August 15, 2003
Diphtheria Outbreak in Southern Afghanistan

People living in Zhare Dasht camp in the Kandahar province of southern Afghanistan are facing a rare outbreak of diphtheria - an infectious disease that has been all but eradicated in the western world. MSF started treatment of the patients and embarked on a mass vaccination campaign to prevent further spread of the disease.

Diphtheria is an acute bacterial disease that affects the tonsils, larynx, nose and throat, and is deadly in 10% of cases. A massive outbreak in 1990 in the thern Soviet infected 150,000 people and resulted in 5,000 deaths. By mid-July in Zhare Dasht, three people died of the disease. All the affected patients so far are less than 18 years old, and none of them had been immunized against the disease.

MSF's mass vaccination campaign targets all 40, 000 people living in the camp. Up to three separate vaccinations per person are required to ensure effective immunization. The first round of the campaign will end this week, and the entire process is expected to be completed in the coming months. MSF has also extended the campaign to children under five in four displaced persons camps in Spin Boldak, further south on the Pakistani border.

The mainstay of treatment for diphtheria is an anti-toxin alongside antibiotics, which eliminate the organism and prevent its spread. In the initial days of the outbreak anti-toxin treatment was no available in Afghanistan, so patients with diphtheria were transferred to Quetta, Pakistan. Within days, though, the World Health Organization (WHO) shipped the medicines to Kandahar and MSF began diphtheria treatment in the camp.

Patients clinically diagnosed with the disease are initially isolated in MSF's basic health care unit in Zhare Dasht until it is possible to transfer them to the Infectious Diseases Ward at Kandahar city hospital. MSF and other aid organizations are also educating and administering prophylaxis to people in Zhare Dasht because the cramped conditions can cause a disease like diphtheria to spread rapidly.

People living in Zhare Dasht, which means "yellow desert", and the Spin Boldak camps are mainly displaced Kutchi nomads from southern Afghanistan and Pashtuns from the north of the country. The ongoing drought in that region of the country has forced many Kutchis to abandon a traditional nomadic way of life and decimate their herds. Many of the Pashtuns have fled northern Afghanistan because of harassment and discrimination at the hands of other ethnic groups.

MSF has been working in the camps of Kandahar province since displaced people arrived there in early 2002, providing basic health care, maternal and pediatric services, reproductive health care, immunizations, nutrition activities and tuberculosis treatment.