Ahmad Abid Humayun is the Executive Director of Sanayee Development Organization, an Afghan NGO that has been working in the health, peace building, conflict transformation, and education sectors for 30 years. Today, the organization has over 3,000 staff engaged from grassroots to international levels. In the health sector specifically, they have been responsible for delivering a basic package of health services in one of Afghanistan’s 34 provinces since 2003, and in three additional provinces including the capital since 2019.
Humayun spoke with UW graduate student Miranda Benson about the impact of COVID-19 on the Organization’s work in 2020.
How has COVID-19 impacted the Sanayee Development Organization and your work this year?
It has had a very direct impact.
While we were shifting all staff members to remote work, the workload of our health programs increased ten-fold. We had to stop work on all other programs. No one was prepared – I think that’s the story of the entire world.
Then we saw a sharp decline in our patient flow, sometimes by up to 50% because people were nervous about visiting health facilities, especially if they could attempt to manage their health concerns themselves. Some developed new diseases or had chronic diseases that they couldn’t address at home or remotely through phone calls, so these limitations also took some lives.
We also experienced budget constraints. The price of medical equipment, especially things required for COVID, increased dramatically. For example, before COVID we would purchase a box of 100 face masks for about $1. After COVID started the same box cost nearly $15. Since our program budgets are predetermined, we took losses purchasing necessary basic equipment. As an NGO it is difficult to cover these costs.
We were happy to see that donors like the World Bank, European Union, and USAID responded quickly. Unfortunately, a disagreement arose between the international community/donors and the Afghan government about whether the COVID response should be managed by NGOs or the government. The domestic and international NGO community knew that the government did not have the capacity to implement these health services, whereas NGOs have a long history in the field delivering other health services. The government insisted that responding to COVID is the state’s responsibility, and that if NGOs continued to manage Afghanistan’s response their political legitimacy would be questioned. This discussion took nearly three months while COVID spread – NGOs were totally handicapped. Finally, in June when the peak of the pandemic had passed, donors helped convinced the government. When we were able to start our interventions, it was far too late.
Did people feel uneasy leaving the house for reasons other than visiting health centers?
We held many public awareness sessions at the village, district, and community levels. We banned shaking hands and encouraged social distancing. Despite these efforts there is public resistance against some very critical safety measures to which political, religious, and cultural factors have contributed.
Politically, COVID has created a massive economic burden on government. Additionally, the mortality rate in Afghanistan is lower than neighboring countries like India, Iran, and Pakistan. Many people don’t think they will be personally affected.
From a religious perspective, there are a few different common narratives around COVID. For example, some think that the pandemic came to kill bad people or those who are not religious enough, or that praying to God will keep them safe.
Culturally, four decades of continued war and bloodshed has had an impact. I recently heard a traditional figure on the media trying to convince people not to worry about COVID because we lose 300–400 lives every day to this war against terrorism and insurgency, but fewer than 100 to COVID.
What are your concerns or hopes for the future concerning COVID-19 in Afghanistan?
There are four important experiences and lessons learned during the first wave of COVID-19 in Afghanistan that I’d like to share.
First, COVID is a health issue and should be dealt with as one. There have been many efforts to politicize this issue in Afghanistan when the response to COVID should not be politicized anywhere.
Second, we now have fewer cases in Afghanistan. We must use this time of relative relief as an opportunity to prepare for a second wave – to build resilience in communities, NGOs, and the government before it is too late. With our international partners at our side, this is possible.
Third, I would like to see international health organizations support the development of a platform for sharing experiences across countries. The model we designed for Afghanistan can likely be useful for other countries, and vice versa.
Lastly, particularly in Afghanistan, we must insist on channeling COVID resources through NGOs and the private sector with strong transparency and accountability measures. Afghanistan receives generous international aid, but it is poorly managed by the government. Aircrafts full of COVID-related equipment and pharmaceutical supplies have disappeared from the airport. For example, many countries sent ventilators to Afghanistan, but no one knew where they went. Many people died as a result – it was a huge scandal. The government has not taken steps towards accountability or transparency despite the NGO community’s advocacy. We hope the international community will join us in this effort.
This interview has been edited for clarity and brevity.