As Western NGOs remove staff and the US strips support, an influx of Afghans from Iran could add pressure on an already depleted medical system

In the Guzargah reception centre for returnees and repatriates in Herat, Afghanistan, 17-year-old Yunos rests on a thin mattress in a small, empty room.

The previous night fatigued him. He spent it sleeping rough in the desert along with thousands of other Afghans, awaiting the opening of the Iran-Afghanistan border. The frigid desert air froze him to the bone and hunger disturbed his sleep.

Yunos moved to Iran one year ago. He crossed the border illegally under the cover of night and made his way to Tehran, where he found a job as an electrician. Last week, however, he decided to return to Afghanistan. The Covid-19 pandemic in Iran has already infected more than 30,000 people, killing nearly 2,400.

Many of the 2 million Afghan workers there have lost their jobs, falling into despair. “In Tehran all shops and companies have closed, the costs of living rocketed. If you do not work in necessary services, you can’t go outside,” Yunos says. “All Afghans are returning home from Iran these days due to the coronavirus. We are terrified. We don’t want to die in a strange land.”

Since late February, more than 115,000 Afghans have returned home through the border crossing in Herat province in what has been the biggest inwards migration wave in Afghanistan’s recent history. Herat’s governor, Abdul Qayum Rahimi, estimated that close to half of the returnees “might be virus carriers”, raising fears that the influx will place greater strain on Afghanistan’s fragile health system.

While Afghanistan has so far reported only 123 Covid-19 cases – including 80 in Herat – and four deaths, officials believe that the real number of infections could be much higher. In a few weeks, the cash-strapped Afghan healthcare system will be put through a test of resilience. Western NGOs have rushed to evacuate their foreign staff and this week the US stripped Afghanistan of $1bn (£801m) worth of support, leaving Afghan health workers as the country’s only defence in the the fight against the pandemic.

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Jawad*, is bracing for what is to come. The infectious diseases department where he works has been responsible for diagnosing patients before they are transferred to a new 100-bed Covid-19 hospital.

In his ward, three doctors, three nurses and one specialist are tending to 200 patients. The lack of equipment such as protective masks, hand sterilisers and medical ventilators is the norm. According to Jawad, the hospital doctors have only one or two masks a day at their disposal.

“I have to keep my mood well, but I’m worried about my family,” Jawad says, before he returns to the hospital for a 24-hour shift. “We haven’t tested ourselves for Covid-19 yet. If someone in our department tests positive, the hospital will be paralysed and there will be no one to provide the services.”

According to Ali*, another doctor from Herat, the new Covid-19 hospital is ready to admit roughly 150 patients. But once the number of infections passes 1,000, Ali believes, the situation will get out of control. And the predictions have been grim. According to the Afghan ministry of health, the coronavirus could infect 25 million of the country’s 35.5 million people.

“Afghanistan is a country that has been affected by gross conflict for the past 40 years. There has been a lot of internal displacement, a lot of people who don’t have access to services and education, water, basic healthcare. The situation in hospitals is very daunting, especially with the increasing arrivals from Iran,” says Nicholas Bishop, the emergency response officer at the International Organization for Migration.

In the main Covid-19 hospital in Herat, only ten doctors, one specialist and twenty nurses tend to all patients. Even though the province recently received 400m afghanis (£4.2m) from the central government to fight the pandemic, supplies are scarce.

Facebook Twitter Pinterest The majority of coronavirus cases have been in Herat province, which borders Iran. Photograph: Jalil Rezayee/EPA

A countrywide awareness campaign designed to improve levels of understanding of the signs and symptoms of the virus has been in full swing. In Herat alone, 2,000 volunteers are going door to door to inform people.

But this may prove insufficient to tame the spread of the disease.

“We are facing problems with compliance, because of the lack of awareness, people’s religious beliefs, and because we went through very difficult times in the past 40 years”, says Rahimi. “Until Afghans do not see things physically right in front of their eyes they do not get alarmed. We are working with the imams to stop prayer gatherings, but we have not been successful. It needs more discussion and this is what we are focusing on.”

Meanwhile, for health workers in Herat and other provinces, the prospectof an outbreak looks grim. According to Ali, several medical professionals in Herat have tested positive for coronavirus in recent days.

“We are not ready for the crisis,” he says.

* Some names have been changed