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Afghanistan: measles is a deadly risk for malnourished children

Zainab didn’t sleep well last night. The lights and incessant sound of the machines in the intensive care unit would keep anyone awake. But she mainly she couldn’t sleep because she was worried about her one year old son.Takberullah, who also had a restless and irritable night as he had trouble breathing until the doctor gave him some medicine. “Why is my baby’s foot cold?” Zainab asks a doctor, as he holds Takberullah’s ankle and places a blanket over his chest.

Takberullah has been in the pediatric intensive care unit for three days. Boost Hospital supported by Doctors Without Borders (MSF), in Lashkar Gah, in the Helmand province of Afghanistan. Ten days ago, he and his two sisters developed a fever and diarrhoea, but Takberullah became much sicker than them. After two days a rash appeared and his mother took him to Boost Hospital, where he was diagnosed with measles.

He now has severe pneumonia, a life-threatening respiratory infection, and hypoglycemia, meaning low blood sugar. These complications explain why he has cold hands and feet, leaving him in critical condition. “How long will he have to be here?” asks Zainab, “I have other sick girls at home, and I don’t know how they are.”

Takberullah receives oxygen, antibiotics and glucose to combat complications. He is one of more than 1,400 children with measles that MSF treated in its projects in Helmand and Herat in February. Half developed a complication that required hospital admission.

there are not enough beds

The number of measles cases has been extremely high at Boost Hospital. From December to the end of February, on average, more than 150 children with measles attended the hospital each week. 40 percent presented a serious complication such as pneumonia and were admitted for treatment.

In Herat, MSF saw nearly 800 measles cases in February. At the beginning of the year, the project had a capacity of eight isolation beds for patients with infectious diseases such as tuberculosis or measles. Very quickly that ward was overwhelmed with measles patients, so another 12 beds were added. Rehabilitation work is now underway to transform an existing building into a 60-bed measles unit, providing intensive care for critically ill patients and hospital care for those recovering. But this is probably not enough.

“60% of the measles cases we see arriving at the Herat Regional Hospital require hospitalization and half of those admitted to intensive care also suffer from malnutrition,” explains Sarah Vuylsteke, MSF project coordinator in Herat.

Measles and malnutrition, a deadly combination

The situation is particularly alarming given that Afghanistan already faces a nutritional crisis. For months, children receiving treatment at MSF feeding centers in Helmand and Herat have often had to share beds because the number of patients exceeds the centres’ bed capacity. In both projects, from January to the end of February, there were nearly 800 children admitted with severe acute malnutrition.

“Most of the children we see in our feeding center and intensive care unit have recently had measles,” says Fazal Hai Ziarmal, MSF clinical team leader at Boost Hospital. “Measles damages their immune system, making it harder for them to fight off complications like respiratory infections like pneumonia.”

“If a girl or boy is suffering from malnutrition, like most in Afghanistan 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, further damages their immune system and makes them very vulnerable. Many children with malnutrition die from post-measles complications.”

Struggling to find medical care

Measles can be prevented by vaccination, but coverage in Afghanistan is low and this is one explanation for the rapid increase in cases. Also, sometimes multiple families live under one roof, creating the perfect conditions for the rapid spread of the disease. Some children recover from measles on their own, while the rest need simple medicines for their complications, but even these can be hard to find in Afghanistan, as many health centers lack sufficient medicines and supplies. For this reason, many mothers and fathers have to buy the drug at local pharmacies.

“My 12 grandsons and granddaughters got sick, but these three are the ones who suffer the most,” explains Han Bibi, who is waiting for her son in the measles detection unit at Boost Hospital, with her grandsons and granddaughters around her. They look dazed and discouraged, all three have measles.

“We bought some medicine in our village, but when the children did not get better, we came here. The older one cried saying that her chest hurt and she vomited. She is drinking a lot of water but she can’t keep any more down.”

Additional pressure on the health system

“In our project in Herat, two girls or boys die every day from measles complications and it scares me to think about what is happening in other parts of the country that don’t have access to more advanced care,” says Sarah Vuylsteke, MSF coordinator in Herat.

“The public health centers we visited in rural areas have the capacity to treat measles patients with mild complications, but the staff at each of them said they would not be able to help severe or complicated cases because they do not have the supplies, staff or necessary equipment. For the girls and boys who are very sick, the most vulnerable, there is very little they can do.”

“We can increase the number of beds in the places where MSF works, but this will not solve the problem. Unless there is a widespread vaccination campaign, we will continue to see cases rise over the next six months, putting even more pressure on an already fragile healthcare system. In the long term, the regular measles vaccination program needs to be strengthened so that girls and boys can be vaccinated routinely, rather than in response to increases in cases.”

In the city of Kunduz, MSF financed the staff and equipment for a new 35-bed measles treatment room at the Kunduz Regional Hospital. The room opened on February 27 and the next morning it already had more patients than beds.

Back in Boost Hospital’s pediatric intensive care unit, the medical team huddles around what used to be Takberullah’s bed, trying to save the life of a new patient. Meanwhile, Zainab has packed her things and is traveling home, alone, to be with her other sons and daughters.

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