Scabies Outbreak in Afghanistan Calls for Urgent International Response

1. Introduction

Scabies, caused by the mite Sarcoptes scabiei (1), is a pressing global health concern often overlooked in resource-limited settings (2). In 2017, the World Health Organization rightfully designated it as a neglected tropical disease, urging concerted efforts for its eradication (1). This microscopic intruder burrows into the skin, triggering an immune response leading to intense itching, rash, and inflammation (2). Given its mode of transmission primarily through close human contact, scabies presents a significant challenge in densely populated areas (2).

The burden of scabies is staggering, with an estimated 100.6 million cases worldwide in 2010 (3). Resource-limited countries, such as Afghanistan, bear a substantial portion of this load, particularly affecting children (4). In Afghanistan, the recent surge in scabies cases, as seen in Herat Regional Hospital, can be traced back to returning refugees carrying the ailment from overcrowded camps (4). According to the hospital's HMIS data, 142 scabies patients were admitted in June 2023 [see Figure 1]. This number increased to a total of 272 scabies patients in July 2023 [see Figure 1].

Figure 1. Gender based prevalence of Scabies (Afghanista-2023)

Afghanistan grapples not only with scabies but also with a myriad of health-related challenges, resulting in a healthcare crisis (6). The exodus of individuals, including healthcare providers, since 2021 has strained the healthcare system (6). Economic instability, food scarcity, armed conflict, drought, and the lingering impacts of the COVID-19 pandemic further exacerbate the situation, disproportionately affecting vulnerable groups (6). The Taliban's restriction on girls' education has led to a scarcity of female healthcare personnel, amplifying the struggles of Afghan women and children in accessing essential healthcare (7).

The rise in scabies cases is a result of a complex interplay of factors, including disruptions in healthcare services, economic hardships, and restricted access due to gender-related policies (7). The movement of populations and close human-to-human contact also contribute to the spread of the disease.

To combat this crisis, a comprehensive approach is imperative. Screening returning refugees, robust surveillance, education initiatives, and targeted public health interventions are pivotal in managing the outbreak (7). Building a skilled healthcare workforce, particularly female practitioners, is crucial in addressing the unique needs of marginalized groups (7). International collaboration is indispensable in supporting Afghanistan through this challenging period (7).

In light of this critical situation, it is imperative for the international community to respond swiftly and effectively. The following key steps can be taken to address the scabies outbreak in Afghanistan:

• Enhanced Screening and Surveillance: Rigorous screening of returning refugees for scabies, coupled with robust surveillance systems, will help in the early detection and containment of the disease.

• Education and Awareness Programs: Launching educational initiatives to inform the Afghan population about scabies, its transmission, and preventive measures will empower individuals and communities to safeguard their health.

• Public Health Interventions: Implementing targeted public health interventions, such as mass treatment campaigns and provision of hygiene supplies, will help reduce the spread of scabies.

• Empowerment of Female Healthcare Workers: Efforts should be made to overcome barriers to education for girls, ensuring a steady supply of female healthcare professionals. This will not only address the scabies crisis but also improve overall healthcare accessibility.

• International Support and Collaboration: The international community must extend support through resources, expertise, and collaborative initiatives. This includes providing medical supplies, funding for healthcare infrastructure, and training for healthcare workers.

In conclusion, the escalating scabies outbreak in Afghanistan within the backdrop of a healthcare crisis demands urgent attention (4). Vulnerable demographics, especially women, children, and marginalized groups, are disproportionately affected (6). Timely and decisive action is needed to not only contain the outbreak but also fortify the healthcare infrastructure (7). Through collective efforts, we have the potential to alleviate the dual burdens of the healthcare crisis and scabies, ultimately enhancing the well-being of the Afghan population. This crisis is not isolated to Afghanistan; it is a global concern that calls for united action. The international community must stand together to curb the spread of scabies and mitigate its far-reaching consequences.

2. Conflicts of interest

None.

3. Author contribution

All authors are equally contributed.

4. Sources of funding

None.

5. Ethical approval

Not available.

6. Consent

Not available.

7. References

1. El-Moamly AA. Scabies as a part of the World Health Organization roadmap for neglected tropical diseases 2021–2030: what we know and what we need to do for global control. Tropical medicine and health. 2021 Dec;49(1):1
2. van der Linden N, van Gool K, Gardner K, Dickinson H, Agostino J, Regan DG, Dowden M, Viney R. A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions. PLoS neglected tropical diseases. 2019 Mar 8;13(3):e0007182.
3. Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, Marks R, Naldi L, Weinstock MA, Wulf SK, Michaud C. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. Journal of Investigative Dermatology. 2014 Jun 1;134(6):1527-34.
4. Engelman D, Kiang K, Chosidow O, McCarthy J, Fuller C, Lammie P, Hay R, Steer A, Members Of The International Alliance For The Control Of Scabies. Toward the global control of human scabies: introducing the International Alliance for the Control of Scabies. PLoS neglected tropical diseases. 2013 Aug 8;7(8):e2167.
5. Louka C, Logothetis E, Engelman D, Samiotaki-Logotheti E, Pournaras S, Stienstra Y. Scabies epidemiology in health care centers for refugees and asylum seekers in Greece. PLoS Neglected Tropical Diseases. 2022 Jun 22;16(6):e0010153
6. Safi N, Anwari P, Safi H. Afghanistan's health system under the Taliban: key challenges. The Lancet. 2022 Oct 8;400(10359):1179-80.
7. Neyazi A, Padhi B, Sah R. Girls’ education and the future of healthcare in Afghanistan. bmj. 2023 Mar 13;380.