Feature N° 204
FEAR IN THE CAMPS
FOREIGN CORRESPONDENT, HERAT, AFGHANISTAN
Humanitarian workers and displaced people are racing against time to build an estimated 6,000 mud brick shelters in Maslakh camp for the displaced just outside Herat, while across the country others are bracing themselves for the consequences of both the attack on Ahmed Shah Massoud, military leader of the anti-Taliban Alliance and the tragic events in the United States.
They have less than eight weeks before winter takes serious hold bringing snow and freezing winds to rake the valley. Another 4,000 shacks need repairs, and neither of these figures take into account accommodation for new displaced who continue to arrive at a rate of around 300 people a day - over 8,500 in the month of August. However, all international UN staff are now being evacuated and many NGOs are doing the same.
Even if the workers meet their construction goals, winter is going to be tough for the thousands that have fled drought and conflict in their home provinces to this camp. Take the eight members of the Saadat family who arrived in Maslakh five weeks ago from a village in Baghdis having lost their harvest for the third year in a row. In the warm nights half the family sleeps outside their 4 metre square room, but winter will see them all crammed inside, day and night, along with the fire smoke, dust and any opportunistic infections that happen along.
Slow arrival of funds and a continuous stream of new arrivals over summer as the drought has gripped harder has meant those providing shelter, water and sanitation and health services have been running to catch up. Testament to their difficulties are the high levels of diarrhoea and dehydration which health workers have been fighting all summer with health education and oral rehydration. All patients coming to the two Medécins du Monde clinics must now attend a session of health education before they are allowed to see the doctor, and Herat Hospital paediatric ward is full of cholera cases from outlying districts.
Luckily so far there have only been two confirmed cases of cholera in the camp itself, but the emergency health taskforce, coordinated by the World Health Organisation, is on high alert. "In these kind of crowded conditions, the attack rate can be as high as 5%. That would mean about 7,500 cases in Maslakh," says Lindel Cherry, medical co-ordinator for Medécins sans Frontieres which has just set up a large cholera treatment centre to be prepared.
But with winter coming, attention is turning to respiratory tract infections as the next major threat to health, especially for children many of whom are under-nourished and have lowered resistance. In such overcrowded and impoverished conditions what starts out as a common cold can become a killer, says WHO officer in charge in Herat Dr Mojibullah Wahdati.
The same conditions also increase the risk of tuberculosis, particularly among women who are often more confined. Previous WHO studies in IDP camps in Afghanistan show as many as 3% of the population will contract TB every year. In Maslakh, this means from 4,500 to 9,000 cases depending on which population figures are used.
As well as chairing the health forum for the camps, and coordinating response to potential epidemics, WHO tries to help the NGO clinics cope with large numbers of patients by bridging the gaps in drug supplies that unpredictable funding and outbreaks of disease bring. It also supports training of health workers in matters from diagnosis and disease management to health education.
Last winter a wave of unusually cold weather saw temperatures fall to -25ºC and more than 150 people die in one week, says Dr Wahdati, who fears the combination of cold, increasing malnutrition and overcrowding this year could have a devastating impact. The two supplementary feeding centres in Maslakh are already providing extra rations for more than 2,000 children every day, and MSF which runs one of the centres reports worrying levels of severe malnutrition, despite the existence of a general food distribution.
"We need to be able to support the IDP health clinics in treating patients quickly and properly this winter, and be ready to help with fuel supplies and other materials to protect against the cold," says Dr Wahdati. But funds are desperately short: WHO’s appeal for donations for health activities in Afghanistan this year has been funded by less than 10%.
Humanitarian organisations are also trying to slow the accumulation of people in the Herat camps by providing aid in their place of origin. The International Committee of the Red Cross is carrying out a massive distribution of food and seeds in Ghor province this month, while MSF has begun targeted feeding of children in highly vulnerable areas in Badghis. For its part, WHO is trying to raise funds to restart defunct health centres in similar areas. Income generation activities are also crucial as are projects to provide water sources such as deepening wells.
But despite these efforts, international observers are expecting another substantial influx of displaced to Herat just before the snows which close the road arrive as families’ final coping mechanisms give out under the weight of a third failed harvest.
"They will try and stay in their homes, but at the last minute if they see they do not have enough food, they will come here. We need to be prepared," says Dr Wahdati.
The trouble is Maslakh camp is full, and new arrivals will soon have to go to a new site on a high flat soon-to-be very cold plain about 30 minutes drive from the city, where right now the only sign of services is single test well rig searching for water.
For further information please contact: WHO Afghanistan Support Office, Islamabad, Representative Dr Said Salah Youssouf, Ph: +9251 2211224 or 2297931, email: WR@whoafg.org, or Dr Khalid Shibib, Desk Officer Afghanistan, WHO Emergency and Humanitarian Action Department, WHO Geneva. Ph: +41 22 791 2988, email email@example.com
This document was researched and written by Hilary Bower, information officer for WHO’s Emergency and Humanitarian Action Department, Geneva, currently on mission in Afghanistan. The content does not necessarily reflect official WHO views or policies. For further information, please contact email firstname.lastname@example.org or email@example.com
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