Bombing Aftermath -- Health Specialists Fear TB Outbreak

World health officials are increasingly concerned about possible outbreaks of TB in Afghanistan and Pakistan following the US-led bombing campaign, prompting calls yesterday for a plan to monitor the health of refugees and displaced people in the region. Pakistan and Afghanistan are among the world's top 20 countries in TB cases. A relatively high proportion of the estimated 150,000 cases reported each year in Pakistan are resistant to most commonly used drugs, which complicates treatment regimens.

The World Health Organization (WHO) and the World Bank will host a meeting in Washington Monday for the 20 countries with the highest number of TB cases to promote expanding the directly observed treatment (DOT) program -- from 23 percent of TB cases worldwide to 70 percent in five years. The DOT program is a six-month daily regimen administered under the observation of health care workers. "We've got to get the world to start taking this threat of TB seriously and putting the resources in to fight it," said Ian Smith of the STOP TB Initiative at the WHO.

Past studies on refugee populations show that the majority of deaths are not from hunger, but infectious diseases that flourish among the malnourished. "In fact, most people actually never starve to death," Andrew S. Natsios, administrator of the US Agency for International Development, testified before Congress last week. "They die of communicable disease before they actually starve to death because their bodies, their immune systems, have been weakened from the hunger." Relief agency officials in Pakistan said yesterday that many Afghan families are now moving from the cities to the countryside, where three and four families are now sharing small homes. "It's starting to get very crowded in the countryside now. With the shortage of food, and with cold weather coming, it's an excellent breeding ground for TB and other diseases," one official said.

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