with specific needs including physical disability and mental health issues.   

A COVID-19 Multi-Sector Humanitarian Country Plan for Afghanistan has been finalised requiring US$108.1m to reach 6.1m people with life-saving assistance across all clusters. The plan outlines initial preparedness and response efforts for the next three months but is expected to be updated as the situation changes. This costed plan will form the basis of an HRP revision in the near future. The plan complements the health response to the COVID-19 outbreak in Afghanistan and has fed into a Global COVID-19 appeal to be launched later today (see below). Importantly, the multisector plan also aims to highlight the potential effects of the outbreak on ongoing humanitarian response and spell out mitigation measures being employed to reduce interruptions to life-saving services.   

The mission of the United Nations Office for the Coordination of Humanitarian Affairs is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors.

Priority activities in the plan include:

Health – Preparedness, Containment and Mitigation • Expand containment and isolation capacity, strengthen detection and surveillance capacity at points-of entry, training of medical staff, mental health support services for staff and beneficiaries

Scale-up of sanitation and hygiene • Establishing hand washing facilities at border entry points, health and nutrition facilities and in IDP sites

Flight Services • The humanitarian community’s ability to travel to affected areas is partially dependent on the ability to access flights from UNHAS. An international air-bridge is also critical to keep implementing partners in country to deliver assistance.

Awareness raising on COVID-19 prevention and spread • Scale-up of messaging to allay fears in the community and provide practical advice that dispels rumors and misinformation. A COVID-19 Risk Communications Working Group has been established and the Awaaz call center is being used to share messages

Minimizing the risk of further food insecurity and malnutrition • Food distributions to at-risk areas and livelihoods support for those whose incomes are disrupted, monitoring food prices and market supplies, ensuring commercial and humanitarian supply pipelines stay open. Also increased the treatment of malnutrition in high-risk districts where people are most vulnerable

Supporting people with specific needs and vulnerabilities • Identification of people with specific needs to be referred for immediate tailored assistance, monitoring for the adoption of negative coping mechanisms fuelled by COVID-19 and GBV support due to the increased risks in pandemics

Advocacy on containment methods • Working with national and local authorities to avoid resorting to detention as a containment measure and raising awareness and contain risks of contagion in prisons and juvenile facilities.

Movement monitoring • Ongoing monitoring of population flows across both the Iran and Pakistan borders

Cross Border Concerns: UPDATED

As of 23 March, WHO reports that there are 24,811 confirmed cases of COVID-19 in Iran. From 8-21 March, IOM reports a spontaneous return of undocumented Afghans from Iran of 115,410 - the highest two-week total on record. Since 19 March, returns have subsided with an anticipated five-day slow-down for the Nawroz- Persian New Year holidays in Iran and Afghanistan. Due to the new movement restrictions in Hirat, the highway from Hirat City to the Islam Qala border crossing is currently closed, meaning that those returnees who are processed can’t reach Hirat City. IOM staff remain at the border crossing and are continuing to process returnees. About 1000 people had crossed the border as of this morning (25 March). A new high-level response plan being prepared by the Government seeks to provide all services and transportation from Islam Qala direct to provinces of origin. All flights to and from Iran are in total suspension.   

As of 23 March, there are 887 people confirmed to have COVID-19 in Pakistan. After initially announcing the country’s border with Afghanistan would close, on 20 March the Prime Minister of Pakistan announced the country was allowing trucks through the Chaman-Spin Boldak border to ensure continued supplies of goods in Afghanistan. IOM reports that while a limited number of commercial trucks were allowed to cross at the Chaman border point for a brief period over the weekend, this has now stopped. The humanitarian community is concerned about the impact of repeated border interruptions on supplies of commercial goods which are driving up domestic prices across Afghanistan, as well as the impact on pipelines for humanitarian goods (e.g food) which are partially sourced in Pakistan.

Humanitarian partners and the authorities are closely monitoring market prices for key food commodities. Price rises in consumer goods as well as transportation costs will have a disproportionate effect on the finances of impoverished households, as well as the country’s economy as a whole. Some 14.3m people are projected to be in crisis and emergency levels of food insecurity through until the end of March 2020. The current price situation may further threaten food security and the health and well-being of individuals, in turn raising the chances of a more severe impact if people are exposed to COVID-19.   

The mission of the United Nations Office for the Coordination of Humanitarian Affairs is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors.

In early March, Afghanistan’s other neighbours – Tajikistan, Turkmenistan and Uzbekistan – either closed their borders for civilian movement or suspended flights to and from Afghanistan- some level of commercial transport is continuing.   

On 16 March, the Government shared revised administrative regulations for its staff with focus on temporary alternate work modalities for older and pregnant staff. Additionally, some NGOs have already started reducing their international footprint in country, especially after recent flight announcements, while others are preparing to scale-up to respond to the COVID-19 risk and ensure continuity of existing services in the areas where they operate. UN offices remain open and staff are working to ensure life-saving assistance continues to vulnerable people. Virtual meetings are being held as much as possible to protect staff from the virus. Coordination: UPDATED Global The UN has launched a $2 billion Global Humanitarian Response Plan to fight COVID-19 in some of the world’s most vulnerable countries. The plan is aimed at protecting millions of people and stopping the virus from circling back around the globe. The response plan will be implemented by UN agencies, with international NGOs and NGO consortia playing a direct role in the response across 51 countries. Governments are urged to commit to fully supporting the global humanitarian response plan, while sustaining funding to existing humanitarian appeals. The plan will: • Deliver essential laboratory equipment to test for the virus, and medical supplies to treat people; • Install handwashing stations in camps and settlements; • Launch public information campaigns on how to protect yourself and others from the virus; and • Establish airbridges and hubs across Africa, Asia and Latin America to move humanitarian workers and supplies to where they are needed most.   National • The humanitarian community’s overall efforts towards the response are coordinated under the Humanitarian Country Team as the strategic decision-making body and the Inter-Cluster Coordination Team as its operational arm. The next HCT meeting will again be dedicated to COVID-19 with an update on the final COVID-19 response plan, flight operations, border crossings, market monitoring and response capacity.   • As mentioned above, a COVID-19 Multi-Sector Humanitarian Country Plan has been finalised requiring $108.1m for urgent activities supporting the COVID-19 response.   • WHO together with the Health Cluster has developed and is implementing a health-focused COVID-19 Preparedness Plan. This complements the MoPH Emergency Response Plan for Coronavirus 2020 and additional funding is currently being sought for this plan.   

Sub-national • From 22-23 March, the Humanitarian Coordinator (HC), Toby Lanzer and WHO Representative, Rik Peeperkorn, visited the Islam Qala border crossing point between Afghanistan and Iran. During the visit, they saw the Reception Center for Refugees and Returnees, screening stations and hand-washing facilities. The WHO Country Representative also visited the Polio vaccination centre and reviewed the risk communication material on site. The team visited the COVID-19 testing laboratory and met with the Hirat Provincial Governor. The team also met with various provincial department health officials. The HC called on health partners to coordinate and ensure complementary responses and for the humanitarian community to prioritise and scale-up COVID-19 response and prevention. He emphasised the need to communicate simple preventative measures such as handwashing and social-distancing and stressed that the UN will continue to support health authorities with risk communication and boosting health services. • At the regional-level, Humanitarian Regional Teams are engaged in local planning for the outbreak and are liaising closely with local Government and health authorities. Price rises in local markets are being monitored by staff on the ground. The situation at various border crossings is also being closely monitored. Funding: • WHO has partnered with the UN Foundation and the Swiss Philanthropy Foundation to launch the COVID-19 Solidarity Response Fund to enable individuals and organization to contribute to the response • On 3 March, the World Bank announced an initial package of up to US$12 billion in loans and grants in immediate support to countries coping with the health and economic impacts of COVID-19.   • On 1 March, the Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator released $15 million from the Central Emergency Response Fund (CERF) to support global efforts to contain the COVID-19 virus. The funding will help countries with fragile health systems boost their detection and response operations.

The mission of the United Nations Office for the Coordination of Humanitarian Affairs is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors.

On 24 February, EU committed €232 million for global efforts to tackle COVID-19 outbreak. Part of these funds will be allocated immediately, while some will be released in the coming months. • On 25 February, the Government of Afghanistan announced the availability of $15 million to respond to COVID-19 outbreak and an additional $10 million in reserve funds for MoPH.   • On 26 February, the UN Humanitarian Coordinator, supported by the Advisory Board of the Afghanistan Humanitarian Fund (AHF), allocated $1.5 million for urgently required COVID-19 preparedness and response capacity in-country. • $2m from the USA and ECHO has been provided to WHO to accelerate preparedness and containment activities in Afghanistan.