Even when their city was repeatedly overrun by the Taliban and fighting reached their doorsteps, the doctors and nurses in the northern Afghan city of Kunduz kept working. They dressed wounds and saved lives at the main government hospital even as a nearby trauma center was bombed, killing more than 40 people.
Now, about 70 doctors and nurses out of a staff of 361 at Kunduz Regional Hospital — the main health facility for several restive provinces in northeastern Afghanistan — are either infected with the coronavirus or in quarantine on suspicion of infection. But there is no choice but to keep the doors open, said Dr. Naeem Mangal, the hospital director. The doctors cannot reject the dozens of war wounded who continue to arrive each day, as fighting rages every night within earshot of the hospital.
“The hospital needs to be quarantined, but what alternative do we have?” Mangal said. “It has made us so concerned that we are all scared of each other at the hospital because we don’t know who is infected and who isn’t.”
Afghanistan’s feeble health system — dependent on foreign donations even for the $5 per head the country spends annually on health, and reliant on nongovernmental organizations for the delivery of its most basic services — has been tested by the spread of the pandemic at a time when the war with the Taliban continues to rage nationwide.
Testing remains extremely limited, but as of Friday, the country had recorded just over 2,300 cases, with at least 228 among medical workers, and 68 recorded deaths. There is a risk that hospital visits could actually be fueling the spread of the virus.
On Thursday, Afghanistan’s health minister, Ferozuddin Feroz, said the spread of the virus has continued as predicted by WHO models, which suggested that more than half of the population could become infected.
“Yesterday, we had 500 tests and about 232 turned out positive,” said Feroz, a trauma surgeon during the country’s bloody civil war in the 1990s. “That would suggest the infection is truly circulating in society.”
Citing the Spanish Flu, which lasted three years, Feroz said he feared an impoverished place like Afghanistan could be grappling with coronavirus not for months but years.
The government’s ban on large gatherings and enforcement of some level of lockdown in major cities slowed the spread, he said, but too many people flouted those measures.
Some Afghans have been swayed by religious leaders who are disregarding advisories and continuing to hold prayers of hundreds and sometimes thousands of people. Even the country’s senate is refusing pleas to call off sessions and respect the government ban on large indoor gatherings.
More widely, the country’s deep poverty, where people depend on wages they make working day to day, has made any strict enforcement of lockdowns impossible. One Western official, speaking on condition of anonymity to brief a reporter, estimated that roughly 80 percent of the population already lived on less than $1.25 a day — just 25 cents more than the poverty line.
There are already widespread food shortages across the country. In Kabul, the government Wednesday started distributing bread to about 250,000 families through 1,200 bakeries across the city, with each family getting between 4 to 10 loaves per day, depending on the family size.
To fight hunger, the charity will be extended to other cities in coming days. But crowds outside bakeries on the first day of distribution raised concerns that the measure will also fuel the spread of the virus.
A hospital in northern Faryab province, where fighting continues in several districts, might be forced to quarantine the ICU section of their only hospital, said the governor, Naqibullah Faiq. He said it “has turned into a source for spreading the virus,” after a nurse there tested positive and another patient died of the virus.