World Health Organization

Afghanistan Health Update

24 January 2003

KABUL A World Health Organization-led team of Afghan Ministry of Health, UN and NGO health experts has successfully completed a mission to northeastern Afghanistan to prevent the spread of a deadly pertussis (whooping cough) outbreak.

The disease first broke out in late October in the north of Badakhshan province, threatening the lives of infants and children in 189 villages in Khwahan and Darwaz districts. Health officials say the epidemic is now under control, with at least half of 40,000- targeted children having received a preventive course of antibiotics. The operation will continue until all children under the age of 15 in possibly affected villages have been reached.

An emergency medical team composed of staff from the Afghan Ministry of Health, WHO and the NGO Focus confirmed the outbreak in early November. The team provided immediate protective treatment for 2000 children and mothers most at risk. Subsequent emergency medical teams have trained 78 local volunteers to administer the antibiotic erythromycin to prevent the spread of the highly contagious disease.

Intervention has been complicated by the extreme remoteness of the affected area, located on the border with Tajikistan, but medical teams have been able to access the mountainous region by Afghan military, Coalition Forces and UN helicopters.

"Thanks to high-level Afghan and Tajik cooperation, and the involvement of numerous humanitarian agencies, we have been able to save the lives of countless children," said WHO Afghanistan epidemiologist Dr. Yon Fleerackers who is coordinating the operation.

The in-field medical teams, trained by Dr. Kayhan Natiq of WHO Afghanistan, also travelled to the most remote villages by foot, horse, donkey or boat to administer the two-week course of antibiotic treatment. Children already affected by whooping cough, or pneumonia- a common complication of the disease- also received appropriate medical care.

According to Dr. Natiq, one of the greatest challenges of the operation was to ensure medical supplies and team members were able to reach the affected villages. "This part of Afghanistan has some of the most difficult terrain in the country. The lack of accessible roads and harsh weather conditions further complicated the emergency operation," said Dr. Natiq. Drugs and equipment were either airlifted by helicopter or brought by inflatable dinghies that crossed the Omu river between Tajikistan and Afghanistan.

Whooping cough is a highly infectious disease with a potential mortality rate of 15%. Health authorities have not yet been able to confirm the number of deaths in this outbreak, but according to Dr. Fleerackers, preliminary reports indicate that two out of five sub-districts in Darwaz and Khwahan were reached in time to prevent a high number of complications and deaths.

Routine immunization provides the best and most cost-effective form of defence against the spread of whooping cough. Following the administration of antibiotics, health workers are also providing polio immunization during a 3-day campaign for all children under the age of five in Darwaz district.

The emergency teams were composed of health experts from the Afghan Ministry of Health, WHO, UNICEF, and the NGO Focus. The Afghan Ministry of Defence, the Coalition Forces, the World Food Programme, the United Nations Joint Logistics Centre for Afghanistan, UNOPS, the UN Assistance Mission for Afghanistan and the UN Office for the Coordination of Humanitarian Affairs in Tajikistan are assisting the on-going operation with transport by air and by road for supplies and team members.

Medical supplies have been provided by WHO, UNICEF, ICRC and Populations Services International in Tajikistan.