Afghanistan is already mired in the world’s worst humanitarian disaster marked by widespread hunger, economic collapse, and the mass displacement of people. Now an extremely contagious viral disease -- measles -- is thriving in the country's weakened state.
Those issues have caused "irreparable damage" to Afghan children, according to the World Health Organization (WHO) and are compounding efforts to contain a major measles outbreak that began in early 2021.
"The rise in measles cases in Afghanistan is especially concerning because of the extremely high levels of malnutrition," WHO representative Luo Dapeng said this month during a visit to the central province of Wardak. "Malnutrition weakens immunity, making people more vulnerable to illness and death from diseases like measles -- especially children.”
In December, WHO launched a measles vaccination campaign to fight the ongoing outbreak. During a weeklongimmunization drive from March 12 to 17, WHO said it planned to vaccinate more than 1.2 million children under the age of five across 24 Afghan provinces.
Mothers sit with their children in a measles ward of a Badghis hospital.
A two-dose vaccination rate of 95 percent is recommended to ensure immunity and lower the risk of transmission to neighboring states such as Iran and Pakistan that host large numbers of Afghan refugees.
Measles cases have skyrocketed over the past year. From January 2021 to March 2022, there were over 48,000 cases and 250 deaths, according to the WHO. In 2022 alone, there have been over 18,000 cases and 142 children have died of measles in the country.
The resurgence of measles, a viral respiratory disease, has taken a terrible toll on children across Afghanistan.
The biggest hot spot, according to a map compiled by the WHO, is in the eastern province of Paktia, bordering Pakistan. To the north, the provinces of Balkh -- bordering Turkmenistan, Uzbekistan, and Tajikistan -- and Kunduz -- bordering Tajikistan -- are close behind. To the west bordering Iran, high infection rates have been recorded in the provinces of Farah and Herat, as well as in Badghis, which borders Turkmenistan.
Doctors Without Borders has expressed particular concern about the rising case numbers in Herat, Kunduz, and the southern province of Helmand, where it said that from December to February an average of 150 children were being hospitalized every week with measles.
Homeira, a 26-year-old mother from the central Ghor Province, told RFE/RL’s Radio Azadi that she struggled to receive needed treatment for her 6-month-old son even when he exhibited tell-tale signs of measles, including white lesions in the mouth known as Koplik's spots and a visible rash.
"He had diarrhea and was vomiting," she said. "Later we went to bed, but he did not recover. The doctors prescribed medicine and I gave it to him, but he was still vomiting."
Doctors at Ghor's provincial hospital said that poor-quality vaccines and medicines, as well as people's lack of awareness about the disease, contributed to the death toll.
Hospital director Abdul Ahmad Nuri said that thousands of children had been hospitalized even before the WHO vaccination campaign, the second following a nationwide effort in December, began this month. The outbreak, Nuri said, had left the hospital scrambling to find beds for measles patients.
In Badghis Province, 340 children were hospitalized with measles in the first two months of this year, a number that Safiullah Khadem, the deputy director of the Badghis Department of Public Health, told Radio Azadi, compared to the total for all of 2021.
In the province, parents have complained of inadequate care, a complaint that has become frequent as health care suffered from a dramatic drop in international aid since the Taliban regained power in August.
The new Taliban leadership has not been recognized by the international community and is restricted by international sanctions.
Zarmina, a 35-year-old mother of three, said she rushed all of her children to the provincial hospital and was told she would have to provide her own vaccines and syringes.
"They took us to the emergency section of the hospital and told us to get a syringe," she said this month. "They administered one shot themselves and we had to buy the rest of the medication from the market."
The lack of trust in the health-care system is a hurdle that the WHO is acutely aware of and is trying to overcome by convincing the population of the need for the entire vaccination course.
"I appeal to every parent to bring your kids for vaccination and give them the best gift of being protected from life-threatening but preventable disease," the organization's Dapeng said.