COVID-19: Indians in Afghanistan seek to be evacuated, doctors stress lack of PPE

Afghanistan has reported at least 299 confirmed COVID cases, with 206 cases in Herat. Parwiz / REUTERS
04 April, 2020

Over the last month, thousands of Afghan migrants have returned to the country from neighbouring Iran, which has been severely impacted by COVID-19. Several returnees have crossed over into the border province of Herat, which has since emerged as Afghanistan’s COVID-19 epicentre. As of 4 April, Afghanistan has reported at least 299 confirmed COVID cases, with 206 cases in Herat. As the situation escalates, Indians in Afghanistan are worried about their safety and are wanting to return home. They are stranded because of the travel restrictions in place—on 17 March, India prohibited flights from Afghanistan. I spoke to several Indian professionals in the country who said they wanted to be evacuated. In addition, Indian doctors told me that there was a shortage of personal protective equipment, or PPE, at their workplaces.

On 30 March, I spoke to one of at least four Indian doctors working in Herat. He described the ground reality in the province, on the condition of anonymity. “They mostly have fanned out without screening as there are no such arrangements,” he said, referring to the Afghans who returned from COVID-hit Iran. “At the government run provincial hospital here, four doctors have caught the infection. There is hardly any awareness regarding COVID-19 in the general public due to orthodoxy and illiteracy. The country is at the brink of a public health disaster. We’re sitting on a ticking time bomb, which is ready to explode any time. The consequences here would be deadlier than Italy and Iran.”

Afghanistan reported its first case of COVID-19 in late February.  According to a report in The Lancet, a medical journal, “A 35-year-old male Afghan shopkeeper visited Qom, Iran, for 1 week beginning 9 February 2020. In Iran, he had contact with employees from the shoe company that supplied his shop. He returned to his home in Herat, Afghanistan, by car on Feb 15, 2020.” After he displayed COVID-related symptoms, he was admitted to a government hospital on 22 February, where he later tested positive for the novel coronavirus. The public health ministry of Afghanistan has estimated that at least one lakh and ten thousand Afghans could die from COVID-19 if serious action is not taken.

Even though a lockdown came into effect in Kabul on 28 March, a report in Afghanistan Times the next day stated, “Many shops are open and cars still commute. Nobody seems to comply by public health orders to self-isolate amid a citywide lockdown.” The health ministry warned that 25 million people in Afghanistan could become infected if they don’t follow the health warnings.

The Indian doctor in Herat noted, “Abdul Qayum Rahimi, the governor of Herat province, recently told press here that the country won’t be able to collect even the bodies if the government did not start acting to check the spread of the disease.” The doctor said that he knew of at least fifteen other Indian doctors working in Afghanistan who are at a risk of getting infected.

He added that he had been writing to Indian authorities, asking to be evacuated. “For the last two weeks, we’ve been sending repeated reminders to the ministry of external affairs, requesting the authorities to arrange for our evacuation,” the Herat doctor said. “The embassy officials are very cooperative and are in constant touch with us over WhatsApp. We have been told they are conducting a survey to know exact number of Indians in Afghanistan.” He continued, “The lockdown in India was announced in haste. Given the security threat and the state of medical infrastructure in Afghanistan, the government of India should have spared a thought for us also.”

According to media reports, a Kam Air flight carried 31 Indians from Afghanistan back to New Delhi on 30 March. This included four diplomats, 26 security personnel and one civilian. Several Indians in Afghanistan I spoke to raised questions on why they were not informed about this flight and taken on board too. They also pointed to flights carrying Afghan nationals back to Afghanistan from Delhi. On 27 March, the Afghanistan Times reported that India has allowed Kam Air, an Afghan airline, to ferry Afghan nationals staying in India back to Afghanistan over five flights. It estimated that around two thousand Afghans will return home. I spoke to Afghans in Lajpat Nagar who confirmed that several people they knew from their country had left India on a flight on 28 March. Indians in Afghanistan questioned why they are not being allowed to similarly return.

Rekha Shetty, a native of Mumbai, has been working in Afghanistan since October last year. She heads the Herat office of the Catholic Relief Services, a humanitarian aid organisation. Shetty said she had written to the embassy asking to be evacuated. “We’re awaiting a response from the embassy,” she said. “While empty flights are going to New Delhi from here to bring back Afghan nationals, we wonder why Indians are not being allowed to travel. Two flights, we have come to know, will leave for India on 3 and 5 April each, to bring back Afghan nationals.” 

On 1 April, the Afghan government suspended flights between Kabul and Herat. Shetty added, “I left Herat last evening, on 1 April, in the last flight to Kabul. I’m putting up in a guest house here but many others here and in Herat are not as fortunate. In the wake of shutdown, they will become jobless.” Shetty stressed that her request to Indian authorities is to “help other Indians who want to get back home.” 

I spoke to Manishchandra Manilal Patel, a native of Gujarat’s Kheda district, who is currently based in Herat. He worked as a laboratory chemist with the Asia Hariva Energy Industrial Company, a company that operates a refinery in Herat. “I’m living alone in a building for over a week now,” he said.  “The local staff has left due to corona scare. My employer, an Afghan national, has terminated my job contract.”

From the Indian prime minister’s office to the external affairs minister and members of parliament, Patel has tagged everyone in his tweets, seeking help. But no one has responded so far. On 17 March, he emailed the COVID-19 control room at the ministry of external affairs. He received a reply stating, “Please contact our Embassy or Consulate in Afghanistan and get in touch with them.”

Patel added, “Just like me, there are at least 35 Indians stuck in Herat, who desperately want to be evacuated. Please tell the government to rescue us. People in thousands have come from Iran, we’re vulnerable to catching the coronavirus.” He continued, “Even if I’ve to die of coronavirus, I’d like to die at my home near my wife and daughter. Not away from them in this country.”

Indians in other parts of Afghanistan narrated similar requests. Sahil Kurukkar, who hails from Maharashtra, has been working in Afghanistan for the last two years. He is physician at the Hayat Balkh Hospital in the city of Mazar-e-Sharif in the Balkh province. He estimated that over one hundred and thirty Indian nationals live in the city. “I’ve a three-month old baby back home. My parents and my wife are very worried about me,” he said. “I had written to the consulate office in Mazar, requesting to be evacuated. But the officials are also helpless. The counsel general has assured me that in case the situation arises, he won’t leave the area until last Indian gets evacuated.”

Asked about lockdown restrictions, Kurukkar said, “The majority of working people here are daily-wage earners. If lockdown is observed in the real sense, people will be penniless. Their prime concern is hunger, not the virus.” Kurukkar further described the prevailing health situation. “Due to lack of general awareness and healthcare facilities, the number of infected persons and deaths due to coronavirus remain hidden here. Nobody knows the actual situation.”

Referring to the out-patient department, he added, “The hospital administration has asked me to close down OPD facility and take to tele-treatment. But we’re running the show and doing our best anyhow, knowing fully anything can happen to us anytime.” Kurukkar continued, “The local people don’t trust government hospitals. If someone comes with symptoms and we refer them to a government hospital, they pick up a quarrel, arguing, ‘You want us to die.’ This is the actual ground reality.” 

On 27 March, an editorial in the Afghanistan Times, titled, “Countrywide Lockdown Required,” highlighted the seriousness of the situation in Afghanistan. “The virus is spreading from thousands crossing the border each day from hard-hit neighbouring Iran,” it noted. “As the pandemic threatens humanity, our fellow Afghans should understand that staying at home and avoiding crowded areas are in their best interests, even if it is temporarily suspending going to mosques. This way every loophole that allows close contact among people should be plugged by the government; otherwise, we would face even more horrific fate than Europe against the backdrop of our depleted and appallingly inadequate health system.”

Several Indian doctors described the poor health infrastructure in the country. Shams Raja, a physician from Varanasi, Uttar Pradesh, is currently working with Rahnaward International Hospital in Mazar-e-Sharif. He highlighted the lack of PPE. “Neither we have COVID-19 test kits nor PP kits,” he said. “We wear two–three general masks, not even N95, to discharge our duties. We’ve raised the issue with the embassy. We’re extremely worried. We’re helpless so far as safety lapses are concerned.”

He added, “Whenever people with symptoms come to us, we invariably refer them to other hospitals. But then all the hospitals are unequipped. The provincial government has started implementing lockdown from today, 1 April, but still a lot more needs to be done.”

A statement by Human Rights Watch, an international human rights body, similarly took note of the insufficient medical gear in Afghanistan. “The Afghan government is building a 100-bed hospital in Herat, along with several new clinics for COVID-19 patients in provincial and district centers,” it said. “But protective gear, ventilators, and other equipment are inadequate to meet expected needs.”

I also spoke to Shah Asrar, a doctor from Jammu and Kashmir, who works at the Kaisha Healthcare Hospital in Kabul as an internal medicine consultant. He too said that the hospital lacked protective gear for doctors and that he had raised the issue with the Indian embassy.  He remained conflicted about whether to stay in Kabul or try to evacuate.  “Being a medical professional, I would feel guilty if I ditch my duties at the time of crisis,” he said. “Just like a soldier worth his salt, I as a medical professional can’t leave the battleground. But you need to be well equipped. The way a bomb disposal expert needs protection gear to defuse the bomb, we doctors too need protection gear for our own safety.”

 “I’m alone here in Afghanistan. So being a frontline warrior, if I get infected by coronavirus no one would be in a position to pay me a visit to look after me.” He added that besides being a doctor, he was also a son, a husband and a father. “Though at times I feel a surge of anxiety but I can’t run away from my professional duty,” he said. “I’ve been trained that way. Even if I get evacuated from here, how will I reach home in the wake of lockdown. So I should better stay put.”

Other doctors said that the public in Afghanistan had not realised the gravity of the situation. Govind Goyal, a native of Ghaziabad, has been working in Afghanistan for the last 10 years. He is a cardiologist at the Amiri Medical Complex in Kabul. “Despite best efforts by the government to sensitise people, there is a sense of carelessness among common masses,” he said. “They believe coronavirus can’t affect them. That’s a big problem.”  

Describing the conditions at his workplace, he noted, “At our hospital, we are exercising utmost caution and are following WHO guidelines. We’ve set up a thermal detector at the entrance to the hospital. Medical staff has been provided protective equipments. OPD facilities for people showing symptoms have been created on the premises and we are not allowing them inside the hospital building.” He added, “We’ve become very particular about travel history of the patients since a lot of people are coming from Iran. Those suspected to be stricken with the coronavirus are not being treated at the hospital to protect others from the hazard. We’re referring them to the Afghan-Japan Communicable Disease Hospital.”

On the condition of anonymity, another Indian doctor told me that he had written to the embassy in Kabul last week, seeking their help to evacuate. He had stressed the lack of PPE at his workplace. He said the embassy told him that they have raised the issue with “the ministry in Delhi” and are awaiting a response.

Other Indians in Afghanistan told me that the Indian embassy runs a WhatsApp group with around two hundred Indian professionals as members. Recently, in message on the group, the embassy suggested that members partake in yoga and posted a video titled “Yoga with Modi.” “In these hours of unprecedented difficulties, these videos of yoga below will help you calm the mind, and react with awareness to the evolving situation,” the message said. The Indian embassy did not respond to email queries sent to them.

The message on the WhatsApp group continued, “The Indian Embassy is fully cognisant of the difficulties. Given the highly infectious nature of COVID-19, lockdowns and travel restrictions, our best safety is to remain where we are, maintain physical distancing norms and follow the protocol prescribed by the health authorities. As soon as the lockdown in India is released and travel restrictions are eased, it would be possible to return to our near and dear ones.”