KABUL -- Even as Dr. Yousuf Aryubi and his siblings, one after the other, started showing symptoms of COVID-19, the family was sure it was just a bad flu. The hospital had promised to tell them if their coronavirus tests had come up positive.
By the time they discovered that their positive results had fallen through the cracks at an overburdened and undersupplied Kabul hospital, it was too late. Within days, Aryubi, his sister, and a brother were dead. Dozens in the family were sickened.
The trajectory of the family’s tragedy points to how Afghanistan has been left vulnerable to the global pandemic by a broken-down health system, slow government response, and public attitudes.
After billions of dollars in international money, much of it from the United States, the Afghan capital barely has a hospital that works. Amid the ongoing war and massive government corruption, resources are depleted and institutions dysfunctional. Afghans have become increasingly poor, with 54 percent of the population in 2019 below the poverty line of $1.9 a day -- a rate likely mounting amid the pandemic.
Aryubi was the first in his family to show symptoms — on March 30, a day after he saw a patient who had a cough and a fever.
The 53-year-old pediatrician and father of four lived in a building with his wife and most of his extended family, which included his 70-year-old mother and five siblings and their families, more than 30 people in all. They often gathered for family dinners, sitting on the floor around mats of food set on the carpet.
By April 1, Aryubi felt worse, and his youngest daughter, 21-year-old Mariam, also had a fever. So they went to be tested for COVID-19 at the Afghan-Japan Communicable Disease Hospital, one of Kabul’s two facilities for coronavirus testing and treatment.
“The hospital promised to call us within 24 hours if the result comes positive and then to send an ambulance to isolate them,” Aryubi’s youngest brother, Behtarin Paktiawal, told The Associated Press.
The next day passed with no word from the hospital, so they assumed the tests were negative, Paktiawal said. At dinnertime, they were all together again, Aryubi, his mother, and the male relatives around the carpet in one room, Mariam and the female relatives in the other, laughing and eating as normal.
Over the next days, Aryubi’s sister, his brothers, his wife, and his mother started coughing or developed fevers. Finally, on April 6, with everyone in the family sick and Aryubi worsening, Paktiawal went back to the Afghan-Japan Hospital.
It took hours until he found a long list of test results tacked on a wall, with his brother and niece's names, both positive.
“I was shocked, like doomsday struck,” he said. “I didn’t know what to do. I had tears in my eyes.” He told the whole family to come immediately for testing. They tried to admit Aryubi, but the staff refused. In an ensuing argument, a doctor hit Aryubi in his face, breaking a tooth, Paktiawal and another brother said.
The Afghan-Japan Hospital, built in 2014 with funding from the Japanese government, typifies the health system’s woes, though it is better off than many other facilities. In the early weeks of the pandemic, suspected coronavirus patients complained of being turned away or of tests lost. It took weeks for staff to get enough protective gear, leaving them afraid to treat patients.
Sayed Massi Noori, a doctor in the Afghan-Japan Hospital’s public relations department, acknowledged that inexperienced staffers sometimes write names incorrectly on tests or code samples wrong. He estimated that 10 percent to 15 percent of tested patients don’t receive their results on time.
“Medical workers on the front line in the fight against COVID-19 don’t have enough experience, which causes us to face bigger challenges,” he said. The hospital has gotten no new funding since it was dedicated to coronavirus treatment. Many of its staff have not been paid for the past two months, he said.
Just going to the hospital risks contagion.
On a recent day when an AP team visited, hundreds of people, including suspected COVID-19 cases, were massed outside. Staff shouted at them to self-distance, but no one listened. Some had slept for days outside the hospital waiting for word on relatives’ tests or treatment.
The government’s response to the pandemic was slow, even as more than 200,000 Afghans flowed in from Iran, where the virus was raging. Political infighting between President Ashraf Ghani and his rival, Abdullah Abdullah, both of whom insist they won last year’s presidential polls, seemed to push pandemic measures to the back burner. The country has had more than 11,000 confirmed infections and more than 219 deaths.
The government closed schools and universities on March 14 and locked down Kabul two weeks later. Residents are allowed to leave their homes only for medical needs or groceries. But the rules are widely flouted.
After being tested, the Aryubi family immediately quarantined themselves. Their neighbors fled, moving out of their homes. Grocery stores refused to deliver to the Aryubis.
“People ran from us like we were monsters,” Paktiawal said.
Desperate for help, the family called relatives in Paktia Province. Four cousins and their families came to stay with them and help. Soon they, too, were showing symptoms, bringing the total infected in the family to 46.
On April 10, Aryubi's sister Gul Khomar died. More relatives came from the village to attend her funeral. Police had to push them back, pleading with them to keep a distance from her body and the family.
On April 11, Aryubi died, followed three days later by one of his brothers, Fazil Rahman.
It took several more weeks of quarantine for the rest of the family’s symptoms to fade.
“I never believed in this disease; I used to say it is a lie, it is propaganda,” Paktiawal said. Now “we have realized ... it’s a huge danger, and for those who neglect it, it can cost them their lives.”