Health sector reconstruction in Afghanistan must be guided by a strong international commitment to save and improve lives, the World Health Organization (WHO) stated today. It also called for generous investment in health, at this crucial moment, as a key to future stability and socio-economic development in the country.

"Whether in the emergency or the post-conflict reconstruction phase, the most important thing is to save and improve lives in Afghanistan. This is our number one goal," declared Dr Gro Harlem Brundtland, Director-General of WHO.

"The total health needs of the Afghan people will become clear, once the fighting tapers off. Indications are that much needs to be done in this country whose long-lasting humanitarian crisis has led to a great accumulation of health needs. The international community must now seize what is an excellent opportunity to turn the health situation around in Afghanistan," she added.

From 27-29 November, Dr Mohamed Jama, WHO’s Regional Co-ordinator for the crisis in Afghanistan will chair the health sector working group, which is part of a meeting for the preparation of the Afghanistan reconstruction plan. The meeting is jointly organized by the United Nations, the World Bank and the Asian Development Bank, and will take place in Islamabad.

WHO experts working on the Afghanistan crisis have indicated that health work – in order to save and improve lives – needs to make an impact in the following five areas:

1. Reproductive Health: One woman dies of pregnancy-related complications every 30 minutes in Afghanistan. Emergency obstetric care needs to be made available. Female doctors, nurses and midwives are badly needed and existing health workers need further training to ensure safe motherhood.

2. Child Health: One-fourth of Afghan children do not live to celebrate their fifth birthday. Acute malnutrition in children is estimated to be around 10% and chronic malnutrition is about 50%, making children all the more vulnerable to disease. Routine immunization needs to be expanded and strengthened. Country-wide catch-up immunization campaigns need to be undertaken. Other childhood killers, such as acute respiratory infections and diarrhoeal disease need comprehensive prevention and control measures, such as improved access to safe drinking water and sanitation; and health workers need to be retrained for Integrated Management of Childhood Illnesses.

3. Communicable Disease Control: There are an estimated 72 000 new cases of tuberculosis each year in Afghanistan. Curing a patient requires DOTS over months, so systems must be in place to ensure the availability of drugs and to guarantee supervision of treatment and care for those affected. Malaria, cholera, measles, typhoid, meningitis and haemorrhagic fever occur as deadly outbreaks in different regions of Afghanistan. Disease early warning and response systems need to be put in place and integrated all across Afghanistan. Health management information systems are in their infancy and need strengthening with information technology and training, streamlining and stable support.

4. Mental Health: Over 2 million Afghans are estimated to suffer from mental health problems. Due to the ongoing war for the last 22 years, it is estimated that most Afghans are suffering some level of stress disorder. Mental disease that one would see in any population has not been attended to for years in Afghanistan. Mental health services must be urgently re-established.

5. Injuries: War-related and other injuries need to be taken care of, both immediately and over the long term, so that the disabled are re-integrated into society and able to lead productive lives.

Healthcare facilities must be completely restored to ensure the provision of essential services. Medicines, vaccines, medical equipment and supplies – even fuel – are required so health workers can deliver the services expected of them.

Health posts need to be established in chronically under-served areas and outreach teams need to be increased to reach the far corners of Afghanistan. There is a critical shortage of health care workers at every level. More doctors, of every speciality, nurses, midwives, laboratory and x-ray technicians, pharmacists, dentists and physiotherapists need to be trained.

Focusing on primary health care and making it available to the entire population is the key to effective and efficient health services which will save and improve lives. Community-based initiatives to reduce poverty need to be strengthened and expanded at the same time as institutional capacity building to rehabilitate Afghanistan.

WHO has almost 200 experienced local and international staff working in Afghanistan in charge of running a number of programmes across the entire spectrum of public health activities, from immunizations to advanced education for health. Many of these employees continued their activities during the crisis: co-ordinating National Immunization Days for polio, maintaining surveillance sentinel sites, distributing essential drugs and training health workers in first aid.

"Significant financial and technical resources are required more than ever before," warned Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean. "I truly hope the international community will rise to this occasion to prevent a health catastrophe in a highly vulnerable population whose suffering continues to be immense," he said.

"Aside from relieving the suffering, rebuilding the health sector is absolutely crucial for the future stability and socio-economic development of Afghanistan," Dr Brundtland pointed out. "Investing in health, among other social services, is investing in peace and prosperity."