‘I’ve never seen a measles outbreak like this’: A childhood killer resurfaces in Afghanistan

The hospital wards increasingly resemble the chaotic alleyways of the local bazaar on market day, reflects Dr Ahmad Fawad Masomi.

The birdsong outside is drowned out by the screams of ailing children and physical fights often erupt between the tired parents of the admitted infants.

Frequently, armed Taliban burst through its doors and threaten the hospital’s medics until they provide urgent treatment for their loved ones. Staff say they hide in supply cupboards out of fear.

Currently, 180 children and their extended families occupy a paediatric ward at the Faryab Provincial Hospital that has the bed capacity and manpower to care for just 30 patients. It is the only remaining hospital in Afghanistan’s northern Faryab Province, home to 2.5 million people – and it is tackling a devastating surge of a childhood killer.

Afghanistan is in the midst of a major measles outbreak. Already this year, 43,000 children have been infected and 214 have died, according to the World Health Organisation – with 97 per cent of fatalities among children under five. This is already more deaths from measles than the country saw in the entirety of 2021.

Dr Fawad Masomi believes these figures are a gross underestimate. Afghanistan has been crippled by an economic crisis and many families in Faryab Province cannot afford to travel to the hospital; many measles victims are being quietly buried in unmarked graves near their homes.

“I have been a paediatric doctor for eight years and I have never seen a measles outbreak like this,” says Dr Fawad Masomi. “I would say we are seeing around four times as many cases this year as usual.”

Neither the Taliban nor international aid organisations have been able to curb spiralling infections, and weekly case numbers are rising in all of Afghanistan’s 34 provinces.

The main reason for the surge, says Dr Fawad Masomi, is the conflict that preceded the Taliban’s return to power in August.

The violence wrought havoc on immunisation campaigns and less than 50 per cent of children are vaccinated nationwide, with these figures falling as low as 18 and three per cent respectively in the provinces of  Helmand and Uruzgan, according to the WHO.

There is also hesitancy among some conservative Islamic communities, despite the spread of the deadly disease. Logistics also present a major challenge. Fighting destroyed the country’s cold chain vaccine network, meaning many of the children who did receive doses were given vaccine that had not been stored properly – rendering them ineffective.

‘The poorest and most vulnerable pay the price’

The United States and its allies had provided 80 per cent of the previous Afghan government’s budget, but this money was withdrawn when the Taliban returned to power.

Many banks are on the verge of collapse amidst a nationwide liquidity crisis, public sector salaries have gone unpaid and international aid agencies face huge funding shortages. Meanwhile The United Nations Development Programme estimates that 90 per cent of Afghans will fall below the poverty line by the end of 2022.

This economic crisis has resulted in widespread food insecurity, while more than 3.5 million children require immediate medical support to combat malnutrition, according to the UN. Hunger only worsens a measles infection.

“What is so heart-breaking is not just seeing Afghan children’s health status flipping back and all the gains that have been made being undone, it is also because it is man made, because of the sanctions. The poorest and most vulnerable in Afghan society are paying the price,” says Noor Hassanien, acting country director for Afghanistan at Save the Children.

“The rise of malnutrition among Afghan children is weakening their immune system to measles and also making them a lot more vulnerable to complications, like pneumonia and brain damage.”

In the northern province of Balkh, Ali Shoker Khan’s* three children contracted measles in mid-February. The economic crisis meant he had been forced to withdraw his eldest son, Nasim*, six, from school to work on a neighbours farming plot and he returned home one day with the tell-tale rash on his chest.

Mr Shoker Khan had only been able to buy several loaves of naan bread, after the cost of the diet staple doubled since August, to feed his family on a daily basis. He says his children were suffering from malnutrition when they contracted measles.

“Measles has always been something seasonal, we had some cases last year too, for example. But, in my whole life I have never seen so many cases at once, as this year,” said Mr Shoker Khan. “My children all had a severe fever and my daughter developed a severe infection. We lost hope, she fell unconscious for three days and three nights.”

His daughter recovered after being admitted to a Save the Children clinic, but her rehabilitation has been slow and she still experiences debilitating weakness.

In mid-March, a WHO-funded measles vaccination campaign was launched. But, as it will only reach 1.2 million children it is just a “drop in the ocean,” says Ms Hassanein. A Taliban Ministry of Health spokesperson told The Telegraph they were planning to ramp up vaccination efforts over the upcoming months.

‘We can’t do enough to save children with what we have’

But up to 90 per cent of Afghan hospitals are facing closure due to funding restraints after money from the World Bank, European Commission and the USAID for the country’s public healthcare sector was withdrawn; many have already shut their doors.

“In some provinces we don’t have any major hospitals left and those that remain don’t have access to drugs, oxygen or funding to pay their staff,” says Dr Waris Aria, chief executive of Tabish, an NGO working to improve Afghan public healthcare.

“We are seeing this epidemic of measles because there is not enough money to do vaccination campaigns or provide services for those who contract the disease.”

In Faryab, shortages of both staff and resources are also acute. Dr Fawad Masomi is one of only six doctors and six nurses in the hospital’s paediatric department. Many former doctors and nurses fled the country in the wake of the Taliban's takeover or left after the hospital was unable to pay wages for three months.

“Our personal efforts are not enough, we only have a few staff and so many of them don’t even have the qualifications to give injections to children. We break down often because we can’t do enough to save the children with what we have,” he told The Telegraph.

“Sometimes we only have one oxygen canister for every four children admitted, many of them lay on the floor.”

But, there are few signs of change on the horizon. On Thursday, the largest UN humanitarian appeal in history was launched, with a virtual pledging conference in Geneva aiming to raise £3.3 billion for Afghanistan.

So far, just £1.85 billion has been raised. The UK has faced criticism for committing only £286 million of emergency aid this year.

Meanwhile, the World Bank suspended more than £600 million of aid projects this week, including in the healthcare sector, in response to the Taliban’s U-turn on an earlier decision to let female students return to secondary school.

“The international community needs to segregate funding for medical and humanitarian services from politics. They need to provide immediate technical and financial support for the healthcare system in Afghanistan,” says Dr Aria.

Back at Faryab Provincial Hospital, Dr Fawad Masomi is set to begin another 14-hour day. Once he finishes at the hospital he will try and see more patients at his home, late into the night.

“This is my country and I want to stay and be of service to my people here despite all the challenges,” said Dr Fawad Masomi.

“If I leave, who will provide this service? I just wish our government or the international community could help us.”