Global Journal of Transfusion Medicine

LETTER TO EDITOR
Year
: 2021  |  Volume : 6  |  Issue : 2  |  Page : 244--245

Challenges in blood transfusion services during conflicts and humanitarian emergencies: Perspective and initiatives from Afghanistan


Enayatullah Hashemi1, Usman Waheed1, Noore Saba2,  
1 Afghan National Blood Safety and Transfusion Service, General Directorate of Curative Medicine, Ministry of Public Health, Afghanistan
2 Peshawar Regional Blood Centre, Provincial Ministry of Health, Khyber Pakhtunkhwa, Pakistan

Correspondence Address:
Dr. Enayatullah Hashemi
Afghan National Blood Safety and Transfusion Service, General Directorate of Curative Medicine, Ministry of Public Health
Afghanistan




How to cite this article:
Hashemi E, Waheed U, Saba N. Challenges in blood transfusion services during conflicts and humanitarian emergencies: Perspective and initiatives from Afghanistan.Glob J Transfus Med 2021;6:244-245


How to cite this URL:
Hashemi E, Waheed U, Saba N. Challenges in blood transfusion services during conflicts and humanitarian emergencies: Perspective and initiatives from Afghanistan. Glob J Transfus Med [serial online] 2021 [cited 2022 Jun 26 ];6:244-245
Available from: https://www.gjtmonline.com/text.asp?2021/6/2/244/331628


Full Text



Dear Editor,

Afghanistan, with a population of 38.09 million inhabitants, is a landlocked multiethnic country lying along the famous “Silk Road” at the intersection of South and Central Asia. Due to its topographical positioning and political developments, Afghanistan remains the most challenging country in the world with humanitarian crisis, armed conflicts, and disaster-like situations.

For the last four decades, the country is in a continuous war-like situation that has affected almost 100% population both physically and psychologically. Over the years, the characteristics of conflicts have become more complex, rendering prevention and response further difficult. These conflicts have resulted in internally displaced persons (IDPs), increased poverty, and a destabilized public health system, thus backsliding the national development targets set to accomplish the sustainable development goals of the United Nations.[1]

The safety and availability of blood and blood components is a great concern for the Afghan population, with an ongoing humanitarian crisis where the public health system has been weakened. As a result, the blood management in humanitarian emergencies is patchy and inadequate lacking coordinated response. The staff is less in number and those available lack capacity to cope with the crisis situation. Over 10 million Afghan people are internally displaced. The refugees have been accommodated in temporary camps with insufficient healthcare facilities and burden the existing local healthcare, especially posing risks to safe motherhood. The transfusion needs in such situations generally remain neglected and unmet.[2]

Afghanistan is ranked 19th least developed country in the world.[3] Until 2008, there was no national counterpart to tackle blood safety and availability issues in Afghanistan. The Ministry of Public Health, in early 2009, established a Blood Safety Advisory Group which led to the formation of the Afghan National Blood Safety and Transfusion Service (ANBSTS).[4] The ANBSTS is steered by a Task Force comprising of individuals from the Ministries of Public Health, Defense, Interior, and Environment, along with private and NGO sector organizations involved in blood banking and transfusion services. In 2020, ANBSTS collected 223,565 blood donations from 284 blood banks across the country.

The ANBSTS, which serves as the nerve center of Afghanistan's unified strategy to ensure the safe and timely provision of blood, is facing grave challenges during humanitarian emergencies. In addition to the political instability, it consists of a fragmented blood transfusion service,[5] lack of adequate budget, standards, guidelines, trained workforce, equipment maintenance, consumables/kits availability, adequate infrastructure, and lack of blood donors, especially negative groups. In fact, it is not the actual shortage of blood but a disruption of the delivery system and an articulated coordinated mechanism to manage the situation, similar to what is reported from earlier experiences elsewhere.[6],[7]

The national narrative of Afghanistan's government, the ANBSTS Blood Policy (2012–2015) does not adequately address the issue of blood management in humanitarian crisis. The only statement mentioned in the policy states that in case of emergency and disaster situations, agreements need to be made with the blood banks of neighboring countries.[8] This may not be an all-inclusive approach; nevertheless, the ANBSTS has planned to develop linkages with bordering countries, e.g. the Iranian Blood Transfusion Organization in Iran, and the Peshawar Regional Blood Centre in Pakistan, which is only 45 km to the Afghan border.

It is very vital to sensitize and advocate both health ministry and blood bank staff to their roles and responsibilities in emergencies, taking into account priorities, needs, and the local capacity for immediate response.

The ANBSTS requires support from international partners including the WHO, and other relevant UN agencies, in formulating an overarching national strategy backed by a regulatory framework for the challenges posed to the blood transfusion services. Even though there are armed conflicts and emergencies faced by the country, the ANBSTS team is committed to continue working for the public's health and safety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1United Nations (UN). Sustainable Development Goals. Available from: https://sdgs.un.org/goals\. [Last accessed on 2021 Aug 27].
2Zaheer HA, Waheed U. Blood transfusion service in disasters. Transfus Apher Sci 2016;55:186-90.
3United Nations Development Programme (UNDP). Human Development Report 2020 The Next Frontier: Human Development and the Anthropocene. Available from: http://hdr.undp.org/sites/default/files\/hdr2020.pdf. [Last accessed on 2021 Aug 27].
4Ayyoubi MT, Konstenius T, McCullough JC, Eastlund T, Clay M, Bowman R, et al. Status of blood banking and the blood supply in Afghanistan. Transfusion 2010;50:566-74.
5Mansoor GF, Rahmani AM, Kakar MA, Hashimy P, Abrahimi P, Scott PT, et al. A national mapping assessment of blood collection and transfusion service facilities in Afghanistan. Transfusion 2013;53:69-75.
6Gammon RR, Rosenbaum L, Cooke R, Friedman M, Rockwood L, Nichols T, et al. Maintaining adequate donations and a sustainable blood supply: Lessons learned. Transfusion 2021;61:294-302.
7Schmidt PJ. Blood and disaster – Supply and demand. N Engl J Med 2002;346:617-20.
8Afghan National Blood Safety and Transfusion Service (ANBSTS), Ministry of Public Health, Afghanistan. National blood policy 2012-2015. Available from http://moph.gov.af/en/information_bank/policies. [Last accessed on 2021 Aug 27].