Stop TB Partnership to Focus on Afghanistan and Pakistan

The Stop TB Partnership Forum in Washington, D.C., warned in late October that efforts to control TB in Afghanistan have been seriously disrupted. The coalition of more than 120 organizations, including the World Health Organization (WHO) and the World Bank, launched the Global Plan to Stop TB. The multi- billion dollar plan will "pay special attention to the alarmingly high incidence of TB in Afghanistan and Pakistan," according to J.W. Lee, director of the WHO department to Stop TB.

Since Sept. 11, hundreds of thousands of Afghans, many with TB, have rushed to the border with Pakistan and now live in greatly cramped conditions. "TB among Afghans is already a big problem and the present situation is definitely going to worsen it. We can't provide them anti-TB medication in the present situation, although we want to," said Lee. Even before the most recent displacements, TB was responsible for 70,000-80,000 new infections and 16,000 deaths a year in Afghanistan.

In 1997, Afghanistan adopted directly observed therapy strategy (DOTS) nationally. Presently there are only 30 health centers that provide TB treatment services. Most of these are in large cities, from which people are fleeing. Drug supplies remain erratic and health workers' knowledge of TB management is poor. The country, in general, has failed to achieve the global targets of detecting 70 percent of infectious cases and curing 85 percent of those detected. In fact, 70 percent of TB patients have no access to DOTS.

To expand DOTS in Afghanistan, WHO and its partners say they need $11 million to $25 million over the next five years. But the funds alone are unlikely to help achieve the TB control targets. According to the United Nations Development Program (UNDP), about 70 percent of the nation's population is undernourished. "In most aspects, Afghanistan is worse off than almost any country in the world," noted Sakiko Fukuda-Parr, spokesperson for UNDP. The withdrawal of Medicins Sans Frontieres (MSF) from Mazar-I-Sharif and Kandahar after its offices were bombed has further complicated the situation. The two cities, MSF said, remained "crucial bases for the provision of medical and nutritional aid to the Afghan population."

WHO, UNICEF and other UN agencies say their ability to keep operating in Afghanistan is diminishing day by day as the situation deteriorates.

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