Not much, compared with some of the traumas suffered in this provincial town that, until just three months ago, was a front line in the country’s latest war. Like so many Afghan children, Faiz and his friends have survived rocket attacks, land mines and malnutrition as they played in Charikar’s dirt and cobblestone alleys. Still, this may have been the shot that will save his life.
Afghanistan’s new-found peace does not mean its children are any safer from diseases like measles, a contagious airborne virus that, according to UNICEF statistics, kills at least 35,000 children per year. Health workers here openly admit they lack proper data to know for sure. But they do know that measles is the largest vaccine-preventable killer of Afghan children.
No longer a major health problem in the developed world, measles continues to ravage children in developing nations–especially in war-torn countries. Afghanistan is a breeding ground for measles because it has virtually no infrastructure or accessible health care, and large numbers of its population live in remote areas. Even worse, the last decade of war has made it nearly impossible for international aid organizations to sustain a nationwide measles program in the country. “This country is a poster child for measles,” says Dr. Muireann Brennan of the U.S. Centers for Disease Control. “In the past six to 10 years, there has been no meaningful immunization program in most of the country.”
Brennan is in Afghanistan to work with the U.N. Children’s Fund (UNICEF), which is in the midst of an ambitious emergency campaign to administer measles vaccination shots to 9 million Afghan children around the country.
The campaign is quite literally a race against time. UNICEF, in partnership with the World Health Organization and other groups, launched an $8 million national measles immunization campaign in Kabul on Jan. 1. Its goal: to immunize all children ages 6 months to 12 years within the next three months.
Afghan parents have responded enthusiastically to the campaign, bringing their children or sending them with older siblings to designated centers, usually a local mosque. By late January, UNICEF reported that it had immunized more than 700,000 children.
In Charikar, a 90-minute drive northwest of Kabul, local officials shouted through megaphones to remind people that vaccinations were being administered that day. Even now, war sometimes intrudes on the campaign. On Jan. 31, seven U.N. officials making preparations for measles vaccinations in the eastern city of Gardez were evacuated after fighting erupted the previous night between forces loyal to rival warlords. The fighting lasted two days and killed more than 50 people, and it is unknown when the vaccination program will finally begin in that area. “Being able to carry out the vaccination campaign without being hindered by fighting is crucial,” said Loretta Hieber-Giardet, a spokeswoman for the WHO.
So is timing. Once children contract measles, they can spread it quickly merely by talking, laughing or sneezing. The virus attacks the lungs and mucous membranes of the nose and eyes. It can cause blindness and affect the immune system, leading to secondary infections such as pneumonia. The majority of Afghan children who contract measles will die, either from the disease itself or related illnesses.
Measles and its secondary illnesses can be treated with oral rehydration salts, antibiotics, Vitamin A and increased food intake–but these remedies are not easily available to Afghan families. “That’s why we have such high cases of mortality,” Brennan said. The measles vaccine is readily available on the world market, but health workers in Afghanistan have logistical problems getting it into remote areas, some of which are accessible only by foot or on donkey. Another problem is that the vaccine is susceptible to warm temperatures and must be kept at between 32 and 46 degrees Fahrenheit. The vaccine, a freeze-dried powder, is mixed with solvent before being put in syringes, and that mixture must also be kept cold and used within six hours. Local health workers in charge of administering the shots are supplied with syringes, coolers and ice packs. They were drilled in the delicate procedure of handling the vaccine during a two-day training course before the program began on New Year’s Day. “After I give the injection I have to throw the syringe away immediately. If I don’t use all the vaccine with six hours, I have to immediately throw that away and prepare a new one,” recited one health worker in Charikar when questioned on procedure by visiting UNICEF doctors.
On Charikar’s vaccination day, most of the scores of children who turned out seemed underfed. Many were wearing dirty clothes and shoes with holes in them, and many had scars on their faces from leishmaniasis, a parasitic infection transmitted by the bite of infected sand flies. The flies nest inside the cracks of mud walls, which is the main material used by many rural Afghans to build their homes. One of the children was so malnourished his older sister had to carry him in a blanket, his thin legs sticking out from underneath.
Still, they were all smiles as they waited for their shots, waving and attempting to say hello to us in English. Their laughter stopped when the needles hit their arms–but the pain was a small price to pay in a country where health conditions are so grave that 25 percent of its children die before their 5th birthdays. For those who had the shots, the odds don’t seem quite so bleak.
