As the novel corona virus sweeps across Iran, the Afghan-Iran border remains open without considering the health. In addition, the chances of importing corona virus from the epicenter of the outbreak will increase by allowing unmonitored movements from Iran to Afghanistan.

On February 24, 2020, the Ministry of Public Health of Afghanistan confirmed its first Corona virus case with a travel history to Iran, in Herat province (bordering with Iran).  Currently there are 24 cases of COVID-19 in Afghanistan.  Almost all positive cases are returnees from Iran. Inadequate screening procedures and lack of quarantine zone for the returnees place doubt on government’s measures towards preventing the spread of the virus in the country.  

even though government, particularly the president of Afghanistan expressed its commitment to battle COVID-19 outbreak through allocating 20 million dollars, and started construction of a 100-bed hospital for COVID-19 patients in Herat province.  However, Afghanistan is at high risk for Corona virus outbreak for several reasons, unless something extraordinary happen. First, Afghanistan decided to leave the border open with Iran despite anticipating the severity of the outbreak in Iran. This decision facilitated the movements of thousands of Afghans to cross the border following inadequate screening procedures. In addition, the failure of MoPH to establish a proper and well-equipped quarantine zone at the Iran-Afghanistan border for individuals crossing the border further increases the risk of corona virus transmission in Afghanistan. Recent studies report that even asymptomatic individuals might own the potential for human-to-human disease transmission. Experiences from Taiwan, Singapore, and Hong Kong that are located in the proximity of China has shown that imposed quarantine procedures and closing the borders was effective in keeping the Corona virus in control. Second, malnutrition, poor hygiene and sanitation, and poverty could also exacerbate the spread of infectious disease including novel corona virus. Unfortunately, Afghanistan is a country that suffer from malnutrition, poverty and lack of proper hygiene and sanitation practices. Due to these factors, premature deaths and morbidity from diseases are higher in the country, and the health system remains incapable of addressing such health-related issues due to technical and financial limitations. The presence of all these factors make Afghanistan more susceptible for rapid transmission of Corona virus.

Furthermore, the majority of population in Afghanistan are not ready to follow the recommendations for Corona virus prevention from Ministry of Public Health of Afghanistan. Fatalistic belief among people remain a grave challenge for public health professionals to convince the public to maintain appropriate prevention methods against COVID-infection. Most Afghans are ignoring the preventive measures due to their inability to comprehend the complexity of the problem and relying on pseudo-religious reasoning such as corona virus inability to affect Muslims. Alternatively, the gap in health communication and lack of context specific solution to the masses also complicates the situation. For instance, many advertisements encourage the citizens to focus on hand washing practices and using soaps or hand sanitizers. However, major cities of Afghanistan lack of public toilets, and utilizing hand sanitizer is a rare practice among public in Afghanistan. In such cases, it is important to provide context specific solutions to the masses and use creative ways to pass the message. For example, the involvement of imams and other religious leaders could play a great role in raising public health awareness; and it requires the policymakers to reach out to the religious leaders and mosque to push the message. but traditionally the religious leaders have shown apathy in engaging in the health awareness programs but the serious nature of this crisis have strong possibility of changing the behavior and playing positive role in this crisis.

The ineffectiveness of health system is not just limited to prevention but it also lacks the ability to contain the virus. The inability of public health system to quarantine suspected individuals for the prescribed period could further worsen the situation by spreading the infection to other provinces of Afghanistan. On March 16, 2020, all suspected and positive cases with corona virus managed to escape from the quarantined facility in Herat city. The situation highlights that neither the patients nor the healthcare professionals were serious about the epidemic. Health professionals do not feel comfortable confronting those patients because they lack proper training on how to deal with quarantined individuals, and how to support patients in critical health condition following complication from COVID-19.  On the other hand, delays in result of the tests for corona virus, lack of trust in hospitals, and lack of sufficient facilities in quarantine facility to keep the individual in quarantine caused frustration among those who were in quarantine and urged them to flee the facility. It highlights deficiencies in leadership and management of health authorities and questions the ability to respond to such kind of critical situations during the outbreaks.

Moreover, the transparency in reporting and mass testing for early detection and control of novel corona virus proved to be effective strategy in some countries. However, Afghanistan have not yet initiated comprehensive screening and mass-testing strategy. Pakistan that received almost one million returnees from Iran has confirmed 326 cases of COVID-19 infections recently. Most of the cases in Pakistan are related to Iran. Afghanistan on the other hand, has reported twenty-four confirmed cases of novel corona virus. Given that the border with Iran remains open, many cases might have gone undetected rather than lower number of COVID-19 cases in Afghanistan. MoPH’s delayed response for early could turn Afghanistan into epidemic center of the corona virus outbreak.

Afghanistan remains an endemic country for several infectious diseases including poliomyelitis. Diarrhea and pneumonia contribute to majority of deaths in Afghanistan. The outbreak of Corona virus could pose a serious challenge to already overwhelmed and weak health system of Afghanistan. Responding to COVID-19 in a proactive means through applying aggressive and comprehensive quarantine and isolation procedures, contact tracing, active surveillance system, preserving transparency in reporting, and paring socio-behavioral models in maintaining communication for raising public health awareness could assist in delay of the outbreak and minimize the impact of corona virus outbreak in country. It is also vital for health ministry of Afghanistan to form a technical advisory committee on national and provincial level and encourage epidemiologists, infectious disease experts, psychologist, public health experts, and communication specialists to provide suggestions for taking preventive measures by ministry of health for battling corona virus crisis in effective way.  

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