Deaths in Afghanistan due to the coronavirus could potentially exceed the total number of civilians killed during the past two decades of conflict. As of April 22, Afghanistan had 1,178 confirmed cases compared to 840 seven days earlier, with 40 deaths and 166 recovered patients. Estimates published by Foreign Policy on April 17 suggest that ultimately up to 25 million Afghans could be infected with the coronavirus, with 110,000 deaths.

These numbers would be catastrophic for Afghanistan, whose fragile health care system, declining economy, scarce resources, and weak governance capacity are already under intense strain by the ongoing conflict with the Taliban. The pandemic also comes at a fraught time for the government due to political tensions following a contested 2019 presidential elections, impasses over prisoner swaps meant to kick start talks between the Afghan government and the Taliban, and declining U.S. military and financial support following the precarious U.S.-Taliban deal signed on February 29, 2020.

Countries in the global north are describing the conditions in their country as a “war zone” as their governments and health systems struggle to fight against the spread of COVID-19. In Afghanistan, the pandemic is an additional front in an existing war that will further destabilize the state’s capacity to meets its citizens’ needs. The Afghan government’s COVID-19 response prioritizes service delivery, emergency health care response, and improved communication but realities on the ground mean this response has been ad hoc and unevenly applied at best.

COVID-19’s Economic Impacts

In an interview for Diplomatic Courier, Afghanistan Deputy Minister of Finance Naheed Sarabi said, “The Afghan government is trying to break the chain and following steps of countries who have successfully controlled this pandemic.” A joint survey conducted by Central Statistics Organization (CSO) of Afghanistan and ICON International shows that nearly 54% of the country’s citizens live below the poverty line. This is likely to increase drastically in the coming months if state is unable to control the pandemic. According to Cordiad’s Afghanistan Director Jaap van Hierden, lockdown measures will have the greatest impact on daily wage earners as “80% of the people work in the informal sector and live from hand to mouth and millions of others are displaced and have even less.” Similarly, Dr. Ferdows Sayedy, at Wazir Akbar Khan Hospital in Kabul told Diplomatic Courier he fears that lockdown measures alone will not be enough to control the spread of the virus if food supplies are not quickly provided to those in need “if lockdown measures continue they will have to leave their homes to feed their families.”

Afghan Government’s Problematic Health Measures

The government’s health response has been aggressive, turning health facilities into coronavirus treatment centers but rollout has been plagued by poor planning and shortages in staffing and equipment, especially at the provincial level. As of April, the country had only two designated coronavirus hospitals with 12 working ventilators between them, although there are reportedly 300 ventilators across the country. The Afghan Japan Hospital in Kabul is the capital’s primary coronavirus treatment facility, but the even this facility faces shortages in equipment, sanitizers, and ICU specialists as well as deficits in procedures and staff training. Additionally, there are only two laboratories in the country equipped to test samples. As of  April 20, the only operational testing center has stopped the intake of new samples due to an overwhelming backlog. The Ministry of Public Health claims the testing center can test 600 samples every day, but Dr. Ferdows Sayedy suggested in an interview for Diplomatic Courier that real testing capability is only around 30 to 40 per day.

In Herat, the epicenter of the crises, the government built a new 100-bed hospital for COVID-19 patients. However, Member of Parliament Naheed Farid lamented that after completion the “the hospital doors remained closed, there is no equipment and no staff.” She argued that “a wedding hall could have been transformed into a hospital, in Herat we do not have a shortage of buildings, we have problems related to procurement of equipment, safety gear, and health experts.” Herat has halted testing as its testing center lacks RNA extraction supplies necessary for labs to evaluate samples. In other provinces, hospitals began dedicating wards for COVID-19 patients and Public Health officials plan to send medical experts to these areas, according Dr. Sayedy. However, a shortage in medical personnel with the required expertise tackle this virus complicates matters.

Between March and April,  approximately 130,000 Afghans returned from Iran following its coronavirus the coronavirus outbreak,  marking one of the “biggest cross-border movements of the pandemic.” Herat MP Naheed Farid told Diplomatic Courier that all of Herat’s MPs appealed to Public health officials to quarantine returnees but were told the state did not have the capacity to create facilities to house such large numbers. Farid stated that MPs then approached the Ministry of Public Health and Ministry of Refugees and Repatriation to coordinate efforts with the governors of primary destinations to ensure returnees were safely transported to their provinces where they could get checked and quarantined by officials there, thereby sharing responsibilities and capabilities. However, both ministries failed to take appropriate steps, according to Farid.

Afghan Government’s Uneven Public Awareness Campaign

The Afghan government has made raising public awareness about the pandemic into a priority. However, provinces have not received the same attention as major cities. In Ghanzi, MP Shagul Rezaie said government awareness campaigns are very limited, and in areas under Taliban control where the government does not have a physical presence there is no public awareness at all.  In Ghazni, “there has been next to no efforts by health officials” explained Razaie, thus “doctors from different medical fields in the province mobilized voluntarily and began to conduct an awareness campaign at the district and village level. Moreover, this group of doctors also took it upon themselves to gather community elders in villages and instructed them to quarantine individuals returning from countries which have large numbers of COVID-19 cases.”

Afghanistan’s Lack of Resources, and the International Response

Delivery of services, improved communication, and awareness raising, and emergency responses are central to the Afghan government’s five-stage plan to tackling the pandemic. This plan aims to manage the health response and economic shock that will follow the pandemic in the country. However, Sarabi warns that the Afghan government lacks the resources it needs to accomplish ahead and will require significant international support. The European Union and World Bank have allocated funds to support Afghanistan’s fight against COVID-19 and countries like China, India and United Arab Emirates have sent medical and food supplies. However, Sarabi points out that the money allocated by donors remains insufficient.

According to Shagul Razaie, international donors and their Afghan counterparts must create mechanisms that can manage, monitor, and report how these resources are being spent—mechanisms which are currently missing. She said, “MPs are often asked to monitor the government’s COVID-19 response, but how can we when we do not know what to monitor?” Others suggest that resources, capacity and quarantine will not be enough.