Press conference with UNAMA, WHO and the Ministry of Public Health

13 Oct 2008

Press conference with UNAMA, WHO and the Ministry of Public Health

KABUL - Transcript of press conference by Dr Abdullah Fahim, Spokesperson, Ministry of Public Health, Dr. Grabar Rana Kakar, Technical Officer, World Health Organisation and Dr. Nilab Mobarez, UNAMA Spokesperson’s Office.

Dari - Pashto 

UNAMA: Salaam alaikum. Good morning everyone and a warm welcome to UNAMA’s press conference today. I am Nilab Mobarez from UNAMA Spokesperson’s Office. Our speakers today are Dr. Abdullah Fahim, the spokesperson for the Ministry of Public Health and Dr. Rana Graber Kakar, a technical officer from World Health Organisation. They will update you on the current diarrhoeal disease we have seen in parts of Afghanistan over the last week or so and measures we can all take to protect ourselves and our families. Before I handover to our honourable guests, let me give you some updates on other United Nations activities.

The first ever Global Hand Washing Day, 15 October, is on Wednesday.

Afghanistan will be among the 70 countries marking the day across five continents in an effort to mobilise and motivate millions around the world to wash their hands properly with soap.

Hand washing with soap is one of the most effective and inexpensive ways to prevent diarrhoeal disease and pneumonia, which together are responsible for approximately 3.5 million child deaths every year.

Diarrhoea diseases also count for 20 out 100 deaths of children in Afghanistan.

By washing hands with soap, families and communities can help reduce child mortality rates from diarrhoeal diseases by almost 50 percent.

The United Nations General Assembly declared 2008 the International Year of Sanitation (IYS). Global Hand Washing Day reinforces the IYS’s call for improved sanitation and hygiene practices.

There is a fact sheet on the side table available which provides facts about the day and its impact.

We will also bring you more information on activities that are planned around Afghanistan to highlight the day over the next two days.

The Food and Agriculture Organisation of the United Nations (FAO) marks World Food Day this week on Thursday.

16 October 1945 was the day the organisation was founded in 1945 in Quebec City, Canada.

The World Food Day theme for 2008 is “World Food Security: the Challenges of Climate Change and Bioenergy.”

As always in Afghanistan, the FAO Representative in collaboration with the Ministry of Agriculture will mark the World Food Day, this year at Badam Bagh in Kabul.

The ceremony will include the inauguration of the National Seed Secretariat, which will become the umbrella institution for all seed industry functions in the country including seed variety research, seed production, quality and regulatory control, and seed marketing.

An exhibition of agricultural projects and activities of FAO and the Ministry of Agriculture will be on display and agricultural toolkits will be distributed to farmers who are the heads or members of co-operatives.

UN Agencies, international NGOs, Ambassadors, donors, representatives of Government authorities, Afghan farmers and national and international media are all invited to attend.

For further information, please collect a press release from FAO on the side table.

The UN’s Educational Scientific and Cultural Organisation (UNESCO) expresses its concern on the reopening of the road at the site of the Herat minarets, which was closed this summer following a decision of the Afghan provincial authorities in order to protect the 15th century historical site.

UNESCO has been actively working with the Afghan authorities to protect the historic heritage of Herat, and would like to call on the authorities to find an alternative solution to ensure the protection of the site and will continue to work closely with and support the Afghan authorities to achieve this.

UNAMA: I would now like to handover to Dr Abdullah Fahim, spokesperson of the Ministry of Public Health (MoPH) who will provide you with an update on the current diarrhoeal disease we have seen in parts of the country over the past week.

MoPH (translated from Dari): As in previous years, this year we are facing diarrhoeal disease in Afghanistan because of unsafe drinking water and a lack of health education. I would like to give you some statistics from the first months of previous years: for example, in the year 1385 (2006) we had an average of 164 cases of diarrhoeal disease in each clinic; while in 1386 (2007) it was 185 cases and this year we have so far registered 173 cases per clinic on average. So you can see there are no significant changes in the figures over the years. Due to the fact that the hot season continued longer than expected this year and coupled with drought, we have seen a slight rise in these figures compared to what we expected. We have received the first reports of this disease in the Achin district of Nangarhar province.

The outbreak has been located mainly in five provinces - Nangarhar, Nuristan, Laghman, Samangan and Faryab - with 1,556 in-hospital patients and 2,431 patients were recorded on an out-patient department basis. We had a few other cases in seven other provinces. Out of almost 4,000 cases we had only 22 deaths due to this disease. These deaths all happened before outside any health facility. We are proud to say that all those who attended one of our health facilities got treated. The measures that the Ministry of Public Health have taken through the scientific research department of the Public Health Institute and an early warning system which is working on the cases of the disease, sampling, health education and proposals to tackle the problem have all worked well.

Other practical measures were regarding the control of the disease. Fortunately, the Ministry of Public Health had enough resources in the community itself and good experience in order to address this problem. In addition to the medicines that we had in the field, we sent for 15,000 chlorine tablets; fifty barrels of chlorine of 50 kilograms each; ORS (Oral Re-hydration Salts) and Doxycycline capsules which is the best antibiotic choice against cholera.

We faced problems in two areas of the country: one was due to security problems in the Mandol district of Nuristan province where we had to put in more time and effort to control the situation. The second area was Samangan. In the Aybak district of Samangan province, unfortunately due to drought and lack of safe drinking water, the people used unsafe water sources. We believe that there was not enough safe water brought to the area in tankers. So in this area, the cases go up and come down and it continues like this. So we feel that this problem requires more public awareness to educate people and more inter-sectorial assistance.

What concerns us the most is that while different types of cholera including Eltor and Anaba exist in our region - in Afghanistan, Iran and Pakistan, they are not very virulent and will not create an epidemic. However, if proper measures are not taken the cases of cholera which have been seen in the deported population from Iran to Nimroz or to Samangan but also within those on the eastern border with Pakistan could rise.

That is why it is very important to communicate our public awareness messages through you – the media as much as possible and also we need the cooperation of our other government colleagues to bring safe drinking water to those areas in most need.

WHO: I am glad to be here today so that you can hear that the World Health Organisation and UNICEF and many of our other partners, are all eager and willing to assist the Ministry of Public Health in taking care of all the problems that they face but especially at this time with this outbreak of diarrhoea. As Dr. Fahim has mentioned, the outbreak has been in at least five provinces and everything is under control at present, except for Samangan and in Nuristan.

As Dr. Fahim mentioned, the disease is spread by contaminated drinking water. The World Health Organisation along with other UN agencies are always emphasising that everyone has the responsibility to be sure that their drinking water is safe. You should always try to be sure that your drinking water is not contaminated by sewage, by waste, or by a septic tank.

In view of the current outbreak, you should boil your drinking water or use chlorine tablets to be sure that the drinking water that you have is safe. Sometimes people say we don't have a way of boiling our water or we don't have chlorine tablets. But you can even take the cleanest water you can find and put it in a clear plastic bottle and put it in the sun for several hours, the sun will kill the microbes responsible for the disease.

You should also be careful about other food that might be contaminated by bad water. For example, the raw vegetables that you buy in the market, you should be careful about the fruit and the vegetables. Before you eat them, if you are going to eat them raw, you should peel them. And if you don't eat them raw – you should cook them thoroughly. Cooking them will also kill the microbes.

As was mentioned earlier, Wednesday is World Hand Washing Day. Hand washing is another way to prevent this disease. You should wash your hands before you prepare food or before you eat any food. Always wash your hands with soap.

The Ministry of Public Health is managing the outbreak very well and they have taken all the necessary steps and we are working well with them. The health facilities are open - some of them are open 24 hours-a-day in case there are people with problems with diarrhoea. There are also some mobile teams which have gone to these areas.

If it happens that you or someone in your family becomes ill with diarrhoea, you should be sure that they continue taking fluids. For example, water or ORS or any kind of safe fluid that is available, any kind of liquid they should drink. If the diarrhoea is severe, they should be sure to go to the clinic, have treatment with the doctor.

As Dr. Fahim said there have been some deaths from diarrhoea but they are the people that did not go to the clinic on time. Those who have gone to the clinic have received life-saving treatment that they need. It is very important to go to the clinic in time and not delay. We hope everyone will take responsibility to use clean drinking water for themselves and their families and wash hands thoroughly before eating. By taking these simple step – you can help prevent this disease.


RFE/RL [translated from Pashto]: You said that if the international community does not assist Afghanistan then diarrhoea and in particular cholera will increase in the country. But you didn’t mention what kind of assistance do you need? May I also know how WHO can help you?

MoPH: On this particular case, we need help in raising awareness and disseminating our messages to communities through you. The community should be encouraged to take an active part in keeping its environment clean and pay attention to sanitation issues. Studies show that 25 percent of Afghans have access to safe drinking water. We hope that the population that is in danger of being affected by diseases is provided with safe drinking water, at least on a temporary basis.

WHO: WHO supports the disease early warning system. This is one of the most important methods of control of an outbreak - to find out about them very early on. Right now we have in every province focal points who are reporting on these diseases. It is also important that everyone who hears about a disease reports it through the Ministry of Public Health and through the disease early warning system. WHO and UNICEF are supporting the Government of Afghanistan in this awareness campaign; in the chlorination campaign to make water safe and also in providing essential intravenous fluids and medicines for affected areas. There is a supply called the diarrhoea kit which has infusions, medicines, ORS and all the things you need to take care of patients when they come to the clinic. Of course we much prefer having patients not come to the clinic and that is why the awareness is very important and that is why we emphasise this and we don’t want this outbreak to come to Kabul. Nobody should think that they are safe; they should try to drink clean water and take the measures we have outlined earlier.

UNAMA [translated from Dari]: I would like to add on behalf of UNICEF – one of the five areas UNICEF works on is sanitation. Under the leadership of MoPH, UNICEF is working on digging wells, providing safe drinking water and in case of necessity providing basic health kits, particularly in remote areas where, for example refugees are coming to.

FARDA TV: [translated from Dari]: As you mentioned there has not be a dramatic decrease in diarrhoeal disease in the last three years. What is the reason? You mentioned about 20 deaths, could you please tell us in which areas and why? Is this because the people who died didn’t have access to health clinics or they were living in insecure areas? What is MoPH’s plan on the prevention of the disease?

MoPH [translated from Dari]: The main cause why this disease has not decreased is a lack of access to safe drinking water which are beyond MoPH’s authority. Provision of water is the job of the Ministries of Urban Development and Rural Development. Contaminated water is the main cause of what we call seasonal diseases with an outbreak in the spring and summer months.

Another reason is sanitation and environmental hygiene. Unfortunately we lack a sanitation and hygiene system even in Kabul. Poverty also leads to the outbreak of any disease. A low level of awareness of our compatriots in many parts of the country about personal hygiene and environmental hygiene is another reason behind the outbreak of the disease.

The factors which led to the deaths in areas such as Nuristan’s Mandol and Laghman’s Dawlat Shah districts were due to insecurity and remoteness of these areas as the people could not come to health centres. The factor in Aybak in Samangan was the severely contaminated water there which caused the deaths.

MoPH’s plans are to expand the provision of health services as a package to more of our compatriots and we have paid a lot of attention to disease prevention which includes the early warning system that has been very useful; and an awareness campaign to raise awareness in the community. The awareness campaign which will start on 15 October is one of MoPH’s key activities.

IRNA [translated from Farsi]: Please tell us about the number of clinics and recorded cases of Eltor in the west. The Government of Iran had promised to send some assistance to prevent the cholera outbreak in the west of the country. Did they send any assistance or was it not needed?

MoPH [translated from Dari]: Among the cases of diarrhoeal disease reported, they are mainly from the five provinces of Nuristan, Laghman, Samangan, Balkh and Faryab. There are also cases reported among the deportees at the border, samples indicate that one or two positive cases of Eltor have been recorded. Fortunately our measures at the provincial level were enough to manage the treatment without any assistance outside of this country. Given the fact that some of the deported Afghans were positive [with Eltor] we believe and hope that the Islamic Republic of Iran, with their health system have already adopted some measures to tackle this problem. I do not think that at this stage we need any assistance at this level between our two countries. But Afghanistan is a country which welcomes assistance with open arms because we are still recovering. About this assistance if we do not need it now, we may find it useful for similar cases in the future.

SHAMSHAD TV [translated from Pashto]: Reports in the media say that not only do the Taliban benefit from the narco-trade and poppy cultivation in Afghanistan but also some locals cultivate and produce poppy to make a daily living for themselves. The other issue is that it is said that some foreigners are involved in the narco-trade. What is UNAMA’s view on this?

UNAMA [translated from Dari]: Your question has two parts. Some Afghan farmers cultivate poppy because of poverty and others who benefit financially from poppy cultivation. We have discussed this issue several times previously from this platform - in press conferences with UNODC and the issue of alternative livelihoods to help farmers make a living with legitimate crops. These efforts are continuing; should go on; and no efforts should be spared to continue this.

There are certain people who do not need to cultivate it for their daily lives - they are doing this to become richer and cultivate thousands of acres of land - that is why they do it. There is a difference between these two groups. Ordinary people who need alternative livelihoods and a lot is happening in this regard. On the other hand there are people who do this solely for profit.

Soon World Food Day will be celebrated and we announced that earlier. We have launched large projects on improved seed production in Afghanistan. In two days time, you will witness the establishment of the Secretariat for Improved Seeds. In different provinces and regions cooperatives have been established which from one side has increased the yields by 30 percent, and from the other side it has raised awareness among the public about alternative options to growing poppy.

The second issue, that foreign hands are involved in the narco-trade: of course there is the issue of criminal groups being involved. We have no further information to add to this. If you have any specific information please do share this with the relevant security authorities.

PAJHWOK [translated from Dari]: What is the latest assessment of the health situation in the five provinces and which are the seven provinces you mentioned earlier?

MoPH [translated from Dari]: Kunar, Balkh, Sari Pul, Nimroz and Shakardara in Kabul. And there are some limited incidents also reported in Parwan and Khost.

We have almost brought the disease under control, but we’re not completely sure because of security in Nuristan. In Samangan, it is due to the lack of access to safe drinking water as I mentioned earlier. One day we come near to eradicating the disease and the next day we experience some new incidents being reported. In other provinces the situation is under control.