Patients being treated for the coronavirus at the Afghan-Japan Communicable Disease Hospital in Kabul, Afghanistan. Photo / .Jim Huylebroek, The New York Times
In Afghanistan, life goes on as though the coronavirus never existed. "Fake news," some say, even as a second wave has brought on a surge of new cases and hospitalisations.
For Mohammad Wakil, 23, social distancing is an abstract concept. Every working day, he shakes hands with scores of customers at the teeming bazaar where he sells secondhand shoes. He handles filthy Afghan bank notes. He disdains hand sanitiser. A mask? Forget about it.
"There's no coronavirus," Wakil said in late October as shoppers swarmed his rickety stall. "It's a lie told by the government."
When the coronavirus pandemic first reached Afghanistan in March, the government struggled to shut down cities and persuade Afghans to wear masks, wash their hands and practice social distancing. The measures were haphazardly enforced for several weeks before citizens began to chafe under the restrictions.
Today, even as public health officials confirm a second deadly virus wave, Covid-19 is an afterthought. Afghans have embraced a culture of denial, where personal priorities triumph over public health experts whose pleas are drowned out by public apathy, scepticism and an enduring belief that Allah determines a believer's fate.
"The mentality that Trump and his supporters have, it's exactly the same for the Afghan people," said Dr. Tariq Ahmad Akbari, until recently the head physician at Kabul's only infectious disease hospital. "They think Covid is Western propaganda."
But unlike in the United States, there is no political party or anti-government movement playing down the virus by spreading misinformation. Even the Taliban have distributed personal protection equipment and run public health information programs. They have allowed government health workers into areas they control, the Health Ministry said.
In cities across the country, people go about their daily lives as if Covid-19 never existed. While the virus is most transmissible indoors, scientists say it can also be contracted through close personal encounters outside. Yet Afghans cram into buses and taxis, eat shoulder to shoulder indoors in restaurants, pray in mosques, embrace in traditional Afghan greetings and cluster together in sprawling bazaars.
On crowded city streets, few people wear masks. Ubiquitous public health posters warning of Covid-19 are routinely mocked as relics of a not-so-distant past when the coronavirus seemed terrifying and indomitable.
"We know people are tired of the virus and the health messages they keep hearing," said Akmal Samsor, a spokesman for the Health Ministry. "We live in a country with serious threats of war and poverty. Covid can't compete."
Afghans continue to contract the virus and die, but the scale of the epidemic is nearly impossible to measure. The Health Ministry's reported coronavirus death toll is 2,074, with 50,677 positive cases, but Afghanistan's testing capacity is severely limited — it has conducted just 180,000 tests since March. Its beleaguered health system cannot always distinguish Covid-19 from other causes of death in a country where disease and violence are endemic.
Health officials concede that Afghanistan's actual death toll is exponentially higher. An estimated 32 per cent of Afghanistan's roughly 34 million people may already have contracted the virus, the Health Ministry said. One World Health Organization model in May estimated that half the population could become infected.
"The virus is circling the country," Samsor said, noting that the Covid-19 mortality rate rose by 47 per cent the first week of December. "If 95 per cent of people wore masks for just two weeks we could bring the virus under control."
Yet local news media have lost interest in the virus, instead focusing on peace talks, the intensifying war and targeted killings in the capital.
Last spring, pharmacies were overwhelmed by requests for purported virus treatments. But some pharmacists now say customers have convinced themselves that the virus is not worth a second thought, although some continue to seek miracle cures.
"People now think Covid is not a deadly illness, so they are not worried about it at all," said Faizullah Faizbakhsh, a Kabul pharmacist.
At domestic airport terminals, passengers ignore faded circles on the floor intended to keep them 6 feet apart. Only some airport workers wear masks. Flight attendants are masked, but not all passengers wear the free masks provided. People nonchalantly cluster in movie theaters and shopping malls.
Even heartbreaking stories of Afghans dying from the virus after infecting loved ones have not aroused widespread fears.
Zalmay Rahman, a resident of Mazar-e-Sharif in northern Afghanistan, said his entire family had worn masks and used hand sanitiser. Yet his mother died of Covid-19, he said, and he and several other relatives also contracted the virus.
"We just hope we can survive this second wave," Rahman said.
The sense of apathy toward the virus seems to trickle from the top down. In October, the Health Ministry ordered government workers to wear masks, reinstating a policy that was disregarded in early summer. But at the presidential palace complex in Kabul, almost all employees recently encountered by visiting reporters were maskless. In a palace cafeteria, workers ate side by side, hugging and shaking hands.
The Health Ministry recently suggested mandatory masks for banks, stores and buses. It also proposed closing wedding halls, sports clubs and funeral halls, and temporarily sidelining vehicles with more than five passengers. The proposals are pending.
The government has been unable to shut down cities because most Afghans must venture out daily to earn a living. Eighty percent of the population lives near the poverty line in a country propped up by foreign aid and a subsistence economy.
Afghanistan's health care system relies on international support, spending roughly US$5 per person annually — versus US$11,000 per person in the United States.
Even before Covid-19, 3.7 million Afghans needed emergency health care services, according to the World Health Organization. At least 30 health care facilities have been attacked this year, amid widespread food insecurity and the world's highest child mortality rate.
In Kabul, the Afghan-Japan Communicable Disease Hospital admits 40 more Covid-19 cases a day now than two weeks ago, said Ramin Hamid, the hospital's health information director.
Since the pandemic began, the hospital has received 32,000 suspected Covid-19 patients, of whom more than 500 have died.
Yet even hospital attendants sometimes neglect to wear masks or gowns, said Dr. Meranay Baratzay, the hospital's infection prevention doctor. As he spoke, a man emerged, unmasked, after visiting the room of a family member with Covid-19.
"They don't understand that Covid is real," Dr. Niaz Ahmad, an emergency room physician, said of attendants and visitors. "It's only the people who have lost someone to the virus who believe it."
Among the patients in the Covid-19 ward on a recent day was a college student, Nazif Rezayi, 21, who squatted in his bed, coughing and wheezing. In a raspy voice, he said he had taken no precautions, even while living in a crowded student hostel.
"I didn't take it seriously," Rezayi said. "I do now. Everyone should."
The 120-bed hospital has just 31 patient monitors, three X-ray machines, two ultrasound devices and no CT scanner. If the second virus wave intensifies, Akbari said, the hospital will not be able to care for every Covid-19 patient.
Ahmad shook his head in frustration. The doctor said he faithfully wore a surgical mask, washed his hands and practised social distancing when he went about his daily life outside the hospital.
"But what good does that do," he asked, "if nobody else is following the rules?"
Written by: David Zucchino and Fahim Abed
Photographs by: Jim Huylebroek
© 2020 THE NEW YORK TIMES
The factory had produced 6616 tons of toxic gases by the war's end.