A patient in the measles isolation ward at Boost hospital. Afghanistan, 2022. © Tom Casey/MSF
Not enough beds
The number of measles cases has been extremely high in Boost hospital. From December to the end of February on average over 150 children with measles came to the hospital each week. Forty per cent of these children have a severe complication like pneumonia and are admitted for treatment
At the beginning of the year, the project had eight isolation beds for patients with infectious diseases like tuberculosis or measles. Very quickly that ward became overwhelmed with measles patients and so another 12 beds were added. Now rehabilitation work is ongoing to transform an existing building into a 60-bed measles unit, providing intensive care for critical patients and inpatient care for those who are recovering. But even this will likely not be enough.
“Sixty per cent of the measles cases we see arriving at Herat Regional Hospital require hospitalisation and half of those we admit for critical care are also malnourished,” says Sarah Vuylsteke, Doctors Without Borders Herat project coordinator.
Measles and malnutrition, a deadly combination
The situation is particularly alarming as Afghanistan is already facing a nutritional crisis. For months, children receiving treatment in Doctors Without Borders’ feeding centres in Helmand and Herat have often had to share beds as the number of patients exceeds the centres’ bed capacity. Across both projects from January until the end of February there were almost 800 children admitted with severe acute malnutrition.
A medic gives glucose to a patient in the measles isolation ward at Boost hospital. Afghanistan, 2022. © Tom Casey/MSF
“Most children we see in our feeding centre and intensive care unit have had measles recently”, says Fazal Hai Ziarmal, Doctors Without Borders' clinical team leader at Boost hospital. “Measles damages children’s immune systems and makes it harder for them to fight complications such as respiratory infections like pneumonia.”
“If a child is malnourished, as many in Afghanistan are at the moment, their immune system is already very weak and that can lead to a more severe and prolonged measles infection. This in turn damages their immune system even further and makes children very vulnerable. A lot of malnourished children die from post measles complications.”
Struggling to find care
Measles is preventable through vaccination, but coverage in Afghanistan is low and this is one explanation for the rapid rise in cases. In addition, sometimes several families live under one roof, creating perfect conditions for the rapid spreads of the disease. Some children recover from measles by themselves whilst others need simple medication for their complications, but even this can be hard to find in Afghanistan as many health facilities lack sufficient medicines and supplies. This means many parents have to buy the medication from local pharmacies.
Han Bibi with her grandchildren in the measles screening unit at Boost hospital. Afghanistan, 2022. © Tom Casey/MSF
“All 12 of my grandchildren got sick but these three are suffering the most,” explains Han Bibi who is waiting for her son in Boost hospital’s measles screening unit, with her grandchildren around her. They look dazed and unhappy, all three have measles.
“We bought some medicine in our village but when the children didn’t improve we came here. The eldest was crying saying her chest was painful, and she was vomiting. She’s drinking a lot of water but can’t hold anything else down.”
Extra strain on the health system
“In our project in Herat, two children are dying every day due to measles complications and I dread to think about what’s happening in other parts of the country that don’t have access to more advanced care,” says Sarah Vuylsteke, the Doctors Without Borders coordinator in Herat.
“The public health facilities we visited in rural areas have the capacity to handle measles patients with mild complications, but the staff in every single one said they wouldn’t be able to help severe or complicated cases as they don’t have the supplies, staff or equipment. For children who are very sick, the most vulnerable, there’s very little they can do,”
We can increase the number of beds in the places where Doctors Without Borders works but this won’t fix the problem. Unless there’s a widespread vaccination campaign, we will continue to see increasing cases for the next six months, putting yet more pressure on an already fragile healthcare system. In the longer term, the programme for regular measles vaccinations should be strengthened so that children can be vaccinated routinely, rather than in response to flare ups in cases.Sarah Vuylsteke, Coordinator
In Kunduz city, Doctors Without Borders financed staff and equipment for a new 35-bed measles ward at Kunduz Regional Hospital. The ward opened on 27 February and by the next morning it already had more patients than beds.
Back in the paediatric intensive care unit at Boost hospital, medics crowd around what used to be Takberullah’s bed, trying to save the life of a new patient. Meanwhile, Zainab has packed up her things and travels home, alone, to be with her remaining children.
