Winter, an Added Health Hazard in Afghan Camps. (On-the-Spot Report)

Humanitarian workers and displaced people are racing against time to build about 6000 mud brick shelters here in the Maslakh camp for displaced persons, which is just outside Herat, a city of 800 000 inhabitants in western Afghanistan. Across the country, others are bracing themselves for the possible consequences of the tragic events in the United States and the attack on Mr Ahmed Shah Massoud, military leader of the anti-Taliban alliance. At this writing (12 September), they have less than eight weeks before winter brings snow and freezing winds to rake the valley. Another 4000 shacks need repairs, and new displaced people continue to arrive at a rate of around 300 a day -- more than 8500 in August. At the same time, all international UN staff, and many NGO workers, are being evacuated. Even if construction goals are met, winter is going to be tough for the thousands that have come to this camp to flee drought and conflict in their home provinces. Take the eight members of the Saadat family, who arrived in Maslakh five weeks ago, having lost their harvest for the third year in a row. in the warm nights, half the family members sleep outside their 4-square-metre room, but winter will see them all crammed inside, day and night, along with the fire smoke, dust and any infections that happen along. Health workers have been fighting high levels of diarrhoea and dehydration all summer. The Herat hospital paediatric ward is full of cholera patients from outlying districts. So far there have only been two confirmed cases of cholera in the camp itself, but the emergency health task force coordinated by WHO is on high alert. "In these kinds of crowded conditions, the attack rate can be as high as 5%. That would mean about 7500 cases in Maslakh," says Dr Lindel Cherry, medical co-ordinator for Medecins Sans Frontieres. But with winter coming, attention is turning to respirator, tract infections, especially in children, many of whom are undernourished. In such overcrowded and impoverished conditions what starts as a cold can become a killer, says Dr Mojibullah Wahdati, WHO officer for Herat. There is also a risk of tuberculosis, particularly among women, who are often more confined. Previous WHO studies in camps for displaced persons in Afghanistan have shown that as many as 3% of the population will contract tuberculosis every year. Last winter, a wave of unusually cold weather saw temperatures fall to -25 [degrees] C and more than 150 people died in one week, says Wahdati. "We need to be able to support the [displaced persons'] health clinics in treating patients quickly and properly this winter, and be ready to help with fuel supplies and other materials to protect against the cold," says Wahdati. But funds are desperately short. WHO's appeal for donations for health activities in Afghanistan this year has garnered less than 10% of needed funds. Humanitarian organizations are also trying to slow the accumulation of people in the Herat camps by providing aid in their places of origin. But they expect another substantial influx of displaced persons here in Herat just before the snows close the road. …