Threat of increasing disease as refugees return

Health experts on Tuesday warned of an increase in the spread of infectious diseases as Afghans return home to a country which has no health-care system. "We are seeing increasing cases of diarrhoea since people started returning," Stethane Robin, the medical coordinator for Medicine Sans Frontieres (MSF) in the Afghan capital, Kabul, told IRIN. He said there had been a dramatic rise in the number of patients they were seeing as the repatriation drive continued to grow. "Last month we saw 6,000 Afghans, and in the first week of May we have already seen more then 1,000 patients." Robin pointed out that there was also a high risk of disease being contracted during the returnees' journey home. "They are travelling in terrible conditions," he maintained, adding that many pregnant women were being forced to give birth on the way, without proper health-care facilities. While some mothers were stopping at clinics in Kabul for a checkup on the way to their final destination, they were not prepared to stay in the area if they needed treatment for several days. "We referred some mothers with children to supplementary feeding centres, but they would not stay, because they said they had paid for trucks to take them home. As a result, we know that some children have died during the journey," he said, adding that another major problem in Kabul was the inaccessibility to clean drinking water. The World Health Organisation (WHO) has echoed these concerns and reiterated the urgency for improved services to be made available to Afghans. "Our primary concern is that returnees will be exposed to diseases which are endemic, for example leishmaniasis," a WHO spokeswoman, Loretta Hieber-Girardet, told IRIN in the Pakistani capital, Islamabad. WHO estimates that 250,000 Afghans are infected with the disease nationwide, with 100,000 in Kabul alone. The disease is transmitted by the bite of the infected female phlebotomine sandfly, and can cause serious lesions on the skin, often to the face. According to Hieber-Girardet, waterborne diseases are also a huge problem in the country. "Without proper sanitation there is the threat that increasing diarrhoeal diseases will continue." As the number of returnees increases daily, there are also concerns over living conditions and overcrowding, which can encourage the spread of tuberculosis (TB). According to the world health body there are 80,000 cases of the killer disease throughout Afghanistan every year, of which 23,000 are women, who are usually confined to cramped conditions. "The worrying thing is that only 20 percent of the population will have access to the preferred treatment for TB," she stressed. Many Afghans returning will expect adequate health services, similar to those they left behind in their home provinces. However, the continuing decline of the country over the years had left the health-care system in ruins, Hieber-Girardet said.