Afghanistan ill-prepared for swine flu

Zakrullah Nouri has never known a time when his country was not at war.

But he doesn’t waste time worrying about Taliban bombs or errant NATO airstrikes. Not when there’s a new and stealthier killer: the H1N1 influenza virus.

Afghanistan’s first reported death from the flu -- that of a 35-year-old engineer from the capital, Kabul -- was announced Oct. 28. Since then at least 10 more people have died in Kabul, said the minister of public health, Dr. Mohammad Amin Fatemi, on Monday. Cases have also been reported in outlying provinces.

The ministry has declared a state of emergency, shutting down schools, universities and public restrooms for three weeks. Sports clubs and wedding halls also have closed their doors. And people wearing blue surgical masks are suddenly everywhere in Kabul: in bazaars, on bicycles, in tea shops and taxis. Nouri won’t leave home without one.

“I’ve seen lots of war. It is an ordinary thing to me,” the 18-year old computer science student said, a mask secured tightly to his face as he waded through a crowded street, shopping for CDs. “But if I become sick, it is impossible to get treatment in Afghanistan. That’s why I’m afraid.”

Although H1N1 cases were first reported here in July, among U.S. military personnel stationed at Bagram air base, most Afghans ignored news of the disease until recent weeks. Many of them made the incorrect assumption that they would not catch the virus commonly known as swine flu because they don’t eat pork.

Of the 779 cases confirmed so far, 456 of them are Afghans, and the rest foreigners. Although the toll of 11 deaths is a fraction of the more than 6,000 recorded worldwide by the World Health Organization, officials in Kabul think there is reason to be concerned.

In many parts of Afghanistan, as part of preparations for winter, people dig graves before the ground freezes. Every year, diseases such as tuberculosis, pneumonia and seasonal influenza take a toll. But H1N1 can be especially virulent.

Based on global statistics, the virus in Afghanistan could infect up to 22% of the population, or as many as 6.6 million people, according to Health Ministry projections. Although most cases are mild, the 5% expected to develop severe symptoms could strain the limited healthcare system, WHO representative Peter Graaff said.

The Health Ministry has distributed antiviral medicine to 34 Kabul hospitals and clinics, but there are only about 50,000 doses, whereas up to 300,000 patients could potentially require treatment, Health Ministry spokesman Ahmad Farid Raaid said. He is optimistic that foreign donors will provide more medicine, but there is still no vaccine here.

The WHO administers a global vaccine donation program, and it will provide Afghanistan with 500,000 of the first 11 million doses it receives. But because of global production delays and huge demand, the WHO has not received any of the doses yet, Graaff said.

Although the H1N1 virus has caused relatively few deaths in the U.S. and other wealthy countries, the toll could be higher here.

“The population is poor. Many live in poor hygienic circumstances, and there is a large amount of malnutrition,” Graaff said. “The mortality rate in Mexico, where H1N1 affected poor people, was considerably higher than in the U.S. or Western Europe.”

Wrapped in white protective clothing, Mari, 38, cradled a fussing infant in the infectious disease ward at Kabul’s Indira Gandhi Institute of Child Health. Like many Afghans, Mari uses only one name.

Monday should have been a happy day for the mother of six. Her 2-year-old son, who was admitted last week with suspected H1N1, had made a complete recovery and was discharged. But her 6-month-old daughter was still fighting a high fever, and Mari had no idea how she would keep the rest of her children healthy.

“I’m so worried,” she said. “We have a house in the mountains. . . . It is very cold there, and we have no money to buy wood for the stove.”

Mari’s husband, a painter, hasn’t worked in months.

“We just eat potatoes all the time,” she said.

The day after Afghanistan declared a health emergency, anxious parents brought 2,000 children to the hospital to be checked for H1N1, said Dr. Khalilullah Hodkhail, a deputy director. Although the numbers have dwindled since, about 500 children fill the red, green and blue plastic seats in the flu clinic each morning, about twice the usual number.

Outside, vendors weave through streets choked with cars, vans and carts, peddling paper surgical masks. The government recommends them only for those with flu symptoms, but many residents aren’t taking any chances.

Every morning, Kambiz Amini, 33, puts on a mask before setting out his row of scales, which customers can use to weigh themselves as they pass through a tunnel running under a busy intersection.

“I’m at risk because it’s crowded in here,” he said.

A government-sponsored TV and radio campaign advises anyone with a fever to stay home, and those with mild symptoms to avoid shaking hands or embracing each other. When they go to mosque, they are told to pray outside if possible, or put on a mask.

It is hard to persuade people to follow such rules when they still think that the disease is spread from animals to humans. Graaff said there were reports of patients being beaten because it was thought they had eaten pork, which is forbidden by the Islamic faith.

One little boy, who was selling masks, panicked when approached by two Western journalists.

“I don’t want to talk to them,” he cried. “These foreigners have swine flu.”

Even the decision to close down universities -- often the sites of political activism -- quickly became politicized. President Hamid Karzai’s opponents accused the Health Ministry of trying to prevent protests over the country’s heavily disputed election.

Public Health Minister Fatemi lashed out at those critics Monday, telling them that because they had belittled the seriousness of the pandemic, a 29-year-old woman had died the previous day having sought treatment too late.

“The responsibility for these deaths is on those people who spread these rumors,” he said.

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alexandra.zavis@latimes.com

Special correspondent Karim Sharifi in Kabul contributed to this report.