The last days of the year 1399 in Afghanistan


In March 2021, our Director Prof. Karl Blanchet visited Afghanistan to discuss with national partners how to initiate two research projects related to the Researching Impact of Attacks on Health (RIAH), and a situation analysis on diabetes and hypertension care management. In this short blog, Prof Blanchet shares his impressions on the studies and travelling again in the context of COVID-19 in a conflict-affected country.

It has been a year since I last travelled. It is somehow surreal to find myself en route to Afghanistan. For global health travellers, like for many other people, the pandemic has radically change our routine. The plane to Dubai is almost empty, whereas the flight Dubai-Kabul is packed.

Over the past year, I have learned that a lot can be achieved by remote meetings, but, in my opinion, meeting people in person is still important specifically when discussing about sensitive topics. A trip to Afghanistan was needed to meet our colleagues from the Ministry of Public Health (MoPH) and Aga Khan University to start the two joint-studies we have planned in partnership with them: the Researching Impact of Attacks on Health (RIAH) and the situation analysis on diabetes and hypertension care management.

I arrive to Kabul on the same day as 500,000 doses of COVAX vaccines. Feeling a bit dizzy after a night on the plane with no sleep, I visit the French Medical Institute for Mothers and Children where my colleague Dr Shafiq, from the Aga Khan University, tells me that vaccinations are available at the hospital. He explains to me that three weeks ago, the government of India has supplied the country with 500,000 Oxford-AstraZeneca vaccine doses. Western media have hardly covered the news. This does ask questions about the biases introduced by European media about our vision of the world. By reading the press from this part of the world, I learn that, as of March 2021, both China and India have donated more than 12 million doses, a strategy that the Western press will call the “vaccine diplomacy”. My message on Twitter about this generates many interesting comments from India questioning my naivety about the biased views of the European press, which I fully recognise.

Professor Karl Blanchet with His Excellency Dr Majrooh, Minister of Health. Photo credit: Geneva Centre of Humanitarian Studies

During my visit to Kabul, I had the privilege to meet His Excellency Dr Majrooh, Minister of Health. We discussed the Integrated Package of Essential Health Services (IPEHS) we had developed with his predecessor, Dr Feroz, and the MoPH teams. Since mid-2019, when we finalised the IPEHS, the country did not have much opportunity to implement the package because of a change of  minister and, of course, the pandemic. During the meeting, we discussed  how to join forces again to make sure the IPEHS will be officially communicated and implemented. We agreed that technical working groups in Afghanistan and globally will be put in place to support this national initiative. On behalf of the MoPH, the Geneva Centre of Humanitarian Studies will coordinate a group of international experts, conduct additional analyses and make the links with national working groups. With this renewed process, we hope to better involve international donors, in particular, and achieve a buy-in from various departments at MoPH.

Professor Karl Blanchet and Dr Arwal, NCD Director at the Afghani Ministry of Public Health. Photo credit: Geneva Centre of Humanitarian Studies.

I also had the chance to travel to Mazar I Sharif to visit health facilities and discuss the situation on hypertension and diabetes management. I learned that diabetes is the “invisible” health condition in Afghanistan, at least in the health information system and, in many ways, in health facilities. In comprehensive health centres, doctors do not even prescribe insulin or provide counselling on diet and physical exercise to patients with diabetes. They are systematically referred to the regional hospital. In regional hospitals, however, surgeons see diabetic patients with gangrene resulting in amputations and ophthalmologists see diabetic retinopathy. The non-management of diabetic patients at primary health care has dramatic consequences for patients and significant extra costs for the Afghanistan health system.

Regarding the attacks on healthcare study, we have worked with the research team at the Aga Khan University on the most appropriate strategy to select districts for the study. According to the WHO data, for the year 2020, 89 incidents were reported in 46 districts. They all vary by nature: facilities closed due to fighting, threats to health personnel, kidnapping and violence against staff or looting. For the RIAH study, it will be essential to select the most affected districts that could be accessible to researchers. We set up a national Steering Committee with representatives from the main stakeholders: MoPH, the World Health Organisation and the International Committee of the Red Cross.

In a few days, the Afghan population will celebrate the year 1,400 on the solar Hijri calendar. All around me, Afghans are hoping that the new year will bring peace to the country. Peace talks starting in a few days in Moscow involving the government, the Talibans and diplomats from Russia, USA, Iran, India, China and Pakistan will hopefully result in concrete steps. Many,however, remain very concerned about their future.

Professor Karl Blanchet is the Course Director of the following courses taking place (online or in Geneva) in spring 2021:

Planetary Health (10 – 14 May)

Non-communicable Diseases in Humanitarian Settings (25 – 28 May)

Sexual and Reproductive Health in Humanitarian Crises (14 – 18 June)

Health System Assessment in Humanitarian Crises (21 – 25 June)