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Immunization

Reaching every child, Afghanistan

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In the past eight years measles immunization has been very low in Afghanistan (under 40 per cent) and the measles mortality rate was the second highest in the world. Weak, hungry children are particularly at risk of measles and other life-threatening diseases. With growing concern about malnutrition following several years of drought, UNICEF, World Health Organization (WHO) and Afghanistan’s Ministry of Public Health (MOPH) launched an emergency vaccination campaign in July 2001. The aim of the campaign: immunize at least 90 per cent of Afghan children (about ten million) between the ages of six months and 12 years old. The campaign – which continued even during the US bombing of Afghanistan – ran until August 2002 and saved more than 35,000 children’s lives.

Due to winter snows, mud and a lack of accessible roads, vaccination teams from Afghanistan’s Ministry of Public Health often have to travel to villages on horseback carrying their vaccines and auto-disable syringes in bulky cold boxes (the measles vaccine needs to be kept between two and eight degrees Celsius). UNICEF pays for all transportation including the cost of hiring horses.

“There are many parts of Afghanistan that are impossible to reach by road or by vehicle,” says UNICEF Health Officer, Ayadil Saparbekov.  “There are many places where there is snow now... That’s why local communities mobilize horses and donkeys.  They put the vaccine in the cold box and put the cold box on the donkey or on the horse to reach the village.”

the vaccination team is heading back to Qalasharbat Village, Karukh district, Herat Province in western Afghanistan for the second time in two months. It’s a “mopping up” exercise. The first time they were here they immunized some 350 children against measles but, according to their calculations, they believe they only covered about 60 per cent of the children in the village. That is why they are returning: because it is as important to reach the last child as it is the first.

It’s a long two-hour journey on horseback but without all-terrain vehicles, this is the quickest way of getting themselves and their equipment here. Planning vaccinations in advance is hampered by the lack of radios or telephones in the area. The teams simply turn up. Nazir Ahmad, the village mullah (mullahs are often the only literate person in a village), plays a key role in mobilizing the community and persuading parents to bring their children for immunization.

Mullah Ahmad tours the village with a megaphone shouting, “Dear Friends, we are inviting you to bring your children aged between six months and 12 years old to register for immunization.” The vaccination team sets up at the village mosque. Only two children are brought forward, a six-month-old baby girl and 10-year-old Jalil Ahmad, who missed the previous vaccination because he was working in the fields. The vaccinators take their details, prepare the auto-disable syringes (single-use injection devices), give the children the measles immunization and get ready to move on to the next village.

Depending on the distances and mode of transportation, one team of three vaccinators can immunize up to 200 children per day. The measles vaccine is safe and even sick children can be vaccinated. Afterwards, mullah Ahmad is satisfied that all the children in the village have now been covered. “I don’t believe there are any more children here left to be done,” he says. “We are encouraging parents to bring the children to vaccinate against measles, tetanus and other killer diseases.”