Dirty water in Aybak linked to high number of deaths

By Najeebullah Danish

Aybak city, Samangan province – In June, Najibullah, a farmer from Larghan village, a collection of primitive, mud-walled compounds on the edges of Aybak city, brought an uncle and five cousins to the Samangan provincial hospital in northern Afghanistan.

All were violently sick after drinking from the river that provides the village’s only potable water, he told a reporter for the Institute for War and Peace Reporting, who was visiting the hospital that day.

Illness caused by contaminated drinking water was not uncommon, the farmer said. But the problem was worsening year by year. Since 2001 Najibullah said increasingly large numbers of villagers had been struck down after drinking from the local water source, despite an influx in development aid that he and other villagers claimed rarely addressed the need for clean drinking water.

At the hospital, an aging facility with few beds, Dr. Ahmad Shah Samie, who treated the men, would later confirm that the water source was the cause of this most recent outbreak of illness.

“They were all suffering from dehydration after getting sick from drinking dirty water,” he said. “In this instance all six were treated and survived,” he added. Many others, however, have not been so lucky

Walking through the cemeteries of the villages that make up Aybak, a city of 170,000 not far from the Uzbekistan border, one can see hundreds of graves of men, women and children who died too soon.

But the dead are not victims of war. If local medical personnel and family members are to be believed, drinking water is the hidden killer leading to hundreds of deaths due to dehydration, diarrhea, typhus fever and kidney disease.

The issue came to light most recently when Dr. Yousef Faiez, the former head of the Samangan provincial hospital, told the local Ariana TV station that only 2 percent of Aybak’s residents have access to clean drinking water – a claim that is disputed by other provincial officials – and defiantly questioned why provincial officials were not addressing the problem.

The day after the interview aired, Faiez was fired from his post by Samangan’s governor, Khairullah Anosh, who was, according to officials from his office, incensed at the doctor’s apparent temerity.

His abrupt dismissal, however, is symptomatic of a larger trend of official indifference toward Aybak’s clean water crisis, according to villagers and some officials interviewed by the reporter.

In an investigation conducted over several months, the reporter discovered that the number of deaths in the villages around Aybak city due to contaminated water appears to be vastly under-reported by provincial health officials.

A handful of senior health officials admit that the issue of water-related deaths has been downplayed, saying that to reveal the true scope of the problem would expose them to sever criticism from the central government.

Others, however, have dismissed the issue outright, with one saying the deaths were “not the media’s business” and another – a senior health official – refusing to allow his subordinates to talk to IWPR’s reporter.

The reporter spent June and July documenting 744 deaths – 219 men, 225 women, 300 children – that occurred between 2009 and 2010 in the Aybak-area villages of Hasan Khil, Quch Nehal-e-Bala, Quch Nehal-e-Payeen, Dalkhahi and Larghan.

He created a basic questionnaire that he used during interviews with the heads of households in the five villages, asking whether deaths had occurred in the family, what caused the deaths, had the officials been notified and whether the death was linked to drinking water.

The reporter then surveyed the village cemeteries, looking for new gravesites, and in interviews with village representatives confirmed that a large number of deaths had been caused by contaminated water.

Aybak, located on the banks of the Khulm River, is known for the melons grown in the region. Villages located inland from the Khulm receive irrigation water from the river about every 20 days. Some of this water runs into underground cisterns and the rest is stored in open-air reservoirs.

A visit to an open-air reservoir some seven kilometers outside Aybak city found about 25 women and children near the water – along with four donkeys who had walked down a series of steps cut into the earthen walls and were standing in the muddy pool at the bottom of the catchment area.

The women and children were gathering water in plastic gallon jugs. One woman filled a bowl and gave it to a donkey to drink. When the donkey finished, the woman poured the rest of the water into her plastic jug. When asked why, she replied: “The water is clean, because donkeys just suck up the water, like sheep. If it was a dog, it would make the water dirty, because they drink differently than donkeys.”

Nearby, a donkey urinated along the edge of the reservoir and it ran into the water, which was choked by plants and grasses covering half the surface area. Stirring the grasses with a stick turned the water a muddy black.

After the jugs were filled, the villagers loaded them on the donkeys to take back to their homes. In front of one house in Hasan Khil village belonging to Shir Ali, several gallon jugs sat in the open under the hot sun. One had no cap. The water was hot to touch.

Ali, a 50-year-old who has lived in the village his entire life, described for the reporter how he makes drinking water for his family, walking over to a group of clay pots and lifting the plastic sheet covering them. The water was gray and worms could be seen. Ali described pouring the water through a piece of cloth to filter out the worms, saying that this prevented his family from becoming sick.

But Ali also said that these primitive measures were not enough to keep everyone healthy, and that those who did fall ill frequently has little recourse other than to wit out their sickness and hope to survive.

“We are poor and don’t have good water sources or [medical] facilities. When we get sick we just wait to see if we die,” he said.

While regional health officials were generally unwilling to release certificates that include cause of death, the IWPR reporter was able to review hundreds of documents that must be filled out by sick villagers before they are admitted to hospital.

Village administrators must collect these documents, which include symptoms suffered by the sick, before the patient is registered at the government hospital in Aybak, a 70-year-old facility with only 30 beds. Approximately 25 doctors are employed to work in the facility.

The documentation revealed a haphazard registration process that frequently failed to accurately record patients’ symptoms and led to overly broad diagnoses and vague causes of death.

Hospital administrators say they see 250 to 300 patients monthly who are ill because of poor drinking water. Dr. Shafiullah, head of the provincial epidemic diseases department, acknowledged that in the past five years, dehydration, diarrhea and typhoid fever – all caused by dirty water – topped the list of illnesses, including those leading to death.

Other hospital officials, however, estimated the number of drinking water-related deaths in 2009-2010 at only around 300.

Most refused to comment when shown the list of 744 deaths compiled by IWPR after a month of interviewing family members and neighbors in villages and photographing grave markers.

But Dr. Abdull Hameed, the Samangan regional health director, disputed both the number of patients and cause of death claimed by those hospital officials who did speak to the reporter.

While visiting the Samangan hospital, IWPR’s reporter witnessed Dr. Hameed accuse Dr. Shafiullah of revealing “our secret information” regarding the number of water-related deaths.

Dr. Hameed later asked the reporter not to publish the findings of his investigation, saying to do so would open the provincial health administration to criticism.

“There have been too many cases involving deaths during that time … if this list of deaths is published, the Ministry of Health will order an investigation into the [provincial] health directorate about this case,” Hameed said.

In Kabul, however, a spokesman for the Ministry of Health dismissed the claims that a larger number of deaths can be attributed to poor quality drinking water.

“In Afghanistan, 27 percent of people do not have access to clean drinking water, but this is not the cause of any of those deaths that you mention,” said the spokesman, Ghulam Sakhi.

Official blame game

In Aybak, the official response to hard questions about water quality and its link to a rising number of deaths has been to shuttle the issue further up the administrative ladder.

“If people want to have clean water, they should put pressure on the governor, the mayor and other representatives,” said Ahmad Ali Tamsake, a member of the Samangan provincial council. “If they do not, this unresponsiveness [by officials] will not stop.”

Governor Anosh refused the IWPR reporter’s repeated requests for an interview, directing him instead to his spokesman.

“These people are not neglected,” said the spokesman, Sediq Azizi. “Every year we present out problem to the ministries in Kabul but they have not taken action yet.

“But basically, these deaths are the will of Allah. They are not the media’s business at all,” he said, adding “it is not the fault of the governor that wells cannot be dug in Aybak.”

Other officials in the provincial government – the Aybak Mayor, the head of Samangan’s reconstruction programs Mohammad Aman Amin, and its water resources directorate Mahammad Rasool, claimed to know nothing about deaths from contaminated water.

None would comment on the situation, though Mohammad Aman Amin claimed the government has spent $4 million in the past four years on improving drinking water province-wide.

He said dozens of 300 cubic-meter covered reservoirs had been constructed in and around Aybak. But villagers claim the illnesses continue, saying the reservoirs are uncovered and the water unfiltered.

In Kabul, ministry spokesman Sakhi said his ministry was not responsible for providing clean drinking water. “Distribution is not our responsibility. We only provide medical services,” he said.

Villagers in Hasan Khil say they expect one or two relatives to die every summer when good drinking water is least available. But they say they have recently carried so many family members to their graves that they don’t cry anymore.

Shir Ali told the reporter that two years ago his 12 year-old daughter fell ill after drinking water. “Moment by moment her condition worsened and she was in great pain,” he said.

“The following morning I took her to a doctor who told me, ‘Your daughter has cholera and she’ll likely die after one or two days.

“Actually, she died five hours after arriving home later that day.”

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