Afghanistan: Stronger prevention measures needed amid measles surge

When Bilal fell ill with a fever, Zakia took him to one privately-run clinic after another, but his condition got worse.

"In the beginning, he had a severe fever, and despite taking him to two private medical facilities, they could not pinpoint what exactly was making him sick,” says Zakia. “At first they suspected he had pneumonia and gave him some medication, but he did not show any improvement." In fact, her son’s condition worsened. 

When she traveled to Mazar-i-Sharif Regional Hospital in the provincial capital, Bilal was diagnosed with measles. He was admitted to the MSF-supported measles isolation unit and then to intensive care, where his condition deteriorated further. Three days later, he is showing signs of improvement. “Today, he slept well for the first time since falling ill,” says Zakia.  

Another mother, Zahra, keeps her eyes on her 10-month-old son, Ali Ramin, in the back of an ambulance while journeying from Bala Dara-i-Suf District in Samangan province to Mazar-i-Sharif Regional Hospital. "He received treatment in the local hospital for several days, but as his condition deteriorated, we rushed here," Zahra says. Ali Ramin’s condition is also improving. 

A worrying spike in measles cases in several provinces  

In the first four months of 2024, Doctors Without Borders saw a surge in measles cases in facilities our teams run or support in three provinces of Afghanistan, affecting babies and young children. Cases of measles are reported annually in Afghanistan, but this year’s spike in Balkh, Herat, and Helmand provinces is particularly concerning.  

Between January and April, our teams treated almost 5,000 children for suspected measles: 2,700 at Mazar-i-Sharif Regional Hospital, 836 at Herat Regional Hospital in Herat province, and 1,406 at Boost Provincial Hospital in Helmand province. Four out of five of those admitted in Herat were under the age of one.  

In Herat, we nearly doubled the number of beds in the isolation unit from 31 to 61. The measles isolation unit in Mazar-i-Sharif was running at more than 200 percent capacity between January and March, forcing children to share beds at times.  

Early vaccination is essential

Bilal and Ali Ramin are some of the lucky ones. Although it is a common childhood disease, measles can be deadly when complicated by other health issues such as malnutrition or congenital conditions. In the Doctors Without Borders measles isolation unit at Herat Regional Hospital, between 7 and 8 percent of children admitted for suspected measles in the first three months of this year ended up dying. 

Babies are particularly vulnerable to the disease, as children in Afghanistan do not receive their first dose of measles vaccine until they are nine months old. Zakia had not yet taken Bilal to be vaccinated when he fell sick, thinking he was still too young.

Since mid-April, the number of children admitted with suspected measles to facilities run by or supported by Doctors Without Borders has started falling, and our teams are hopeful that this peak is over. But to reduce future cases and deaths among young infants,  the first dose of the measles vaccine can be given at six months old and there must be a sustained effort to vaccinate every child in Afghanistan against the disease.  

“Our main priority is to treat sick patients, but this is not enough,” says MSF medical coordinator Dr. Piex Uwiragiye. “The best way to combat measles is prevention through vaccination. We are already vaccinating all eligible children who come to us, but more needs to be done to prevent the further spread of the disease. We recommend that the reactive vaccination age in Afghanistan be expanded to cover children from the age of six months, who are currently left out, despite being disproportionately affected.” 

About our measles response in Afghanistan 

Doctors Without Borders teams are currently supporting the Ministry of Public Health by treating patients with suspected measles in three locations. At Mazar-i-Sharif Regional Hospital, we help manage a 36-bed isolation unit, donate medical supplies, and provide financial support to local health workers. We manage a 61-bed isolation unit at Herat Regional Hospital, and at Boost Provincial Hospital in Lashkar Gah, Helmand province, we support the isolation unit and treat measles patients.