Disease stalks Afghan refugees

Science World, Jan 21, 2002 by Nicole Dyer

In the U.S., winter can be tough on health: Cold weather brings a barrage of runny noses, nagging coughs, and occasionally the flu, or influenza, an illness marked by fever and body aches. Fortunately for most Americans, common winter ailments can usually be treated or prevented with medicine.

But in war-torn Afghanistan and neighboring Pakistan, where an estimated 5 million people live in overcrowded refugee camps, typically benign diseases turn lethal fast. "With mass population movement, overcrowding in camps, and insufficient health services, the Afghan population is highly vulnerable to communicable diseases," says Dr. Mohamed Jama of the World Health Organization (WHO).

For every 1,000 Afghan babies born this year, 257 will die before age 5. And in refugee camps that shelter families displaced by two decades of war and drought, the death rate is higher. "About one out of every three families reports the death of a child," says public health expert Terry Rives at the University of Texas Health Center at Houston.

Infectious diseases--illnesses caused by microbes that spread easily from one person to another--kill 14 million people globally each year. And 90 percent of victims live in developing countries like Afghanistan. Among the top killers: malaria, an illness caused by a parasite, a microscopic organism that feeds on living cells. Each year, an estimated 500 million people worldwide are infected with malaria, which is endemic (highly prevalent) in more than 100 poverty-stricken countries, including Afghanistan. The disease is transmitted through mosquito bites and causes intense fevers and chills. Although malaria is preventable with anti-parasitic medicines, such treatments are often beyond the reach of poor communities.

Another refugee health threat: measles, a widespread viral disease characterized by an itchy skin rash and fever (see chart, right). Measles is a major killer of children under age 5 worldwide, according to the WHO. In the U.S., measles is relatively rare, thanks to a vaccine, a medicine typically given in an injection to prevent disease. A vaccine works by stimulating antibodies, or blood proteins that attack foreign cells. But in Afghanistan, less than 50 percent of the population receives the measles vaccine. As a result, the WHO estimates that 1 in 10 Afghan children who contract measles will die.

Rampant starvation and dehydration also add to the spread of illness by weakening the immune system, the body's defense against germs. "A typical refugee family receives about 15 liters of water per day," explains Rives. "But it needs about 40 liters to survive." Water is essential for life: It makes up to 75 percent of your body weight and helps facilitate many chemical reactions, such as the conversion of food to energy. "You can live for a while without medicine, but you simply can't live without food and water," Rives says.

KILLER DISEASES AMONG REFUGEES

              TUBERCULOSIS              MALARIA

CAUSED BY     Bacterium (single-        Protozoan
              celled germ):             (single-celled
              Mycobacterium             parasite):
              tuberculosis              four species of
                                        Plasmodium
                                        protozoa

COMMON        Bad cough, night          Fever, joint pain,
SYMPTOMS      sweats, bloody spit       shivering, vomiting

HOW IT'S      Through the air via       Bites from infected
SPREAD        coughs, sneezes,          female Anopheles
              spit; highly              mosquitoes
              contagious

ESTIMATED     8 million                 300 to 500 million
ANNUAL        (U.S.: 28,000)            (U.S.: 1,200)
INFECTIONS
WORLDWIDE

ESTIMATED     2 to 3 million            3 million
ANNUAL                                  (1 child every 30
DEATHS                                  seconds)
WORLDWIDE

WHERE IT      Crowded                   Damp, crowded
THRIVES       environments              environments; 90
                                        percent in sub-
                                        Saharan Africa

TREATMENT     Antibacterial             Antiparasitic
              drugs: e.g.,              drugs: mefloquine,
              isoniazid, rifampicin     chloroquine

              CHOLERA                   MEASLES

CAUSED BY     Bacterium: Vibrio         Virus (microscopic
              cholerae                  unit of disease-
                                        causing chemicals):
                                        Paramyxovirus

COMMON        Watery diarrhea,          Fever, cough, red-
SYMPTOMS      severe dehydration,       brown blotchy
              vomiting                  rash

HOW IT'S      Contaminated              Through the air
SPREAD        water and food            via coughs,
                                        sneezes, spit;
                                        highly contagious

ESTIMATED     118,932                   45 million
ANNUAL        reported in 2000;         (U.S.: 350)
INFECTIONS    (U.S.: 1,200)
WORLDWIDE

ESTIMATED     4,908                     1.2 million
ANNUAL        reported in 2000
DEATHS
WORLDWIDE

WHERE IT      Near polluted             Crowded
THRIVES       water and                 environments
              estuaries; 87
              percent in Africa

TREATMENT     Rehydration with          None; preventive
              sugar/salt solution       vaccine is available
              and water;
              antibiotic
              tetracyline