Situation Overview: UPDATED
Global Update: According to John Hopkins University, the number of people worldwide who have died with COVID-19 has passed more than 1.4 million, with many regions still reporting surging numbers of new infections as part of a second and sometimes potentially third wave of the pandemic. The pandemic has spread to 191 countries with more than 60 million confirmed cases, as of 26 November.
MOPH Figures: MoPH data shows that 45,490 people across all 34 provinces in Afghanistan are now confirmed to have had COVID-19. Some 36,145 people have recovered, and 1,725 people have died - 79 of whom are healthcare workers. Only 143,465 people out of a population of 36.7 million have been tested. Afghanistan now has a test-positivity-rate – positive tests as a percentage of total tests – of more than 31 per cent, suggesting overall under-testing of potential cases. The majority of recorded deaths were men between the ages of 50 and 79. Men account for close to 69 per cent of the total COVID-19 confirmed cases in the MoPH data, although this may be the result of over-representation of men in testing. Due to limited public health resources and testing capacity, lack of people coming forward for testing, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely to be under-reported overall in Afghanistan. Stigma is considered a major factor in people choosing not to get tests and risk communications work is critical to turning this around. WHO notes that the official numbers reported by MoPH are unlikely to be capturing the full scale of the situation since testing remains limited to only the most severe cases. WHO warns that widespread complacency and failure to follow public health advice is creating grave risks in the community with people generally not observing physical distancing or mask wearing protocols.
Second Wave: The MoPH confirmed on 19 November that Afghanistan is in a second wave of the COVID-19 pandemic. Following two months of consistently lower confirmed COVID-19 cases, MoPH tracking data is beginning to reflect anecdotal reports of a recent uptick in cases, with 1,357 new COVID-19 cases recorded over the past week. While the official numbers are not yet at the same level as the May/June peak, when taken together with reports of increased hospitalisations for COVID-19-like symptoms, the need for vigilance should be reinforced. The rollout of the annual influenza vaccination across Afghanistan will be more important than ever to help the health system manage the rise in COVID-19 cases. Increasing influenza vaccine coverage can reduce the strain on the health care system and free-up limited health resources to focus on treating more severe cases of COVID-19. Public health experts strongly urge the public to follow health advice on physical distancing, mask wearing, good hygiene, hand washing and other proven strategies that mitigate the risk of COVID-19 transmission amid this second wave.
Health Services: Hospitals and clinics continue to report challenges maintaining or expanding their facilities’ capacity to treat patients with COVID-19, as well as maintaining essential health services, especially in areas of active conflict. WHO stresses the need to balance the demands of responding directly to COVID-19, with simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery, mitigating against the risk of system collapse.
Almost 9 per cent of the total confirmed COVID-19 cases are among healthcare staff. Health facilities across the country continue to report shortfalls in PPE, medical supplies and equipment, further challenging their capacity to treat COVID-19 patients. In support of the Government, humanitarian partners have provided hundreds of thousands of pieces of PPE and several thousand items of life-saving medical equipment to MoPH. In total, since the start of the pandemic, almost 1.3 million PPE items have been delivered by humanitarian partners to both MoPH and directly to frontline NGO workers in Afghanistan. With a second wave of the gathering pace globally, there is an urgent need to ensure a rapid distribution of medical and protective equipment to all corners of the country.
While 14 laboratories are now operating in Afghanistan, the capacity of these facilities remains limited and stocks of supplies have periodically run out. National capacity for COVID-19 testing has topped 5,500 a day, but according to WHO, lack of demand means that fewer than 400 tests are actually being conducted daily. Humanitarian partners urge the Government to ensure laboratories are appropriately equipped, staff receive timely renumeration and that procured supplies go to under-resourced health centres in a transparent manner so that life-saving support can be delivered to those most in need.
Socio-economic impacts: The socio-economic impacts of COVID-19 are translating into a dramatic impact on food insecurity with levels now similar to those seen during the 2018 drought. An estimated 16.9 million people are in crisis or emergency food insecurity through until March 2021, 5.5 million of whom are in ‘emergency’ level food insecurity (IPC 4). According to WFP’s market monitoring, the average wheat flour price (low price and high price) increased by more than 11 per cent between 14 March and 25 November, while the cost of pulses, sugar, cooking oil and rice (low quality) increased by 21 per cent, 18 per cent, 35 per cent, and 22 per cent, respectively, over the same period. This price increase is accompanied by declining purchasing power of casual labourers and pastoralists – which have deteriorated by over 11 per cent and almost 14 per cent respectively (compared to 14 March). These factors, combined with COVID-19 related interruptions to informal employment and decrease in remittances, are driving people into crippling debt. Data from the Whole of Afghanistan Assessment shows that household debt is rapidly escalating in terms of both the number of people in debt and the scale of that debt. Average household debt is now 46,299 AFS/US$604, up from 9,813 AFS/US$128 in 2019. Of displaced households in debt, the primary reason for taking on this debt was to pay for food (53 per cent).
Winterisation support: Afghanistan is facing a grim winter ahead as people struggle to keep themselves warm amid soaring poverty driven by the economic shock of COVID-19. Given this situation, there is an urgent need for additional funding for winterisation support from both the Government and donors to help struggling households survive the harsh weather ahead. The ICCT’s $137m winterisation plan aims to reach 2.5m people over the winter months with a range of life-saving support including cash and in-kind heating assistance for households and classrooms, warm clothes, seasonal food support, nutrition treatment, and health services for winter sickness. To date, $63.6m has been committed by donors, leaving a gap of $74m. Distributions of winter support are imminent and addressing this funding gap could not be more urgent.