Ashfaq Yusufzai
PESHAWAR, Pakistan, Jan 10 2006 (IPS) – Afghans, survivors of Soviet helicopter gunships and the bombs dumped on their country by a United States prosecuting its war on terror , are now confronted by another killer-tuberculosis.
Experts say it is difficult to say who are worse off, the millions of Afghans who continue to live in refugee camps in Pakistan and neighbouring Iran, or the millions who opted to return to a bombed out country where health infrastructure is nonexistent.
After the Palestinians, Afghans remain the world s largest refugee population despite the millions of dollars poured into rehabilitation programmes after the U.S. and its allies ousted the oppressive Taliban regime in 2001.
And no one knows the dangers of erratic tuberculosis treatment in the uncertain conditions of refugee life better than Mujahida Bibi. This Afghan widow lost three of her four sons to TB because she could not ensure uninterrupted treatment for them.
Living on the edge of the sprawling Kacha Garhi slum, Pakistan s largest refugee camp, Bibi is determined to stay put and obtain for her surviving son the full eight-month course of treatment that TB demands.
His chances are better here in this frontier town, than in Afghanistan where, even now, only 40 per cent of children receive vaccination against major diseases and there is just one doctor per 6,000 people.
Two hospitals, 98 basic health units (BHUs) and 47 laboratories have been dedicated to the needs of three million refugees in Pakistan wherein about 10,200 patients have been diagnosed with TB in the last three years.
I lost my husband in the Afghan war in 1980. Then I saw three of my grown sons die over the last year from TB, she said sitting on a string cot outside her one-room mud-hut in the refugee camp.
Afghans get free treatment in Pakistan, but many do not care to get case- transfer cards for continued TB treatment, when they visit or return to Afghanistan. The disruption can have fatal consequences as Bibi discovered.
An official census of Afghans living in Pakistan, conducted last year, showed that some three million still remain in this country while another 900,000 live in Iran.
Last year, the number of TB patients in over 250 refugees camps in Pakistan was 4,000, but this year the number of such patients is well over 5,000. The reason for this is the sudden relocation of refugees and health units, said Akmal Naveed, director of the Association for Community Development (ACD).
Funded by the United Nations High Commissioner for Refugees (UNHCR), the ACD is responsible for the implementation of the TB Control Programme for Afghan Refugees.
After the UNHCR slashed funding last year, priority is being accorded to about 60 per cent of the patients while the others have to make do with whatever other resources are available or drop out of treatment.
Akmal says women are more vulnerable to the disease, because of their physical weakness and the overcrowded environment in which they live. Females account for 63 percent of the disease burden. Most of them are malnourished and anaemic.
The ACD, which started operations in 1985, has been imparting training to the doctors and health staff drawn from healthcare outlets in Afghanistan, he said.
Zabeehullah, a doctor with the ACD, said many refugees discontinue treatment while in their own country and end up with the invariably fatal multi-drug resistant TB, which is fatal.
ôTB patients are expected to avail of transfer-out cards from the respective camp clinics so they can be given drugs back home, he said. Citing World Health Organisation figures, he said that about 70,000 to 80,000 new TB patients are detected in Afghanistan, yearly.
Zabeehullah expressed concern at the slashing of funds by the UNHCR and said that more donations were needed to address the problem of refugees afflicted with TB.
Said Ghulam Qadir Habibi, an Afghan microbiologist: There is no uniform and standardised system for the diagnosis and treatment of TB and if the international donor agencies want to help they should start by rebuilding hospitals in a country ravaged by over a quarter century of wars.
Since armed conflict intensified after the Soviet invasion in 1979, civilians have suffered enormously from continuous fighting that lasted through the takeover by the Taliban and its ouster in 2001. In the intervening years, a fifth of Afghanistan s population of about 30 million people fled to neighbouring Iran and Pakistan.
Habibi attributed life in one muddy and filthy room shared by 10 people, to resurgent TB in Afghanistan and in the refugee camps of Pakistan. Abdul Muqeem Saadat, a training coordinator with ACD, said TB was curable as long as patients got unhindered treatment for eight months under the DOTS (directly observed treatment short course) regimen, but this is difficult under refugee conditions.
While the international community pledged 13 billion dollars worth of aid to Afghanistan, soon after the Taliban s ouster, only about three billion dollars is marked for resettlement of refugees while the rest, according to the government in Kabul, is being spent on security and rebuilding the armed forces.