To Afghanistan's many problems, now add the flu

KABUL, Afghanistan — As if the Taliban, car bombs, roadside bombs, leftover Soviet land mines, political unrest and errant NATO air attacks weren't enough, Afghans are facing a new killer: the H1N1 flu pandemic.

The government has declared a state of emergency, and closed schools, universities and even wedding halls and public bathrooms for three weeks to slow the spread of the virus, which has killed 10 people in the capital in less than two weeks. Cases are popping up in provinces spanning the country, with new outbreaks reported in two more provinces on Saturday.

"There is no doubt that we have an epidemic in our country now, and we are moving into the fall season when the conditions make it more likely to spread," said Ahmad Farid Raaid, the spokesman for the Ministry of Public Health.

In the past few days, surgical face masks have bloomed like poppies on the faces of worried pedestrians along crowded streets and markets of the capital as more cases were reported.

The effectiveness of such masks in preventing a wearer from contracting flu is uncertain, according to the Centers for Disease Control and Prevention, but they are selling quickly in Kabul. Many vendors are boys who would be in school except for the emergency closing.

"I would prefer to be in class, but I can sell these for 10 afghanis (about 20 cents)," said Hafzuillah, 12, waving a fistful of masks as he stood among money changers and carts of roasted pine nuts in the chaotic human tide of Kabul's open-air central market. Like many Afghans, he uses just a single name.

In the past few days, the government has ramped up its response to the epidemic, Raaid said. Most of the 456 cases among Afghans — and all the fatalities — have occurred in Kabul. Friday, his ministry distributed flu medicine and 10 tons of related medical supplies to 34 hospitals and clinics in the capital.

The Afghan government has enough anti-viral medicine to treat about 50,000 flu patients, with another 30,000 doses on the way, Raaid said. But there is no H1N1 vaccine on hand, although the government expects to receive 550,000 doses through the World Health Organization and is asking for 11 million doses of vaccine.

The initial round of vaccinations will go to a prioritized list of people, starting with health care workers, then pregnant women, young children, the national army and police, then students.

Since August the health ministry has been running a public awareness campaign aimed at stopping the spread of the disease, Raaid said, but last week, it racheted up the effort, signing contracts with several TV and radio stations for about $200,000 in additional ads.

Signs in government buildings urge workers not to shake hands, to wash their hands often with soap and to use masks. Posters bearing similar messages have been places in public locations around the city.

Even as the health ministry spreads information about prevention and treatment, though, it's having to fight rumors that undercut the effort. A common one, because of what some regard as the suspicious timing of the emergency declaration, is that the government is exaggerating the danger to discourage gatherings to protest the outcome of the presidential election, which left incumbent Hamid Karzai in place despite massive election fraud in his favor. The runoff that had been scheduled for Saturday was called off after his main rival, Abdullah Abdullah, pulled out and Abdullah's supporters remain angry.

Asked about that rumor while touring a Kabul clinic Saturday with journalists and an official of the U.N.'s World Health Organization, Afghan Health Minister Amin Fatemie said there was absolutely no truth to it.

Raaid said that the rapid spread of confirmed cases and the deaths mean the government had to take aggressive measures. The three-week shutdown was modeled after the way other countries have responded to the pandemic, he said.

Several other countries have shut down schools briefly to block the flu, among them neighboring Iran, which recently closed its schools because of an outbreak similar to Afghanistan's.

"This was not a political decision, it's a pure technical decision," Raaid said.

Still, in Afghanistan, talk on the street can carry more weight than the official line.

Abdul Karim, 46, a moneychanger in Kabul's chaotic central market — one of the busiest in the world and exactly the kind of place flu experts say to shun during an outbreak — said that several of his friends stopped using masks when they heard the rumors.

Karzai, meanwhile, accidentally added to his flu troubles during a television address Friday night when he referred to the illness by its common name, swine flu, rather than H1N1. The strain is transmitted from person to person, not from animals to people.

The first reported cases in Afghanistan were among U.S. soldiers and other foreigners working on military bases. Muslims are forbidden to eat pork, and so some Afghans have begun saying that clearly the flu is passing from pigs to the foreigners then to Afghans. For them, there is one logical solution.

"They say that we should throw out all the foreigners," Raaid said. "As you can imagine, this is a delicate matter for us."

As the epidemic has grown, prices for the masks have jumped from less than two cents to more than 20 cents in some places, he said.

That may not sound like much, but in one of the world's poorest countries, it's enough to prevent many people from buying the masks, said Atash, 30, who makes $12 to $15 a day selling international calls on three dirty cell phones he carries in the market.

By Afghan standards, he is prosperous, but spending the equivalent of even a few cents on a fresh mask every day or so is a burden, he said.

"If the price is one afghani, then everyone will wear it," he said. "And for sure if the government brings a truck and distributes them free, then you will see everyone wearing them."

Raaid said the government discussed plans over the weekend for an upcoming massive mask giveaway.

The masks are believed to be helpful when worn by those who have flu because they can stop some of the spray from coughing or sneezing, a key means of transmitting flu.

Still, it's clear that even some Afhgans who have a vested interest in the illness understand little about it.

Even though he sells the masks in the market Padsha, 15, sells masks in the central market but said he had a good reason for not wearing one.

"I had one before," he said. "But I took it off and sold it."

(McClatchy special correspondent Hashim Shukoor contributed to this story. Price reports for the Raleigh News & Observer.)


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