January 6, 2013
A worsening hunger crisis is developing in Afghanistan and the reasons are under dispute. From the New York Times:
Afghan hospitals like Bost, in the capital of war-torn Helmand Province, have been registering significant increases in severe malnutrition among children. Countrywide, such cases have increased by 50 percent or more compared with 2012, according to United Nations figures. Doctors report similar situations in Kandahar, Farah, Kunar, Paktia and Paktika Provinces — all places where warfare has disrupted people’s lives and pushed many vulnerable poor over the nutritional edge.
Even the capital has seen an increase. “In 2001, it was even worse, but this is the worst I’ve seen since then,” said Dr. Saifullah Abasin, head of the malnutrition ward at Indira Gandhi Children’s Hospital in Kabul.
Reasons for the increase remain uncertain, or in dispute. Most doctors and aid workers agree that continuing war and refugee displacement are contributing. Some believe that the growing number of child patients may be at least partly a good sign, as more poor Afghans are hearing about treatment available to them.
What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.
Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.
Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.
One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.
Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.
Now, M.S.F. is planning to open five satellite clinics with intensive feeding programs in Lashkar Gah to take the pressure off the overcrowded hospital.
Despite the increase in the malnutrition caseload, doctors and health officials are not sure there has actually been a sharp rise in child malnutrition that can be attributed to any single factor.
“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.
In part, expansion of the hospital’s facilities has acted as a magnet, drawing more cases, Mr. Vandormael said. Unlike at other public hospitals in Afghanistan, patients and their caregivers do not have to pay for their own medicine and food at Bost. And M.S.F. has been able to ensure that it gets regular deliveries of Unicef-provided therapeutic foods used to treat malnutrition.
Global Health and Development Beat
Poverty - The 50 year war on poverty in the US has produced a mixed bag of results, reports the New York Times.
The Plague - Officials confirm new cases of the bubonic plague in Peru. (in spanish)
Polio - A report from the Inter Press Service describes how the Taliban is a stumbling block to polio eradication in Pakistan.
Measles - The measles outbreak in the Philippines is a threat to many parts of metro Manila, warns the Department of Health.
Polio - Polio vaccines remain on hold due to a lack of agreement between political administration officials and polio workers in Pakistan’s Khyber Agency.
Flu - Reports of a human case of the H7N9 flu in eastern China.
World Bank - Questions are being asked over whether World Bank activities in Honduras are causing more harm than good.
Buzzing in the Blogs
A New York Times board editorial remarks on the health crisis in Syria. They write:
Immunization coverage in what are now mainly opposition areas was already below accepted standards in 2011, but the situation has deteriorated. Data on routine immunization from the World Health Organization reveal that over the past two years a large proportion of the Syrian population has gone without vaccination.
Across Syria, coverage went down to 60 percent in 2012, and was as low as 50 percent in the embattled eastern city of Deir al-Zour, a front line between government and rebel forces. The latest W.H.O. figures from 2013 show that the level is now down to 36 percent in largely rebel-held Deir al-Zour Province, although it has remained at 100 percent in government-controlled areas such as the western stronghold of Tartus.
Given these conditions, it was no surprise to medical practitioners that a polio outbreak occurred. The question is why the international community did not prepare better for this eventuality. A disturbing part of the answer is that the United Nations itself has aggravated the situation.
Like other United Nations agencies, the World Health Organization works directly with the Syrian government. The W.H.O.’s Syria office is in the Ministry of Health building in Damascus; many of its staff members are former ministry employees. A recent Reuters report on how the Assad government uses red tape and threats to prevent the provision of aid in opposition areas has raised doubts about the ability of the W.H.O. to act with impartiality.
The W.H.O., working with the Syrian government, excluded Deir al-Zour from a polio vaccination drive that began in December 2012. According to the W.H.O., the province “was not included in the campaign as the majority of its residents have relocated to other areas in the country.” Ten months later, this was the province where polio re-emerged.
There is no evidence that most of the province’s one million residents had, in fact, migrated. The United Nations World Food Program continued to distribute food there throughout 2012 and 2013 (with occasional interruptions because of worsening security conditions). In December 2012, the agency reached 69,000 people in Deir al-Zour.
Last month, an investigation by the German weekly newsmagazine Der Spiegel charged the W.H.O. with obstructing the testing of polio samples from the Deir al-Zour region. These samples had been presented by an agency working under the aegis of the Syrian National Coalition. It took nearly a month to get the test results — positive for poliomyelitis — and then only from an independent provider in Turkey. By that time, thousands of displaced people had moved within Syria or fled as refugees to neighboring countries, most likely spreading the disease.
The latest draft of a W.H.O. situation report for Syria reveals that it took three months for the W.H.O. and the Syrian Health Ministry to confirm a polio case detected in Aleppo in July 2013. It was then some weeks before a nationwide vaccination campaign began.
The consequences of these delays and failures now reach well beyond Syria’s borders. Lebanon and Jordan, where a large proportion of Syrian refugees have fled, are particularly at risk. Their public health systems are already overloaded and underfunded. Unicef figures for immunization from the Lebanese Health Ministry indicate that only 77 percent of the population had been routinely covered for polio in recent years, placing thousands of Lebanese children at risk. “If the Unicef figures are correct, then this would be far too low to keep an introduced infection at bay,” said Professor Martin Eichner, a disease expert at the University of Tübingen, Germany. “With 4,000 Syrian refugees a day leaving the country, and the majority entering Lebanon, the virus is already in Lebanon or they will get it sometime soon.”
There is also no discernible plan for delivering vaccination coverage to the hundreds of tented settlements that house as many as 200,000 Syrian refugees across Lebanon.
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By Mark Leon Goldberg and Tom Murphy
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