Central Asia Crisis Update-WHO
# 1. October 19, 2001
General Points
The WHO has appointed a Regional Health Coordinator for the Central Asia
crisis. He is Dr. Mohamed Abdi Jama, Assistant Regional Director in the
Eastern Mediterranean Regional Office in Cairo. Dr. Jama will have an office
in Islamabad. This special appointment, of limited duration, will help ensure
consistency in all WHO activities that contribute to the health of the people of
the Afghanistan area - whether they are within or displaced from the country,
or are in other communities that have been directly affected by events in or
around Afghanistan.
Country Updates
Afghanistan

The WHO is concerned about the deterioration of the health situation that
is due to come as winter approaches. The expected exodus of refugees to
neighbouring countries has not yet taken place. However a growing
number of persons within Afghanistan are facing a worsening health
situation without adequate support. Even so, international agencies still
have little idea of the humanitarian impact of the on-going conflict in the
country.

Residents are fleeing urban centres, particularly Jalalabad, thereby
overloading rural hospitals. Ensuring hospitals in Afghanistan are
equipped with medical equipment, and surgical supplies remain a key
concern.

Together with UNICEF and UNFPA, WHO works to provide essential
obstetric care. In Afghanistan, an estimated 16,000 women die per year
due to complications from pregnancy. With 5% of the population pregnant
at any times, reproductive health will remain a priority.

The WHO office in Islamabad is investigating cases of acute flaccid
paralysis, or AFP, which may be caused by polio, two of them in Ragh in
Badakhshan Province, two in Herat and Badghis, and four cases in other
southern and eastern districts. Specimens from each case have been
collected and will be tested in labs in Pakistan and Iran. To collect the
specimens in Ragh, WHO volunteers, who normally provide polio
vaccines, walked for as long as ten hours. Since UN flights are not in
operation, these specimens are being stored in a freezer below 20C until
they can be sent to a lab.

Last week, WHO managed to send the first two AFP specimens collected
in Herat and Badghis to a lab in Tehran. The specimens were hand carried
by a staff member of the WHO from Herat to staff on the Iranian border.
From there, they were transported to the central laboratory in Tehran.
These are the first AFP specimens to have found their way to a laboratory
since 11 September. Specimens of nine more cases are waiting in
freezers inside Afghanistan in other regions.
Field Notes

The WHO office in Mazar-I-Sharif was looted, one car and other
equipment were stolen.

The commercial road between Kabul and Mazar-I-Sharif is open, and
46 trucks are being used to transport medical equipment and drugs to
Mazar-I-Sharif.

A 400-bed hospital in Kabul was damaged after being narrowly missed
by a bomb. There were no reports of injuries.

Some WHO materials may have been destroyed in the ICRC
warehouse that was hit by bombs.

To date, WHO has supplied 60 Emergency Health Kits (60 tons of
material) to Afghanistan. Some of these kits reached Jalalabad on their
way to Kabul, Mazar, and Herat. WHO is supplying the Hazarajat area
and Panjsheer Valley through two NGOS, LEPCO and Aide Medicale
International. Each Emergency Health Kit provides enough medicines
and supplies for 100,000 people for 3 months. WHO is also examining
possibilities for sending to Afghanistan an unspecified number of
Emergency Trauma Kits, each containing surgical supplies for 100
people.

Eight WHO sub-offices are still intact with national staff present in each
location, but communications from inside Afghanistan are extremely
difficult.
Pakistan

WHO is prioritising support for the local health structures in Pakistan.
WHO is providing 25 Emergency Health Kits to ensure local health
structures are equipped to deal with a potential influx of refugees, and
local needs.

Access of refugees to essential preventive and curative health services in
and outside the camps remains a key issue. To date, 29 casualties from
Afghanistan have arrived in Peshawar and 4-5 in Quetta. Their injuries
include spinal cord and head trauma, and fractures. WHO is responding to
an urgent request for surgical supplies by airlifting 2 trauma kits to
Islamabad. The supplies will be used for hospitals treating casualties in
Pakistan, and potentially Afghanistan.

In refugee camps, the major health concerns continue to be acute
respiratory infections, and diarrhoea.
Iran

No new refugee arrivals have been reported and the situation remains
stable.

The WHO reports no new cases of Crimean Congo Haemorragic Fever in
the past three weeks. Over the past six months, 70 suspected cases of
CCHF were reported, of which 36 were confirmed.
Central Asian countries
Turkmenistan

There is concern over the lack of NGOs in the area. MSF Holland is active,
but only have mandate for TB. A joint needs assessment will be carried
out (30/11 to 1/11) with UNHCR, MSF, Red Crescent and WHO to further
identify health, and water/sanitation priorities.
Uzbekistan

UN agencies are intensifying efforts to open corridors and facilitate crossborder activities.
Tadjikistan

10,000 refugees are still stranded on an island between Tadjikistan and
Afghanistan. Health requirements are substantial and currently being
covered by the NGO Merlin.
Other information

The WHO Central Asia Crisis Unit has a new communication officer,
Loretta Hieber-Girardet, who can be reached at 791-3949 and by mobile
phone at 079-475-5549. E-mail: hiebergirardetl@who.int.