Over 600 000 Afghan refugees and undocumented returnees have returned from Pakistan during 2016. October saw the highest number of returns this year with 170 000 people crossing the border from Pakistan.
WHO, along with partners, supports health service provision to returning Afghans and has stepped up vaccination activities in border areas to ensure every child under 10 years of age is immunized against polio and measles.
Through this photo story, meet some of the Afghans returning to an uncertain future, and some of the hard-working and dedicated health workers ensuring that all children are vaccinated so they can live healthy lives as they start their new journey in Afghanistan.
Photo story
Photo credits: WHO Afghanistan/S.Ramo
A truck arrives at the Torkham border in Nangarhar, eastern Afghanistan, after crossing the border from Pakistan. Many families have been forced to flee due to harassment and pressure by the police and the number of returnees has spiked in the past months, with October seeing the highest number of returns in 2016. Families often have little time to pack their belongings on a truck that a few families share and rent together to make it across the border to Afghanistan. Many are undocumented returnees as they do not have refugee status in Pakistan but also do not possess identity documents from either country.
The large influx of people is far surpassing the planning figures for the humanitarian community and people’s needs for food, shelter, sanitation and health care are grave, especially as the winter sets in. With over half a million being displaced by conflict in Afghanistan in 2016 alone and over 600 000 returnees settling to Afghanistan, over 1 million people are currently “on the move”, in need of assistance.
Polio vaccinators climb up a truck to vaccinate a child at the Torkham border in Nangarhar, the busiest border crossing in Afghanistan. This family just arrived from Pakistan with all their possessions packed in the truck – food, firewood for the winter, clothes, furniture and their cow.
Polio social mobilizers talk to women who have just arrived from Haripur, Pakistan, about the different kinds of vaccinations children need and the benefits of immunization. Polio workers at this UNHCR encashment centre in Kabul, where refugees come to register and collect their cash allowance, say that very few families have refused the polio vaccine. “Some families have been suspicious of the side effects of the vaccine, but after we explain that the vaccine is completely safe, that it has no side effects and it is essential to make sure our children stay healthy, they accepted it and we could vaccinate their children,” said one of the vaccinators.
During the interactive education session, social mobilizers ask all women to ensure their children are vaccinated during regular house-to-house polio immunization campaigns. They also describe to them the symptoms of acute flaccid paralysis (AFP), an indicator for polio, asking the women to bring their children to the nearest health centre if they suffer from any floppy weakness of the limbs.
Elina prepares the inactivated polio vaccine (IPV) to administer to Maryam, a 3-year-old refugee, at the UNHCR encashment centre in east Kabul. Elina has worked as a vaccinator for 3 years. “The past months have been really busy here, I vaccinated hundreds of children during some of the most hectic days when a lot of families returned,” Elina says. “I am a mother of 3 daughters and really enjoy my job as a nurse and vaccinator. I want to help our children and make sure all Afghan children can be spared from polio paralysis by giving them the polio vaccine.”
Jamil Rahman leans on his colorful truck at the Torkham border crossing as he watches as his children get vaccinated by polio teams working at the “zero point” border crossing area that has a temporary basic health centre providing vaccinations, nutrition screening and counseling on infant and young child feeding practices as well as vitamin A and deworming tablets for children.
“We have lived in Pakistan for 40 years – here we don’t have a house or anything else. I was a mathematics teacher in Pakistan but now I hope to find some work in the agricultural sector. I have 2 sons and my biggest hope is that they grow to be healthy and get to go to school,” Jamil Rahman said.
An Afghan family has just reached the border and are getting clean drinking water from people working at the “zero point” border crossing area at Torkham.
Most Afghans are returning to a country they barely know. Many have lived in Pakistan for years, even decades. As winter is fast approaching and few returnees have existing coping mechanisms and networks in Afghanistan, many are facing an uncertain future in bleak conditions.
The large influx has led to health services being overstretched, especially for reproductive, maternal and newborn health services as well as for treatment of mental health issues and communicable and noncommunicable diseases. Outbreaks of vaccine-preventable diseases such as polio, measles and pertussis pose major threats.
As health services are overburdened, additional human resources and medicine supplies are required at health facilities in areas where many returnees and refugees settle. AADA NGO operates the emergency health centre at the Torkham border where returnees get vaccinations other basic health services before they continue their journey.
“We get between 100 to 300 patients a day with different health problems such as early deliveries, children with respiratory infections and diarrhoea, tuberculosis and also many trauma cases and injuries as a result of people travelling back in crammed trucks,” said Dr Mustafa Kazim, director of the emergency health centre at Torkham. “There is a lack of supplies and medicines and we are also under-staffed. We desperately need a female doctor.”
Wali Mohammad has lived in Pakistan for 25 years and is now returning because the authorities were harassing and threatening his family, pushing them to leave. Wali has seven daughters and five sons.
“I broke my arm as I was rushing to pack all of our belongings to the truck,” he said, pointing to his white cast on his left arm while holding his 3-year-old-daughter Amina in the other at the IOM transit centre near the border in Nangargar. “My goal now is to find work and money to live,” Mohammad said, as he watched vaccinators administer measles and polio vaccines to Amina.
Children arriving from Pakistan are at risk of communicable diseases such as pertussis and measles and many suffer from acute respiratory infections due to colder weather conditions. Many are also at risk of malnutrition.
Afghanistan remains a polio-endemic country and there is a risk that even more children may contract polio and become paralysed if caregivers overlook getting their children vaccinated against the disease. This year there have been 12 confirmed polio cases in Afghanistan from the eastern, southern and southeastern regions.
Sardar has been a polio vaccinator for 5 years. “We vaccinate hundreds of children every day by giving them 2 drops of the oral polio vaccine. We often climb into the trucks as they cross the border if the children don’t come down. This way we know we reach all children,” said Sardar, one of the vaccinators immunizing children at the Torkham border crossing in eastern Nangarhar province. “I want to help our children. Our country needs to finish polio for good.”
Nasir Ahmad and Ismail Shah have been immunizing Afghan children against polio for the past 3 years and they form part of a 6-member vaccination team working at the UNHCR repatriation centre receiving refugees in Kandahar province, southern Afghanistan.
“We have been very busy in the past months with many families returning to Kandahar. Almost all families have accepted the vaccines without any problems. Only a few times we had to convince some by telling them more about the benefits and safety of the vaccine, but it was quite easy,” said Nasir Ahmad. In October 2016 alone, over 3000 returnee children were given the oral polio vaccine (OPV) while over 700 children received the IPV and over 500 were immunized against measles in this Kandahar repatriation centre.
Razi Khan holds his daughter Asma as she gets the injectable inactivated polio vaccine (IPV) at the IOM transit centre near the Torkham border. Razi Khan has 5 daughters and four sons and he has lived in Pakistan for the last 30 years after moving there from Laghman province. “My hope is that my children can go to school and that I manage to find some work as a day labourer,” Razi Khan said while Sharifullah administered IPV for Asma.
“I’ve been working as a vaccinator for the past month and a half and I enjoy my job. I don’t want to miss any children and I want to see polio gone from our country,” Sharifullah said.
Vaccinator Jawad calls out for children under the age of 10 at the Torkham border to get a polio vaccination if they have not yet received it from teams climbing into trucks.
Currently polio teams are working at 17 cross-border points to ensure that all children entering Afghanistan get immunized against polio. Over 280 permanent transit teams vaccinate children who travel in and out of security-compromised areas and children traveling to other destinations to ensure that every child on the move receives 2 drops of the oral polio vaccine to grow up healthy.
With transmission limited to small geographic areas this year, Afghanistan is close to stopping the circulation of wild poliovirus. To eradicate the debilitating disease for good, vaccination teams must continue to reach every single child, everywhere.
