Building public health capacity in Afghanistan to implement the International Health Regulations: a role for security forces.

The government of Afghanistan, with international partners and donors, has achieved substantial public health improvements during the past 8 years. But a critical gap remains: capacities to detect and respond to disease outbreaks that could constitute a public health emergency of international concern, as required by the International Health Regulations (IHR). The Afghan Ministry of Public Health seeks to build these capacities, but conflict and scarcity of resources hinder public health surveillance and response, diagnostic laboratory and clinical management capacity is limited, and massive international population movements could permit outbreaks to cross international borders. Several diseases covered by the IHR, such as polio, are endemic in Afghanistan, and risk of novel disease emergence may be elevated in some areas. The security forces of the United States and other countries with military presence in Afghanistan are potential partners for the government of Afghanistan in strengthening the public health capacity. They could extend specialized disease surveillance and response capabilities to the Afghan military and civilian sectors and could integrate surveillance and response capacity building into ongoing development programs, especially in insecure areas. The World Health Organization could provide the forum for coordinating military and civilian contributions to public health capacity strengthening in Afghanistan and could help ensure that international health sector development efforts address Afghan public health priorities in addition to IHR requirements.