SULEIMAN KHEL, Pakistan - When Tariq Nawaz’s daughter was born a year ago, he borrowed money to pay for his wife’s cesarean delivery. Seven months later, they learned their baby had polio and sold the little bit of jewelry his wife had received for her wedding to pay mounting medical bills.
Then the new coronavirus pandemic struck Pakistan, prompting a countrywide lockdown. Still in debt, Nawaz lost his job, his monthly paycheque of $95 and the means to provide treatment for the baby’s polio.
“It’s all I can think of. I feel like my head is going crazy,” he said.
For millions of people like Nawaz who live in poor and troubled regions of the world, the novel coronavirus is only the latest epidemic. They already face a plethora of fatal and crippling infectious diseases: polio, Ebola, cholera, dengue, tuberculosis and malaria, to name a few.
The onslaught of infectious diseases is made worse by the many other threats in lives already overwhelmed by adversity. A crushing poverty leads to malnutrition and lack of medical care, and the violence of militants, gangs and government soldiers can make campaigns to fight disease more difficult.
This story was produced with the support of the Pulitzer Center on Crisis Reporting.
Just when the Democratic Republic of Congo appeared to be nearing the end of its deadly Ebola epidemic this year, the first COVID-19 cases appeared.
“People here have been victims of attacks by Ugandan ... rebels, Ebola and now COVID-19,” said 46-year-old physician Philémon Tsongo. “They are traumatized.”
In war-torn Yemen, there is growing concern that the fight against the recently arrived coronavirus will undercut the anti-cholera campaign. UNICEF, the UN children's agency, needs at least $18 million through the end of the year to buy more supplies for water, sanitation and hygiene services, but it appears the money will go to fight COVID-19.
In Central America, Honduras has seen a steep climb in COVID-19 cases in the midst of a full-blown epidemic of dengue fever.
“The collapse of the health systems are imminent if these two illnesses continue rising,” said Dr. Carlos Umaña, president of the Social Security Doctors’ Association for northwest Honduras.
In Pakistan, where Nawaz lives, coronavirus cases are rising sharply. The country’s toll of above 113,000 coronavirus cases surpasses that of neighbouring China, and at least 2,255 people in Pakistan have already died.
Meanwhile, Pakistan continues to suffer some of the world’s worst outbreaks of infectious diseases. It has 4.3 million cases of malaria annually, and is one of the top 10 countries for new cases of tuberculosis each year. It is also one of only three countries, including Afghanistan and Nigeria, where polio is still endemic.
Militants have spread rumours that the polio vaccine is a Western conspiracy to make the next generation of Muslims infertile. Dozens of vaccinators, with heavily armed security at their side, have been targeted and killed in recent years.
Nawaz’s daughter, Tuba, was vaccinated against polio at four months, but before she could receive her second of three doses, she contracted the disease. Now, the arrival of the coronavirus means 40 million children won't get their polio vaccination this month.
Dr. Rana Mohammad Safdar, the country's leading immunologist, has ordered his army of more than 250,000 vaccinators to shelter in their homes for their own safety, and to prevent a COVID-19-infected vaccinator from spreading the virus to an entire village.
The virus already has devoured most of Pakistan’s budget to fight the other diseases. There’s no money left to disinfect the countless fertile grounds for mosquitoes that carry crippling diseases such as dengue or malaria.
“COVID has been a devastating blow to our efforts,” said Safdar.
So far this year, 40 children have tested positive for polio, including Nawaz’s daughter Tuba. Safdar fears new infections this year could surpass 150.
The covonavirus and the lockdown to fight it are also making worse the endemic poverty that leaves people more susceptible to disease in the first place. Nearly 30% of Pakistanis live below the poverty line, earning less than $2 a day.
Nawaz’s debts have been piling up. He already had sold his share of the family plot to his elder brother for money to cover his wedding and construction of his family’s one-room house.
He and three of his brothers also care for the five children of another brother who couldn't get work and found an escape in opium. And one more brother is broke after losing his job as a security guard to the virus lockdown.
Nawaz’s young daughter is his joy and his greatest worry. Tuba doesn’t talk yet. That afternoon, her round brown eyes were outlined with a thick coal and her tattered shirt was caked with dirt. Tuba can’t stand, and when Nawaz touched her right leg she pulled away because her leg is lifeless and painful.
When Tuba became sick, Nawaz took her to the village clinic and two government hospitals, to no avail. Finally he took her to a private clinic where she was diagnosed with polio.
Since being laid off there’s no money to buy Tuba medicine or even the milk she needs to keep her other limbs strong. Instead, Nawaz says, he gives her tea with a little milk.
In late February she fell ill, but the virus had shut the government hospitals and Nawaz had to take her to a private hospital again that cost 8,800 ($50) a night. Tuba was there for four nights.
“We had no choice, she needed treatment,” he said.
They were told to return after three months but he knew they wouldn’t. There is no money to treat the polio.
Now they can all just pray that the family is not struck with the coronavirus. A COVID-19 patient is more likely to die in Khyber Pukhtunkhwa province, where Nawaz lives, than anywhere else in Pakistan.
“It’s a scary place to be,” he said.
Associated Press writers Haruna Umar in Maiduguri, Nigeria; Al-Hadji Kudra Maliro in Beni, Congo; Christopher Sherman in Mexico City and Riaz Khan in Peshawar, Pakistan, contributed to this report.