A health worker checks the body temperature of men waiting for Friday prayers outside a mosque in Kabul. Photograph: Wakil Kohsar/AFP via Getty Images
The main hospital in Zabul, southern Afghanistan, was abandoned after a Taliban attack last September destroyed most of the building and killed nearly 40 people.
But when coronavirus slipped into the province this spring, desperate health authorities, casting around for ways to fight this new enemy, settled on its shattered remains.
The paediatric ward, the only part of the building still standing, was refurbished and opened as an isolation centre for patients with Covid-19. It now stands beside the ruins of the rest of the hospital as a symbol of the terrible double challenge Afghanistan faces in fighting the virus while still in the middle of a long and bloody civil war.
“After the Taliban destroyed our main hospital, something remained and we made a two-storey building from that to hospitalise Covid patients,” said Dr Lal Mohammad Tokhi, head of the pubic health directorate in Zabul.
“We have plenty of protective materials like mask and gloves. We need ventilators but are expecting to get two from Kabul.”
The province has seen 10 cases and no deaths so far, and is trying to impose a lockdown, but it is being widely ignored by people who will not eat if they do not go out to work. “People are so poor, there are serious problems with hunger,” Tokhi said.
Poverty and conflict meant that Afghanistan’s health systems were over-stretched before coronavirus - by malnutrition, war injuries and infectious diseases eliminated elsewhere long ago. It is one of just two countries where polio is still endemic.
Last week, the US watchdog for war and reconstruction efforts warned in a report that when coronavirus arrived, Afghanistan was “likely (to) confront a health disaster”, because of its many challenges.
On Friday, health authorities said nationwide confirmed infections hit 2,335, with 68 deaths. The disease is widely accepted to have spread further than captured by official tests, although a very young population – over half under 25 – may have helped keep mortality rates lower than elsewhere.
“It’s possible that we have more deaths that are unreported to us,” health minister Feroz Ferozuddin told the New York Times. “But we haven’t seen mass deaths.”
The disease may cause huge collateral damage, however, among Afghanistan’s many vulnerable citizens. Save the Children has already warned that lockdowns – although they are being widely ignored – have put 7 million children at risk of hunger.
Adding to Afghanistan’s challenges, the country went into 2020 with a divided government facing political, military and economic crises. The government has been paralysed by a months-long political dispute over who won last year’s presidential election, which prompted the US to withhold a billion dollars of funding, vital to the functioning of a country with little tax base.
US President Donald Trump’s decision to sign a withdrawal deal with the Taliban, in a bid to end America’s long war, has thrust the civil conflict between Afghan factions into an uncertain new phase. The militants have scaled back attacks in major cities but have rejected calls for a ceasefire to give time to fight the virus. They continue to attack government forces around the country, arguing their pact of non-aggression is only with the US.
In northern Kunduz province, a hospital where a fifth of staff have been quarantined with suspected infections remains open to receive war wounded from the battles raging nearby because there is nowhere else to treat them, it has been reported.
The Taliban has allowed health officials in the south to travel to rural areas, including those under militant control, to provide coronavirus information and checks, doctors and officials say. But information reaching Afghanistan’s scattered villages may be too little, too late to stop the disease spreading.
Zabul is a sparsely populated province far from the worst outbreak in the capital Kabul, apparently at the very fringes of Afghanistan’s battle against covid-19. Yet cases have been rising sharply in neighbouring Kandahar , and there are also infections thought to have been imported directly to the province from Iran, by people trying to flee the epidemic there.
“Some Zabul residents who had been labourers in Iran, and came home to escape the outbreak there, brought it with them. There have been two cases confirmed in a remote district here over the last two days,” said Hashim Tokhi, a doctor in Zabul.
“People have no access to heath equipment; they don’t heed the lockdown or cooperate with public health, and there is also no information about the virus in remote areas.”
In nearby Helmand province, where British troops once fought the Taliban and nearly 400 lost their lives, the situation is even more grave, said Abdul Majid Akhundzada, a member of the provincial council. There have been 24 cases confirmed already, but hospitals were unprepared, he claimed, after funds were siphoned off by corruption.
“In terms of equipment, we have zero of that, nothing. We have no lab to test suspected people, no testing kits, no place even to isolate the patients there. There are masks and gloves in the shops that people are buying for themselves.
“Civilians and security forces continue to die in frontlines and their homes. The people of Helmand are so vulnerable: both corona and the war are killing them.”