nlp-thedeep/humsetbias huggingface dataset:
The roll out of the annual influenza vaccination across Afghanistan will be more important than ever to help the health system manage the rise in COVID 19 cases. Increasing influenza vaccine coverage can reduce the strain on the health care system and free up limited health resources to focus on treating more severe cases of COVID 19. Public health experts strongly urge the public to adhere to physical distancing, mask wearing, good hygiene, hand washing and other proven strategies that mitigate the risk of COVID 19 transmission amid this second wave.
While responding to COVID 19, humanitarian partners are also mobilising to respond to needs in southern Afghanistan where at least 11,00 displaced people have been confirmed as being in humanitarian need as a result of conflict.
According to the Border Monitoring Team of the Directorate of Refugees and Repatriation  ( DoRR ) , a total of 23,640 Afghans returned from Iran through the Nimroz  ( Milak )  and Herat  ( Islam Qala )  borders between 01 07 Nov 2020, a 20% decrease from the previous week  ( 29,420 ) . 13,820 persons returned voluntarily and 9,820 were deported.
The conflict has also resulted in a surge in trauma cases and has stretched hospitals in Hilmand, Kandahar and Uruzgan provinces to capacity. Furthermore, attacks on health facilities during fighting are particularly worrying with WHO reporting that 15 health facilities have been targeted in Hilmand alone. One hospital and three health facilities are reportedly closed in Kandahar province due to active fighting and the risk of IEDs making it difficult for health staff to access the clinics. The closure of health clinics across the three provinces due to insecurity is directly affecting close to 150,000 people.
COVID 19 awareness raising and community engagement work is being incorporated into this response due to the increased risks facing people who are displaced and living in crowded conditions without proper access to hygiene facilities.
Health Services: Hospitals and clinics continue to report challenges maintaining or expanding their facilities' capacity to treat patients with COVID 19, as well as maintaining essential health services, especially in areas of active conflict. WHO notes that when health systems are under stress, as is being seen in Afghanistan, both direct mortality from the outbreak and indirect mortality from vaccine preventable and treatable conditions increase dramatically.
More than 9 per cent of the total confirmed COVID 19 cases are among healthcare staff. Health facilities across the country continue to report shortfalls in PPE, medical supplies and equipment, further challenging their capacity to treat COVID 19 patients.
In support of the Government, humanitarian partners have provided tens of thousands of pieces of PPE and several thousand items of life saving medical equipment to the Ministry of Public Health. Additionally, frontline NGO workers are set to receive new deliveries of PPE – including both surgical and N95 masks, face shields and shoe covers – from WHO over the coming weeks. So far, through support of the European Commission Humanitarian Aid Office  ( ECHO ) , WHO has delivered more than 520,000 PPE items to frontline NGO workers in Afghanistan since the start of the pandemic. With a second wave of the gathering pace globally, there is an urgent need to ensure a rapid distribution of medical and protective equipment to all corners of the country.
While 14 laboratories are now operating in Afghanistan, the capacity of these facilities remains limited and stocks of supplies have periodically run out.
Humanitarian partners urge the Government to ensure laboratories are appropriately equipped and that procured supplies go to under resourced health centres in a transparent manner, so that life saving support can be delivered to those most in need.
Socio economic impacts: Average prices for key commodities remain elevated above pre COVID levels while purchasing power has diminished. According to WFP's latest market monitoring, the average wheat flour price  ( low price and high price )  increased by more than 10 per cent between 14 March and 4 November, while the cost of pulses, sugar, cooking oil and rice  ( low quality )  increased by 23 per cent, 19 per cent, 29 per cent, and 21 per cent, respectively, over the same period.
Border Crossings: The Milak  ( Nimroz )  and Islam Qala Dogharoon  ( Hirat )  crossings with Iran are officially open to commercial traffic and movement of documented Afghanistan nationals. According to the Border Monitoring Team of the Directorate of Refugees and Repatriation  ( DoRR ) , a total of 29,420 Afghanistan nationals returned from Iran through the Milak and Islam Qala border crossing sites between 25 and 31 October, a 7 per cent increase from the previous week  ( 27,524 ) . More than 20,000 people returned voluntarily and more than 9,000 were deported. IOM provided post arrival humanitarian assistance to 1,271 people or 4 per cent of all undocumented Afghanistan nationals returning from Iran at its transit centres in Hirat and Nimroz during the past week. Afghanistan's border with Pakistan at Spin Boldak officially opened on 21 August and the border at Torkham on 28 September.
Humanitarians stress the critical importance of maintaining a reliable flow of humanitarian cargo from all neighbouring countries and are advocating for special consideration to expedite movement of humanitarian food and relief items through border crossings. To enable and sustain this operation, urgent funding of US$900,000 is required until the end of the year.
IOM is actively supporting the Ministry of Public Health  ( MoPH )  and WHO in addressing preparedness and emergency coordination actions through its Cross Border Return, Migration Health and Displacement Tracking Matrix  ( DTM )  Units. IOM support is primarily focused across 4 of WHO's Global Response Pillars include 1. Coordination; 2. Risk Communication and Community Engagement; 3. Surveillance/DTM; and 4. Points of Entry. Activities include training for frontline health workers, deployment of staffing to areas of need including placement in health facilities, secondment of staff to cross border surveillance, material support of PPE and other equipment, ambulance based referral services, distribution of MOPH WHO IEC materials and community level awareness raising and sensitization efforts through health education sessions including within Displacement Tracking Matrix focus group discussions in over 12,000 settlements across 34 provinces.
The Protection Unit completed case management assessments for 24 PSN cases in Nimroz, Kabul, Ghor, Balkh, and Kunduz, including 18 persons in specific situations, 2 women at risk, 2 elderly persons at risk, and 2 single parents. In addition, COVID19 protection monitoring assessments were conducted for 41 cases all of whom received specific information related to COVID 19 prevention and awareness.
34% mentioned of using private transportation to transport the suspected or positive cases due to non availability of ambulances
According to the Directorate of Refugees and Repatriation  ( DoRR ) , 5,768 undocumented Afghans have returned from Pakistan since 01 January 2020. Over the past week 173 undocumented Afghans returned from Pakistan through the Torkham  ( 50 returnees and 10 deportees )  and Spin Boldak  ( 113 returnees )  borders. The Afghan frontier with Pakistan at Spin Boldak officially reopened on 21 August and the border with Torkham on 29 September.
During the period of August to October 2020, corresponding to the post  harvest season, it is estimated that a total of 11.15 million people  ( 36% of the analyzed population )  were facing high levels of acute food insecurity  ( IPC Phase 3 or above )  and required urgent humanitarian action.This includes around 7.54 million people in Crisis  ( IPC Phase 3 )  and 3.6 million people in Emergency  ( IPC Phase 4 ) . Around 11.34 million people were also in Stressed  ( IPC Phase 2 )  and required livelihood support.
During the projection period of November 2020 and March 2021, corresponding to the lean season, around 13.15 million people  ( 42% of the analysed population )  are likely to experience high levels of acute food insecurity  ( IPC Phase 3 or above ) , out of which an estimated 8.85 million people will likely be in Crisis  ( IPC Phase 3 )  and nearly 4.3 million people will likely be in Emergency  ( IPC Phase 4 ) . Furthermore, around 10.6 million people are expected to be in Stressed  ( IPC Phase 2 ) .
The 2020 lean season, analysed in April 2020, shows an estimated population of 10.9 million people  ( 10,857,000 )  that was facing high levels of acute food insecurity  ( IPC Phase 3 or above ) . Meanwhile, the analysis conducted in October 2020 over the 2021 lean season  ( November 2020 and March 2021 )  shows 13.1 million people  ( 13,155,000 )  will likely be facing high levels of acute food insecurity  ( IPC Phase 3 or above ) , corresponding to an increase of 2.3 million people  ( 2,298,000 )  from the 2019 to 2020 lean season.
Ongoing conflict in most provinces has led to displacement, caused loss of livelihoods, or affected people's livelihoods. As a result, farmers don't have access to their agricultural lands for cultivation and harvesting at the right time, with a similar effect on livestock and other sectors. Overall, access to contested areas remained limited during the current period and is expected to remain the same during the projection period.
On average, half a million people leave their homes every year because of the conflict.
According to OCHA's IDP tracking data, a total of 202,856 IDPs fled their homes from January to mid September 2020, which shows an increment of 73% compared to January  December 2019, and by end of the year 2020, the IDP number is likely to further increase.
According to the internal displacement monitoring centre  ( iDMC ) , there were 2,993,000 IDPs in Afghanistan in December 2019 and this number is expected to further increase by the end of 2020.
It is expected that a second wave of COVID 19 infections will further exacerbate the situation. Even if restrictions will not be put in place in Afghanistan, there will still be impacts from global restrictions and economic downturn. Reduced support for the most vulnerable populations by government and international organizations is expected, due to multiple factors linked to COVID 19 restrictions imposed on organizations and the government, and decreased funding after the drought emergency resumed.
High awareness of preventive measures are Clean and disinfect frequently the objects and surfaces been touched by people  ( 100% ) , Avoid touching eyes, nose and mouth with hands and fingers  ( 92% )  and Avoid large gathering  ( 72% )
Information collected suggests 95% of respondents have adopted three or more negative coping strategies to address the prevailing economic hardships.
In 2017, approximately 8.5 million youth and children were enrolled in general education schools, representing a nine fold growth since 2001, while the under five mortality rate dropped from 257 to 50 per 1,000 live births from 2003 to 2018.
39% of the respondents mention that they are in the risk group, men are higher with 45% and women  ( 30% )
In late March, the Afghan government implemented a lockdown to stem the spread of SARS CoV 2; it remains to be seen how effective this will be in slowing the spread of the virus.
While Afghans continue to return to Afghanistan from both Iran and Pakistan, spontaneous returns from Iran through two main border crossings reached a new record high totalling 150855 alone in the month of March 2020  ( UNHCR , 2020 [ 26 ]  )   ( IOM , 2020 [ 27 ]  ) . They then decreased sharply to 40025 at the end of April 2020, coinciding with lockdown measures adopted in the host country ( IOM, 2020 ) .
In a rapid assessment of six conflict affected provinces, children from IDP families  ( enrolled in CBE )  in urban areas were nearly four times more likely to access distance learning than those in rural areas
In this context, the key public health response to limit impact of COVID 19 is to limit transmission of the disease. However, the case of Surkh Dewall demonstrates the many challenges associated with stemming the spread of the disease among populations of informal settlements. Overcrowding, and multiple occupancy housing, is a key risk of COVID 19 transmission for the population of Surkh Dewall.
On average, over 15 people reside in each dwelling, with the majority of households  ( 92 per cent )  living in single roomed mud brick dwellings. There is also a highly vulnerable five per cent of households residing in tents, accounting for a total of 30 families and over 150 people.
In such conditions, anecdotal evidence suggests that women often limit water intake and limit the frequency of urination and defecation. These practices can lead to physical and psychological stress, leading to adverse health impacts that could complicate COVID 19 and result in worse health outcomes.
Crowded living quarters, limited to no access to clean water and sanitation, and severely curtailed health care all increase the risk of the coronavirus spreading among displaced communities, yet all are a daily reality for many displaced Afghan families.
Already surging poverty levels, ongoing violence and natural disasters have fueled Afghanistan's displacement crisis and left hundreds of thousands of Afghans particularly vulnerable to an outbreak of a respiratory disease like COVID 19, which could spread easily through the overcrowded confines of many settlements.
Internally displaced families in Herat, in western Afghanistan, are among those that have received soap distributions. UNICEF has reached thousands of internally displaced children with soap supplies to help prevent the spread of COVID 19.
Inadequate wastewater management, therefore, is an important potential route of transmission. In this context, residents of Surkh Dewall suffer low capacity WASH systems, presenting severe transmission risks. Nine per cent of respondents – accounting for a total of 56 families, and 325 individuals – report practicing open defecation; female headed and lower income households are most likely to practice open defecation  ( Fig 1 ) . The remainder of households used basic open latrines, which also present high contamination risks, particularly in the context of overcrowded housing.
Norwegian Refugee Council is closely working with the Self  Learning Taskforce to develop learning materials to reach out children at household level.
Overcrowding may lead the spread of the COVID 19 infections among the prisoners. As per the Presidential Decree  ( March 2020 ) , the prison authorities should develop a list of prisoners /under trials to be released to reduce the crowd in the prison. Priorities be given to women, women with children, elderly and under trials with no significant criminality involved
There is no quarantine room in the prison to segregate the infected persons away from other prisoners. A mechanism to be worked out with Provincial Authorities to safe guard the prisoners and segregate infected people into quarantine in Spinzar Hospital in Kunduz.
Increased access to health facilities, include testing facilities, laboratories, screening facilities and treatment centres at the provinces is needed. Health staff needs protective gear to save themselves from the risk of COVID 19 and provide services to people who are at the risk
Psychosocial Debriefing  the nurse who works in the prison can do this, individually or in group  ( 3 4 prisoners but should maintain physical distancing. In debriefing, basically the role of the facilitator is to listen without being judgmental and allow the person to talk about his/her feelings, fear, worries etc. By allowing people to unload their emotional reactions makes them feel better. Giving assurance to the prisoners that they are not alone and that other people also experience such reactions gives them that feeling of normalcy that it is okay to be sad, to experience fear as this are normal human reactions to a crises situation.
Family support  it is essential for the prisoners to be in contact with their families. Since visits to prison are reduced due to COVID, it will be good if the Jail warden allows each of the prisoners to be speak to their families at least once a week. The NGOs running awareness sessions with the prisoners can take permission from the Prison warden to allow prisoners to speak with their families. A specific budget to be allocated for communication so that prisoners can talk to their families. Being able to talk to their families helps them feel calm and reduce the stress
Cluster identified solutions to ensure continuum of care and access to services: This is currently being discussed. Partners have been invited to apply for the 3rd RA and were instructed to apply only alternative modalities.
Given ongoing challenges and a determination to break community level spread of the disease, IOM and our partners are placing an emphasis on community level engagement to ensure local people are taking the right actions to keep themselves safe throughout the outbreak.
After four decades at the epicentre of conflict and natural disasters, Afghanistan today is teetering on the brink of a public health catastrophe, facing the collapse of an economy whose most marginalized are heavily reliant on remittances at a time when traditional donor countries are increasingly focused on domestic economic recovery efforts, and the spectre of a resurgent Taliban.
The failure to aggressively support the country's efforts to combat and contain the spread of COVID 19 is deeply alarming for the health and safety of its citizens, provides those whose agenda is to roll back the fragile success stories wrought by nearly two decades of international investment a virulent new propaganda tool, and threatens many more years of regional instability.
COVID 19 is having a wide ranging impact on mobility between Afghanistan and the Islamic Republic of Iran   a global coronavirus hotspot and destination for hundreds of thousands of Afghan migrant workers   which reopened its economy in late April. Since that time, the number of new infections has spiked from roughly 2,000 per day to nearly 3,600 new daily infections on 5 June.
In the month of March alone, over 160,000 undocumented migrants returned home to Afghanistan from cities across Iran; a dangerous narrative that the returnees brought COVID 19 home with them is unsupported by evidence, yet the resulting anti migrant stigma has been widespread, influencing government policy and driving local communities to isolate and in some cases prevent the return home of Afghans from Iran.
Food insecurity is alarmingly high in Afghanistan during the current period  ( April May 2020 )  with 10.9 million people  ( 35% of the population analysed )  facing IPC Phase 3  ( Crisis )  or above. These include around 7.38 million people in Crisis  ( IPC Phase 3 )  and 3.47 million people in Emergency  ( IPC Phase 4 ) . With the harvest beginning in June, it is expected that food insecurity will slightly improve. From June to November 2020, it is expected that 10.3 million people  ( 34% of the population )  will face acute food insecurity, with 22% of the population in Crisis  ( IPC Phase 3 )  and 11% in Emergency  ( IPC Phase 4 ) .
Ongoing conflict in most of the analysed provinces has caused population displacement, affected people's livelihoods or caused them to lose their livelihoods completely. In 2020, there have been an estimated 65,000 newly internally displaced people  ( IDPs )  as a result of conflict.
On Oct 15 – 2020 in a meeting with the DoRRs of Balkh and Faryab Provinces agreed on the provision of covid 19 response for the IDPs and Returnees populations in Mazar and Maimana Cities. They requested IMC to provide COVID 19 response. The population of two cities are in dire need of emergency WASH services including COVID19 awareness messages and providing information on hygiene practices to mitigate the spread of COVID 19 for 3,520 most vulnerable families in Mazar e Sharif and 1000 families in Maimana Cities
At the outset of the report, over 95% of all respondents were not aware of COVID 19 and 100% aren't attributed to mass messaging campaigns from government and non government actors.
After the harvest, it is likely the food insecurity situation will improve in rural areas, since households will have increased access to food from own production and prices may also decrease. However, despite the overall reduction in people facing acute food insecurity, the population in Emergency  ( IPC Phase 4 )  is expected to increase in the projection period, as the urban households relying on market for food purchase and on daily labor opportunities for their income, will likely experience larger food gaps. In urban centers, the negative economic impacts of COVID 19 are likely to counteract the positive impacts of the harvest. The severity will be higher in areas where humanitarian access is limited
As of June 04, 872 healthcare workers were infected with COVID 19 in the country which accounts to 4.6% of total infections and 13 deaths which accounts to 4.2% of total deaths due to COVID19.
28%  [ of respondents ]  reported at least one negative symptom among the household's children, with women more likely than men to report these  ( 31% vs. 21% ) . The most common symptoms are similarly feeling worry  ( 11% )  and feeling depressed  ( 9% ) .
17 respondents considered these protective measures unnecessary, while 14 said they did not have means or space to quarantine themselves.
To overcome COVID 19 transmission, the Government of Afghanistan, IOM and partners are scaling up response efforts by deploying hundreds of new staff and resources around the country. However, without a negotiated ceasefire to end the fighting and enable successful health interventions and much greater engagement from the international community over the short to medium term, the unfolding catastrophe will deepen and act as a further driver of migration and instability in the region.
As wealthier economies make positive strides to stop transmission and flatten the curve, more focus must be urgently devoted to low resource environments with compromised public health systems to ensure countries like Afghanistan can protect the most vulnerable inclusive of the elderly, inform and persons suffering from pre existing health conditions
Action to protect returnees include providing cash or in kind supports for sanitary items as well as basic needs, such as shelter, food, and water.
Responding to the question on how much the community trust these health information sources, Health facility staff  ( 89% )  were considered the most trustworthy followed by Mass Communication tools like Radio/Television  ( 75% ) , and next is the social platforms like WhatsApp, Facebook  ( 52% )  and are followed up by religious leaders  ( 37% )  and community elders  ( 24% ) .
However, the least trustworthy health information sources are, government officials  ( 77% ) , Friends  ( 64% ) , the posters used by government and NGOs  ( 32% ) , family members  ( 13% ) . Few also mentioned religious leaders  ( 9% ) .
Most of the respondents are worried about COVID 19 as their daily routines are slightly  ( 42% )  or greatly  ( 56% )  disrupted.
75% mentioned problem in selling their harvested crops and other farm produces due to COVID 19 and the restriction of movements.
When we ask for the reasons, the government is most untrustworthy as it hides information about the disease and doesn't clearly communicate to the people. People don't trust the government departments when they present that there are very low cases. The posters are not helpful as they are more content and most of them are illiterate.
64% of the responders have mentioned about impact on Agriculture due to COVID 19 and the restriction of movements.
87% have mentioned that there is huge impact on livelihoods due to COVID 19 and the restriction of movements as there is loss of daily wage labour  ( 90% of men have mentioned that the daily wage labour is the major impact )
In January 2020, NRC conducted 52 FGDs and 224 HHs  ( 45% female and 55% male ) . 98% of the FGD respondents to reported having no intention to return. Respondents highlighted the insecurity/conflict in the areas of origin as the main reasons deterring their return to the areas of origin and compelling them to stay in the locations of displacement..
CP AoR  [ Child Protection Area of Responsibility ]  and PC  [ Protection Cluster ]  identify for HCT  [ Humanitarian Country Team ]  members how to best support UNAMA  [ UN Assistance Mission in Afghanistan ]  Human Rights and other interlocutors engaged with the Commission to ensure the Taliban respect IHL and take action to implement the Guidelines for Protecting Schools from Military Use
Other practices noted include nutritional ones – “Taking Vitamin C, eating fruits and vegetables, drinking warm water and tea' as well as the religious “offering prayers and repentance is the best way to prevent COVID 19'.
Despite this counterflow there has been a major downturn in remittances   the World Bank estimated remittances amounted to nearly USD 868m in 2019   a significant revenue stream for the rural poor.
As the number of cases continues to soar due to the questionable effectiveness of lockdown measures which have been met by protests across the country; the demand to restart economic activities by reopening shops, offices and local services and perceived inequities in the distribution of food and other humanitarian support. The targeting of civilians by combatants has further exacerbated the situation.
A key constraint hindering a meaningful response to the pandemic is the low capacity for testing. Afghanistan's 10 labs established since January 2020 have a daily testing capacity of 1,790 tests with a call by the national government for private clinics to extend testing capacity.
Afghanistan has very limited infrastructure to treat severe cases; has a life expectancy of only 50 years for both genders and a high percentage of the population suffers from pre existing health conditions such as TB, HIV AIDS, malnutrition, cancer, heart and lung disease, and environmental pollution. This lack of testing and treatment capacity has been further exacerbated by attacks on healthcare facilities by armed groups.
Our seven mobile health teams and over 200 health staff are assisting the Ministry of Public Health in testing, surveillance screening, arranging awareness and hygiene sessions in over 12,000 communities, and ensuring the continuity of basic essential health care to underserved populations including IDPs and returnees.
IOM has served over 170,000 vulnerable Afghans with critical basic health care interventions in 2020.
CP AoR  [ Child Protection Area of Responsibility ]  and PC  [ Protection Cluster ]  identify for HCT  [ Humanitarian Country Team ]  members how to best support UNAMA  [ UN Assistance Mission in Afghanistan ]  Human Rights and other interlocutors engaged with the Commission to support a total ban on the use of children in hostilities and recruitment into armed forces or remain in armed forces to reduce killing and maiming.
IOM is also actively engaged in the socio economic recovery of Afghanistan with programming to support the sustainable reintegration of returnees.
From the interviewed teachers, 33 % support the use of teacher self learning materials for their continued professional development, 33 % of them agreed with teacher development through smart phone, 34% of teachers have agreed with learning through radio and 0% was agreed with learning through TV programs because of lack of electricity. However, these preferences should all be framed around limitations on access to these different platforms.
To minimize the disruption and reduce student's learning loss, many organizations have turned toward using the Education in Emergencies  ( EiE )  Working Group developed Self Learning Packages  ( SLP ) . However, education experts at the International Rescue Committee  ( IRC )  have flagged the importance of providing multiple opportunities and platforms for learning, to improve equity, reach and impact of remote learning support. Since the Self Learning Package is very challenging for children in early grades  ( 1 3 ) , due to a lack of foundational skills, the IRC has started to consider the use of remote and distance learning modalities to support the delivery of the Self Learning Package, specifically for these younger age groups.
The result shows that only 16% of family members – 473 men and 50 women   have education levels of grade 6 or higher. 84% have not completed primary school education, showing a significant lack of higher education amongst the targeted population as well as potential challenges with caregiver support for home based learning
Almost 95% of families do not have access to a reliable source of electricity in their communities that would allow them to support their children to continue learning with electronic devices during this time.
Having a TV and access to TV programs is a big challenge and almost all  ( 95% )  of respondents mentioned that they do not have a TV in their home. Nevertheless, all parents contacted reported that they would give permission to their children to watch educational TV programs.
All of the parents  ( 100% )  agree with supporting selflearning materials and using radios as they have available access to these resources. Only 143 households  ( 4% )  support learning through TV as very few have access to televisions. 0% of participants recommend smart phone as tools for learning.
Approximately 81% of deaths occurred in males and 19% in females.
Maternal mortality also declined from 600 deaths per 100 000 livebirths in 1990, to 299 deaths per 100 000 livebirths in 2017.
Strategic Recommendation 5: Ensure adequate, timely and flexible funding to enable anticipatory action, preparedness and sustain critical humanitarian assistance
Investing in food and social protection systems is relevant for all the countries covered in this report. For example, in Afghanistan, it is vital to support women farmers, smallholders and sharecroppers to access unconditional assistance and cash for work to rebuild their livelihoods. In addition, it is recommended to extend social protection systems to IDPs who cannot return to their communities of origin due to conflict.
The highest recovery rate is reported in Nimroz province  ( 37% )  and lowest in Badakhshan province  ( 3.6% )  while the national recovery is 9.3%.
At the same time, 29% have mentioned that the OPD and Emergency Units are running over/above the normal capacity of the hospital.
The fragile health system is further overburdened by mass casualty incidents and recurrent outbreaks of communicable diseases, especially among internally displaced people.
As per need assessment, IMC found that there are 30 water point that were constructed by the MRRD ten years back. Also, as per IMC observation, these boreholes cannot fulfill the needs of the people. As per the community elders, more than 400 families use unsafe water.
Hirat  ( 59 ) , Balkh  ( 44 ) , Kabul  ( 39 ) , Kandahar  ( 22 ) , Ghazni  ( 16 ) , Baghlan  ( 13 )  and Panjshir  ( 10 )  are the provinces with highest number of deaths.
63% of the lower health facilities have mentioned that they don't have functional infrared thermometer
Afghanistan has established a Central Public Health Lab and Veterinary labs in Kabul, labs in Herat, Jalalabad, Kandahar, Mazar e Sharif, and Paktya are testing for COVID 19. A second lab in Herat  ( veterinary lab )  is expected to begin testing in the coming days.
36% of the respondents mentioned that Training provided by MoPH and WHO and practices in the hospitals is more informative related to COVID 19. Men  ( 40% )  outnumbered women  ( 29% )  in this response.
That means that all the COVID 19 positives are not fatal. Thus, there is need for health workers to be oriented that COVID 19 is not fatal and patients can recover for this disease with specific measures.
With death of 8 doctors and 283 health workers were infected in the country  ( see the following table related to infections ) , there is a fear and concern among the health workers related to COVID 19.
31% of the health workers mentioned that they are somewhat confident of using PPEs  ( high among men  ( 34% )  and less among women  ( 28% ) . This is quite high among the professionals dealing directly with COVID treatment or response  ( 43%, slightly high among men with 45% and women with 37% )
40% of the health workers mentioned that they are either not confident or a little confident about the safety of using PPE. This is more among women  ( 48% )  compared to men  ( 35% )
Close to one  third of the surveyed Kuchis reported that their transhumance was either blocked or limited resulting in some localized tensions.
Of the 360 clusters planned for this survey, 338  ( 94% )  completed the survey. Similarly, of the total planned 5760 households, 5177  ( 90% )  households completed the survey. A total of 9,514 household members in this 338 clusters were interviewed and tested for COVID 19 in this survey.
The epicenter of the outbreak was Hirat province in west of the country having shared border with Iran in which the first case was imported and reported.
Only 15 per cent of victims indicated receiving any kind of acknowledgement of harm by a party to the conflict, and only approximately 12 per cent of victims were aware of any investigation into the incident.
In terms of emergency response, items such as hygiene kits and Personal Protective Equipment  ( PPE )  to limit transmission are urgently required.
Residents also report unbalanced diets, which typically consist of cereals  ( usually bread ) , oil and fat and sugar; on average vegetables and pulses are consumed less than 3 days a week, while meat, fruit and dairy products are rarely consumed.
44% of the respondents are illiterate and never attended schooling  ( high among women, 70% ) . Only 20% of the respondents have completed grade 12  ( women are only 10%, where as it is 26% among men respondents ) .
In this context, the WFP reports that COVID 19 pandemic has caused price surges for staple foods such as oils and cereals of up to 20 per cent  ( OCHA 2020 ) . Increasing food prices synergise with disruption to informal livelihoods to present severe risks for residents' health: as nutrition is a key determinant of health, there is the risk that worsening food security will negatively impact the mortality rates of COVID 19.
In addition, lower incomes and increased expenditure will present additional transmission and socioeconomic risks to households, with low income and female handed families most affected.
Other priority housing, WASH and infrastructure investments include the construction of public toilets to meet the need of those currently practicing open defecation and improving water supply for residents promote hygienic practices that limit transmission. These interventions should be coupled with public health messaging, which provide residents with clear guidance on limiting transmission in the context of overcrowding and low capacity WASH, and that is tailored to the needs of women.
In the medium to longer term, upgrading housing, WASH and local infrastructure will strengthen the resilience of the community to COVID 19 and other shocks. These investments can be facilitated through community based organisations, using a cash for work modality that draws on labour from the settlement. This will improve living conditions, support local livelihoods and contribute to upskilling the local workforce, reducing COVID 19 transmission risk and strengthening community resilience to the disease.
As cases grow, the likelihood of many of the frontline workers have possibility of contracting COVID 19.
In this backdrop, Johanniter International Assistance, who are working with Provincial Public Health Directorates of Kunduz, Khost and Kabul through its national NGO partners, JACK, ACTD and OHW, decided to do a perception survey among HCWs about COVID 19. In this Page 11 of 48 context, it has written to its other partners, AADA and BRAC4 . Thus, Johanniter International Assistance has conducted the assessment in eight provinces of Afghanistan with six participating agencies.
Although food is still available in nearly all markets, the prices of basic food commodities increased by 10 to 20%.
The constant stream of deportations from Iran – annually at around 400,000 between 2007 2017 – requires caution and attention. In 2018, nearly 800,000 undocumented Afghans returned or were deported from Iran
In the projection period, the impact of COVID 19 on economic access is expected to continue. There will, however, likely be a slight improvement during the harvest season as food price levels will likely decrease. People from urban areas may also migrate to rural areas in response to decreased employment opportunities in urban regions.
Religious leaders, respected elders and influential community members must be included in awareness raising campaigns to reduce violence against women and children, including abuse and gender based violence resulting from the lockdown;
Dedicated efforts must be made to protect returnees from Iran and Pakistan  ( perceived COVID 19 hotspots )  from stigmatization and discrimination, and to disseminate accurate information to dispel rumors on the cause, transmission and treatment of COVID 19.
Afghanistan has been ravaged by four decades of violent conflict and war, fracturing the social fabric of the country, destabilising development efforts and leaving the majority of citizens impoverished. Grievances between individuals, communities, tribes and political leaders are deep seated, multi faceted and impact on all segments of society.
According to IOM, between Jan 1 April 11, nearly 243,000 people crossed back into Afghanistan from Iran, tens of thousands also returned from Pakistan. Returnees are at high risk of stigmatization. The Iran border remains open, but fewer people are travelling due to lockdown restrictions. The border on the Pakistan side has opened for four days in April to allow for the return of Afghans stranded in Pakistan. Now two border points open twice a week for documented returnees to return to Afghanistan, although ad hoc openings and closures are also in place.
Social distancing will be particularly challenging during Ramadan  ( April May )  when individuals visit mosques and homes en masse. Though many villages across the country are remote and isolated – which might initially serve a protective function – if the virus reaches them, very few healthcare options are available. This is problematic for both Afghanistan and the international community – risking turning Afghanistan into an incubator of the virus long after a vaccine is distributed, as is the case for almost eradicated diseases like polio.
To help mitigate the health risks, and subsequent socio economic consequences of the lockdowns, the UN has developed a response plan to support the efforts of the Afghan Government in responding to the pandemic. This will require funding of USD 108.1 million until 30 June. The government has emphasised the need to coordinate at the provincial level with governors, so UN and government plans align.
In addition to challenging social norms, WV must work to provide alternative income through sustainable livelihood opportunities to families with children at risk of being forced to marry early.
Partial lockdowns of varying severity across the country are limiting movements of humanitarians. The Protection Cluster are undertaking advocacy at the highest level to maintain freedom of movement for humanitarian organizations, with some exemption letters being issued to partners requiring them. Overall, there is reduced partner presence on the ground, with essential staff teams working on a rotational basis. The humanitarian community does not support the establishment of camps to isolate people returning to Afghanistan. This is not in line with current Government of Afghanistan recommendations or global best practice and has proven an ineffective tool in other contexts.
Arbitrary / discriminatory restriction to freedom of movement: Local authorities are enforcing imposed lockdowns and restrictions of movement, preventing heads of household from earning daily wages. In some cases, this results in confrontational situations with the police
As of writing this report, 45,139 samples have been tested in all central and regional public health laboratories since last week of February, of which 18,969 were declared positive by Reverse Transcriptase Polymerase Chain Reaction  ( RT PCR )  in Afghanistan. The sample positivity rate was 42% which was twice as high as six weeks  ( 19.5% )  before on 24 February. The frequency of cases and deaths have been slow in the beginning of the outbreak while started to increase in late March and continues to grow.
Afghanistan as a conflict affected country has experienced enormous challenges including political unrest, complex emergencies, socio economic hardships, humanitarian crises and high burden of infectious and non infectious diseases.
Around 30 per cent of the population has limited access to basic health services within a two hour travel radius and maternal mortality is among the highest in the world.
The findings of this study indicate that those in the age groups of 20 30 and 30   40 years are at higher risk of infection while the age group of 60 years and more had the highest rate related deaths. It is obviously manifest that young population is economical group and more exposed, therefore more infected but due to high level of resistance and immunity has low rate of death.
It has been documented that people over 65 years of age and younger people with chronic diseases are at a greater risk of complications resulting from viral infections than healthy adults. This indicates that older and unhealthy younger people are more likely to become infected with COVID 19 owing to a weak immune system, and infection is more likely to be fatal in these groups.
Although UNAMA documented an overall reduction in civilian casualties caused by Afghan national security forces for the quarter, it is concerned that their operations led to an uptick in civilian casualties in March  mainly ground engagement, particularly from the use of indirect fire, and airstrikes.
UNAMA repeats its call on the Government of Afghanistan to cease the use of indirect fire  ( mortars, rockets and grenades )  and other explosives with wide area effects in populated areas, and to continue to develop and improve tactical directives, rules of engagement and other procedures in relation to the use of armed aircraft.
Under international humanitarian law, medical facilities and personnel must be respected and protected in all circumstances. Intentional attacks on medical facilities or protected personnel may amount to war crimes. During the COVID 19 pandemic, any incidents affecting medical facilities or personnel can have particularly serious and wide ranging consequences impacting individuals' access to essential healthcare services.
The pandemic has necessitated a reallocation of both recurrent and development expenditures towards COVID 19 response activities, including social protection and healthcare  ( World Bank, 2020 ) . Subsequent sections estimate the growth impact of such budgetary adjustments and propose alternative policy options using the UNDP CGE model for Afghanistan.
Economic literature shows that institutional weaknesses in the tax collection systems of conflict affected economies such as Afghanistan, constrain the country's ability to service debt – even when debt to GDP ratios are moderate by the standards of advanced economies  ( Aizenman and Jinjarak 2012 as in World Bank, 2017 ) . Relating the debt stock to realized tax collection or to the size of the tax base is therefore recommended as a better gauge of a government's ability to service its debt.
Furthermore, by improving the business environment, the gain in terms of real GDP growth could reach about two percentage points for the whole period  ( 2020 2024 ) .
To mitigate adverse effects from the pandemic, the financing need of the Government has increased. The Government requires additional assistance to maintain its current level of expenditure on basic services. This is the main reason for the request for increased support from the international community.
If the Government decides to cover financing needs by increasing its fiscal revenue or by reducing expenditure, this will have additional negative effects on growth and unemployment in the medium term. International support from the donor community will therefore be essential if the country is to return to a path close to the pre pandemic one and put the economy on a sustainable path to growth
UNHCR  ( 2014 )  carried out a global survey of their employees' mental health and wellbeing, with results showing that 47% of staff experienced sleeping difficulties & 57% reported depressive symptoms.
World Vision Afghanistan  ( WVA )  is responding to COVID 19 global pandemic. Focusing on supporting the Government of Afghanistan  ( GoA )  to scale up preventive measures to limit the spread of COVID 19.
The Danish Refugee Council  ( DRC )  and the Norwegian Refugee Council  ( NRC )  newly restarted providing, respectively, services on mine risk education and services on legal assistance to returnees.
Social exclusion, stigmatization, discrimination: Returnees from Iran and Pakistan are reporting stigmatization from local communities. Persons living with disabilities and the elderly are also at risk of being left behind during crisis management.
The situation is even more severe among IDPs. Both IDP men and women noted the highest increases in barriers to purchasing medical and hygiene products, and longer waiting times to see a doctor.
80% of respondents agreed to allow female members of the family to be hospitalised for 2 14 days if they get infected by COVID 19. Men outnumbered women in the response marginally by 2%
Providing enhanced education and training services linked to local livelihood opportunities would support the socioeconomic development of the settlement and residents. Implementing a cash for work settlement upgrading programme – in tandem with education and training support – could address this issue.
A large proportion of respondents suffer extremely low incomes. Around 30 per cent reported a family income of less than 1,000 AFG a month  ( 13 USD ) , equating to less than 2.25 USD or around 0.08 USD per person per day. Female headed households were most often in the lowest income bracket, with over 50 per cent reporting a family income of less than 1,000 AFG a month, and were least likely to be in the highest income bracket, with only four per cent  ( one family )  reporting a monthly income over 5,000 AFG.
Mitigation: An annex focusing on Covid 19 related questions including risk of stigmatization and discrimination was added in April 2020 to the general Protection Monitoring form.
Cluster adoption of alternative modes of working modalities : Only the Snr Protection Cluster Coordinator and the Child Protection Sub Cluster Coordinators remain in Afghanistan and are working from offices. National staff are working from home. Co lead and other Sub Cluster Coordinators are working from their countries of origin via tele working arrangements. A mapping of partners' presence in the field shows a 50 per cent reduction of staff, with essential teams working in rotation.
With the arrival of the lean season  ( November 2020 to March 2021 ) , 13.1 million people  ( 42% of the total population )  are expected to be facing acute food insecurity  ( Integrated Food Security Classification, IPC Phase 3, or above ) . This represents a 16% increase compared to the same period of last year. The main reason for this deteriorated situation are the COVID 19 pandemic  ( resulting in a contracting economy, associated with a significant decrease of daily wage opportunities and small trade income ) , the ongoing civil conflict  ( leading to more displacement and the loss of livelihoods )  and high food prices impacting the purchasing power. These factors further exacerbate food access, especially for households already living below the poverty line.
He shared that Batikot district faces lack of water, clinic and shelter.