The low socio-economic status of the people was accompanied by insufficient primary health care services in the region. The first avian influenza cases were diagnosed after lower respiratory tract infection symptoms appeared. All the fatalities were among those who had recently applied to a health center and been diagnosed as avian influenza. Informants have differing explanations for the late diagnosis of the patients. According to some, the first admission of the families was late. Others claim that the family of the first cases was sent back home during the first admission, and avian flu was diagnosed only after their second admission.