The World Health Organization reports insecurity in Afghanistan is jeopardizing health operations and preventing qualified staff from working in remote and rural areas of the country. WHO says this is of particular concern right now as the H1N1 influenza pandemic is spreading in cold parts of the country.
Years of warfare have wrecked Afghanistan's health care system. The country's health infrastructure was completely destroyed by the time the U.S. invasion began at the end of 2001.
Since then, with the help of non-governmental organizations, Afghanistan has rebuilt much of its primary health care system. Most of the country is polio-free and international health agencies recently conducted a successful three-day polio immunization campaign.
The World Health Organization's Country Representative to Afghanistan, Peter Graaff, calls this trend positive. But, notes Afghanistan's overall health care system is nothing much to cheer about.
"Here we have a country where the life expectancy of women is less than men. Here we have a country where every hour two women die because of the most natural events-being pregnant or giving birth. Here we have many, many young children dying, being malnourished and many, many people without having access, having regular access to even basic health services."
Graaf says more than six million people, or about one-quarter of Afghanistan's population, have no access to health services. This is mainly due to insecurity and natural disasters.
He notes northern Afghanistan is largely peaceful. But, he says large numbers of people living there will not be able to get to health facilities for several months because of the heavy snows. And this is likely to result in many deaths.
He says health workers are very worried because of the huge increase in acute respiratory infections and the emergence of the H1N1 influenza. So far, 18 of 34 provinces have reported community transmission of the virus.
He says nearly 1,000 cases of H1N1 have been confirmed, but adds this number is probably grossly under-estimated. He says most of the cases are in the colder northern parts of the country, such as Herat, Mazar, the capital Kabul and Baghram airbase.
"The first cases seen in the country were in the military, both international and Afghan army. So, we have a large number of relatively young men who fell ill and from that, we think it spread into the community. And, that is also, perhaps the explanation. Kabul itself is by far the largest city in the country but because of military going home, visiting their families, spreading this way."
Graaff says most cases of H1N1, so far, have been among healthy young men. They had mild symptoms and recovered. But, he says cases now have spread to pregnant women who are at high risk of dying.
Pharmaceutical companies and a number of countries have pledged to donate some 200 million doses of H1N1 vaccines to the World Health Organization. They will be distributed to 95 vulnerable countries.
Afghanistan is in line to receive 2.8 million doses. This will cover 10 percent of the population. Graaff says Afghanistan will receive a first batch of 500,000 doses in the coming weeks, which will be used to vaccinate health care workers against the disease.