In mid-April, the man leading the Afghan government’s coronavirus response in northern Faryab Province, Mohammad Naim Musamam, staged a face-to-face meeting with local members of the militant Taliban.
Conflict was flaring across the country, and promised peace talks between the government and the Taliban were stalled. But Afghanistan was also weeks into its coronavirus outbreak, and Musamam had a stark message for the Taliban: it’s time to prepare for the pandemic.
“We talked to them and told them, ‘You are from Afghanistan’,” recalled Musamam, who is director of Faryab’s provincial health department. “‘The coronavirus is your problem, our problem, and the problem of the poor and the rich. It does not discriminate.’”
Afghanistan’s government and the militant Taliban have a common enemy in the coronavirus pandemic. But health officials and aid groups say conflict is jeopardising efforts to contain a virus that has overwhelmed wealthier nations across the globe.
The coronavirus has infected more than 17,200 people nationwide since the first cases emerged in late February. But many believe the true figure is far higher: testing has been inadequate across the country, and scarce in areas under Taliban control. The group vies for control in more than half the country’s roughly 400 districts and has full command of at least 21, according to a UN report published last week.
Decades of war have left Afghanistan’s health system in tatters, propped up by international aid funds. Health clinics in contested areas – often run by local NGOs contracted by the government – are even more basic. NGOs and analysts fear women in particular may be missing out on testing and healthcare.
“The coronavirus is your problem, our problem, and the problem of the poor and the rich. It does not discriminate.”
Formal cooperation between the Taliban and the government on the coronavirus is rare. Provincial-level officials like Musamam have tried to engage with the Taliban directly, offering treatment in provincial hospitals for suspected cases, or advice on preparedness and containment measures. But these efforts vary from district to district, dependent on ground-level relations with local Taliban.
“Though the group would never admit it, it does not have the technical capacity, nor does it allocate sufficient funds, to mount effective disaster relief on its own,” said Andrew Watkins, a senior analyst at the International Crisis Group who previously worked for the UN in Afghanistan. “During humanitarian crises, the Taliban is rather dependent on whatever outside resources and aid are able to access their territory, which the group often makes very difficult.”
Conflict killed or injured more than 10,000 Afghan civilians last year, according to UN statistics, and skirmishes and threats routinely shutter health facilities and hospitals. Hundreds of thousands are displaced by conflict or disasters each year, and more than 9.4 million people were projected to need aid even before the pandemic hit. A three-day Eid ceasefire in late May raised hopes that direct peace talks, delayed since March, would follow. But sporadic fighting quickly resumed.
Health officials say the conflict stands in the way of containing the virus, leaving the entire country’s population at risk.
“Every community is vulnerable. Cooperation of every group in Afghanistan is vital,” said Wahid Majrooh, a deputy in Afghanistan’s health ministry. “If we face security problems… we will not be able to contain COVID-19.”
Since the pandemic began, aid groups say fewer people, particularly women, are seeking out health services and some clinics have closed, driven in part by fears of contracting the virus. Active conflict makes it even more difficult to deliver health services in contested areas, or for the government to track suspected patients.
Musamam said the April meeting with the local Taliban in Faryab was aimed at reaching across the battle lines in order to save lives. He told the militants that people in Taliban-controlled areas could be treated in government hospitals; the Taliban have sent at least three people with COVID-19 symptoms.
“If you are infected and not fighting, we will bring you for treatment and guarantee your safe return,” Musamam said he told the Taliban.
During the meeting, provincial government health workers and Taliban members discussed how to disinfect public areas, and how to institute lockdowns aimed at containing the virus. Convoys of cars carrying health staff and Taliban members then went from village to village – some in areas under Taliban control, some controlled by the government – to promote health advice.
But such coordinated operations have been rare. Next door in Badghis, west of Faryab, local Taliban have refused access to government health workers in two districts, said Abdul Latif Rustayee, the director of the province’s health department. He called the lack of cooperation “a serious concern”.
These ground-level negotiations mirror the complexities of delivering aid in conflict zones, where the success of health campaigns often hinges on personal relations and local politics. Previously, door-to-door polio campaigns have been derailed because Taliban or other militant groups refused access.
“If you are infected and not fighting, we will bring you for treatment and guarantee your safe return.”
Gholam Dastgir Nazari, a spokesperson for Afghanistan’s Public Health Ministry, said Taliban cooperation for polio campaigns, and now the coronavirus, often depends on who commands a given area. When members of the Taliban’s health commission hold more sway than its military commanders, access is more likely to be granted, Nazari said.
Community elders can also help ease access for health workers to do awareness campaigns on hygiene and social distancing, and to track suspected cases. “Local elders demand health services,” Nazari said. “They play an important role in local communities.”
Local and international humanitarian groups with a track record of negotiating access are also trying to step up programmes in Taliban areas. In March, the Taliban issued a notice promising safe passage to aid groups and medical staff.
The Afghan Red Crescent Society, for example, said it has activated 130 medical teams to work on the coronavirus, including in areas that are contested or under Taliban control. The teams bring advice on hygiene and staying safe, trains local medical workers, and tells people where to get help if they have symptoms, a spokesperson said.
The Norwegian Refugee Council, which focuses in Afghanistan primarily on food and hygiene programmes for the displaced, has held coronavirus awareness sessions in Taliban-controlled areas in southern Zabul Province. There are plans to ramp up food and hygiene distribution in Taliban areas, said Elisabeth Koek, the NRC’s protection specialist, adding that each aid delivery requires careful negotiation.
“We encourage all authorities, including the Taliban, to allow people the freedom of movement to access medical facilities, as well as allowing aid agencies to operate freely,” Koek said.
Life in Taliban areas
Without consistent access for government health workers or aid groups, however, the effectiveness of the Taliban’s own coronavirus containment efforts remains unclear.
Social media pages connected with the group have shown Taliban members in white suits and gloves advising people on public health and hygiene. Other posts show armed militants disinfecting marketplaces and distributing posters about the virus.
“Every wealthy person should assist fellow citizens of their mosque, village, and city, so that no Muslim brother suffers food shortages,” one public statement read.
But some Afghans living in Taliban territory say they’ve received minimal help.
Residents of Musa Qala district, a Taliban stronghold in southern Helmand Province, told TNH they had seen little in the way of lockdowns, quarantines, or other measures advised by the government.
“I have heard the Taliban distributes soap for people,” resident Mohammad Musa told TNH by phone. “But I have not received such help.”
“What the Taliban says is just a formality,” said Shamsullah Sahra, a resident of Helmand’s Sangin district. “They do not understand what the coronavirus is. There is a propaganda issue, and there is a reality. The Taliban does not care about such a thing.”
The Crisis Group’s Watkins said the Taliban were insisting on quarantining returnees – particularly migrants returning from neighbouring Iran, from where many of the region’s early cases first emerged. But the virus has now reached every Afghan province.
“I have heard the Taliban distributes soap for people. But I have not received such help.”
“We generally only have a good picture of what the Taliban want the outside world to see: the propaganda that they share,” Watkins said. “The information being shared does not seem to sufficiently emphasise social distancing and best practices, and, critically, it is not clear if women are being included in awareness or treatment campaigns.”
Health services were also inadequate even before the pandemic.
“The situation is dire,” said Attaullah Wesa, co-founder of the Afghan education NGO PenPath, which has recently launched an outreach campaign promoting public health in rural areas, including Taliban-controlled territory. “Where there is conflict, a doctor does not take the risk to go there, even if the armed opposition group allows,” he said.
Instead, clinics often lack basic equipment or properly trained staff. Doctors may simply issue prescription drugs and leave female patients untreated, Wesa said, adding that “people think that anyone who is shaved” and wears a white suit is a doctor.
As Afghanistan’s conflict continues, early signs of progress against the coronavirus are also easily erased.
Days after the mid-April summit between Taliban and health workers in Faryab, militants attacked security outposts in the same district where the meeting was held, reportedly killing at least two police officers. Taliban fighters later stormed five district compounds in one night, said Musamam, the provincial health official.