foreignpolicy--2020-01-24--As America Shuts Its Doors, Afghan Refugees Are Stuck in Turkey

VAN , Turkey—It ’ s been two years since Qadir fled Kabul , but the fear that someone will kill him for having worked with U.S. troops still haunts him in the Turkish city where his family has been allowed to stay and wait in hopes of reaching the United States .
He doesn ’ t take the same way home from the odd jobs he can find and hasn ’ t called his relatives in Afghanistan since leaving .
“ I am afraid someone there will get my phone number in Turkey .
Even my mother doesn ’ t @ @ @ @ @ @ @ , ” Qadir said .
Slim and clean-shaven , Qadir—a pseudonym , given his concerns for his safety—cradles his right arm as he talks , switching between English , Urdu , and Dari .
In his back are metal plates , a reminder of a bombing he survived at Camp Eggers nine years ago , when it served as the headquarters for U.S. forces in Kabul .
He can ’ t lift his arm above his shoulders .
He sits on a raggedy carpet in the city of Van near the Iranian border @ @ @ @ @ @ @ rice and meat with raisons and carrots—cooked by his wife .
The city is home to thousands of Afghan families , some new arrivals like Qadir , others who have been waiting for up to a decade to find a permanent place to live .
The official number of Afghans waiting for resettlement has hovered at around 170,000 for years , while nearly half a million other Afghans who entered the country illegally , authorities say , were detained between 2015 and 2019 .
The war in Afghanistan , now entering its fifth @ @ @ @ @ @ @ ’ s longest ongoing conflicts , and it shows no sign of ending soon .
More than 2,563 civilians , including 892 women and children , were killed between January and September 2019 in Afghanistan , according to the United Nations , continuing the previous year ’ s trend of violence .
Hundreds of thousands of Afghans flee the country each year , hoping to build stable lives in Europe and other Western countries .
For most of them , including Qadir , the relative stability of Turkey is the first resting point @ @ @ @ @ @ @ lead to a new life in Europe or the United States .
But finding a country to build a new life in is nearly impossible .
Neither the bloodletting in Afghanistan nor the droves of refugees showing up on Western doorsteps have prompted sympathy from the world ’ s wealthiest nations .
Afghanistan is a conflict the West would rather forget .
Even those who worked with the U.S. Army like Qadir have a slim chance of settling down in a safe country .
The extreme vetting of immigrants now enforced by the @ @ @ @ @ @ @ at just 18,000—means it takes several years for people like Qadir to benefit from a special visa program for Afghans who worked alongside U.S. troops .
Turkey does not grant asylum to Afghans , only temporary protection , just as it does for Syrians , Iraqis , and others who make up the country ’ s refugee population of nearly 5 million .
Turkey does not grant asylum to Afghans , only temporary protection , just as it does for Syrians , Iraqis , and others who make up the country ’ s @ @ @ @ @ @ @ Afghans are expected to register with Turkey ’ s immigration authorities , which have been delegated the task of sifting through applications for resettlement in a third country by the United Nations .
But the Turkish public is increasingly hostile toward the refugees , and Afghans have turned out to be the most politically expedient demographic that authorities can target for deportation .
Turks themselves are largely unaware of the ongoing conflict in Afghanistan .
Turkish authorities , meanwhile , have cited a precedent set by Europe , which in 2016 said Afghan @ @ @ @ @ @ @ to avoid deportation to the country , reversing decades of policy that granted blanket protection to Afghans on account of the ongoing war there .
Turkey detained 201,000 Afghans living illegally in the country in 2019—twice the number in 2018 and four times the number in 2017 .
Hundreds are detained in the country each day and then put on flights back to Kabul .
Many of those being deported are never given a chance to even make a case for temporary protection , and the lucky few who do manage to register @ @ @ @ @ @ @ they wait for the distant possibility of a Western country ready to take them in .
Under the temporary protection status granted to Qadir by Turkey , he and other Afghans can not leave the city they are registered in nor can they legally work .
It was too dangerous to bring the documents with him when he fled Kabul , but Qadir has copies of some them on his phone .
There is a business visa to the United States , from his days as a leader in a merchant ’ s @ @ @ @ @ @ @ badges collected over the last decade from his time working on U.S. bases in Kabul .
There is a photo of him with an American officer , a colonel whom Qadir taught to speak Dari .
He wonders if the colonel remembers him .
“ We were not poor or anything in Kabul , ” Qadir said of his family .
“ We had a good business , and I only left because I thought my life was in danger .
Anyone who works with foreigners , especially Americans , the Taliban and @ @ @ @ @ @ @ They keep asking why you are working with them.
” After several years of going back and forth , by 2008 he had decided to move his family to Kabul .
“ It was not a good situation in Afghanistan at the time .
There were bomb blasts happening all over , ” he said .
“ But I had this [ International Security Assistance Force ] card , and I could sell inside the U.S. bases , so my business was doing well.
” “ I only left because I thought my @ @ @ @ @ @ @ works with foreigners , especially Americans , the Taliban and ISIS do not leave you alive.
” His presence on the bases brought new opportunities , too , as Washington attempted to turn the tide in the war , deploying 30,000 additional troops to the country by 2010 .
Along with the surge in personnel , Gen. Stanley McChrystal pushed for a deeper integration between U.S. officers and Afghan officials , training hundreds of soldiers who were called “ Afghan Hands.
” The goal , said Col. Steven Heffington , one of the @ @ @ @ @ @ @ , was to “ create people who were better at understanding Afghanistan and had some language capacity and training on culture and history.
” Around two dozen interpreters , including Qadir , were involved in teaching him and the other Afghan Hands to speak Dari .
The Afghan Hands program went on to train around 1,000 officers but was largely unsuccessful at turning the tide of the war and is scheduled to be completely wrapped up this year .
The U.S. troop presence in Afghanistan fell over the years , but for Afghans @ @ @ @ @ @ @ business on U.S. bases was still a lucrative opportunity , albeit a deadly one .
Each day he showed his coveted security badge to enter the base in Kabul , bringing along jewelry he would sell from a stand near the entrance .
At one point , a suicide bomber struck Camp Eggers , a blast that killed dozens of people and left Qadir with shrapnel in his body and one arm that no longer worked .
In 2015 , he left for Pakistan for a few months after the Taliban began calling @ @ @ @ @ @ @ final straw came in 2018 , he said .
He was picking up his wares as the camp was shutting down for the day when he noticed two men outside waiting for him .
“ Everyone wears a shawl in Afghanistan in the cold , but these men , I could clearly see the shape of a Kalashnikov under theirs .
My only thought was to get away from them .
I left everything there , maybe $ 6,000 in stones , and I ran , my shoes came off , and I @ @ @ @ @ @ @ , ” he said .
He took his family first to the western Afghan city of Herat , hoping as in the past that the danger would pass , but it did not .
In Kabul , someone burned down his house .
His relatives there told him they received threats , including phone calls and hand-delivered letters telling them the Taliban were looking for Qadir and that they wanted to kill him .
Believing that his presence in the country was putting his whole family at risk , Qadir took his wife @ @ @ @ @ @ @ , following a well-worn route through Iran for Afghans looking to build a new life .
Few carried any documents that could identify them , but local officials say the bulk of those crossing the border are Afghans .
Authorities conduct an autopsy , collect a DNA sample in case they need to match it in the future , and then bury the dead in paupers ’ cemeteries strung along the border .
At one cemetery just outside Van , nearly 100 are buried , with freshly dug graves ready to receive more @ @ @ @ @ @ @ on them , the sequence the body was found in .
Scores are marked “ Kunduz ” —the best guess by Turkish authorities about where they might have come from , based on information from other migrants who survived the trip .
Surrounded by blast walls , and under the shadow of a freshly constructed concrete watch tower , a Turkish military base overlooking the no man ’ s land between Turkey and Iran stands guard for new arrivals .
Visitors to the base are stopped by soldiers who come barreling down the @ @ @ @ @ @ @ fight against terrorist groups here , but lately we keep seeing refugees coming through here , and we end up detaining them as well , ” said a soldier clambering out of an armored car to block the path to the base entrance .
“ We don ’ t know why they are coming , fleeing a war or whatever , but for us our job is to stop the flow because we don ’ t know who they are .
Maybe they are terrorists , maybe they are wanted criminals in their @ @ @ @ @ @ @ were initially meant to check the movement of Kurdish fighters across the border , but today they are the front line in the Western effort to keep refugees from Afghanistan out .
Alarmed by the influx of nearly a million migrants and asylum-seekers , in 2016 the European Union made an agreement with Turkey : In exchange for visa-free travel for Turks to Europe and 6 billion euros , Ankara would put an end to the westward flow .
The deal has largely worked to stem the flow into Europe from Turkey : @ @ @ @ @ @ @ crossed the Eastern Mediterranean into Europe .
The largest group among them was Afghans , 28,565 of whom European authorities detained last year .
The deal coincided with the declaration by European governments that Afghanistan was now a so-called safe country to which asylum-seekers could be legally returned .
Afghans who now seek asylum in Europe must prove individual danger and can not claim a general threat to their lives simply because they are Afghan .
Afghans who now seek asylum in Europe must prove individual danger and can not claim a general @ @ @ @ @ @ @ are Afghan .
In 2018 , Ankara and Kabul reached an agreement to expedite the return of Afghans as well .
“ Our brothers who have come to Turkey through legal ways are more than welcome here , ” then-Turkish Prime Minister Binali Yildirim told Afghan Chief Executive Abdullah Abdullah on a visit to Kabul that April .
“ But those who come via illegal ways are causing trouble.
” Entering Turkey legally for Afghans is a formidable task though , one that includes providing proof of income and proper documents .
In @ @ @ @ @ @ @ residing in the country with proper residence permits , according to Turkish immigration authorities , while some 100,000 were detained for illegally entering Turkey that year , a figure that went up to more than 200,000 in 2019 .
Meanwhile , Turkish President Recep Tayyip Erdogan regularly threatens to unleash a wave of migrants on Europe if more of the promised 6 billion euros—only half of which has been transferred , according to Ankara—is not turned over .
Part of the money goes to the Turkish Red Crescent , which distributes it as @ @ @ @ @ @ @ registered in Turkey : around $ 20 a month for each child .
Hundreds of millions of euros , meanwhile , are spent on border security .
Along the Syrian border , Turkey has built a 566-mile-long , 10-foot wall to keep Syrians out .
Turkey has already begun work to build a similar wall along parts of the Iranian border , and in the meantime it has stepped up the presence of soldiers in the region to stop the migrants .
At least 80 million euros ( $ 88 million ) was @ @ @ @ @ @ @ armored trucks with machine guns mounted on top—the same vehicle the soldiers at the base at the Iranian border use .
In November , the EU said it was earmarking an additional 50 million euros ( $ 55 million ) for the Turkish coast guard and facilities inside the country to deal with the migrants .
Those facilities are meant to process asylum-seekers .
Officially , the 28 centers across Turkey can hold a total of 20,000 migrants—a fraction of the 454,662 authorities say they detained in 2019 .
Tens of thousands of @ @ @ @ @ @ @ makeshift , unlisted locations : military bases along the Iranian border , hastily built camps surrounded by barbed wire in thick forests along the border with Greece , even a stadium in the eastern city of Erzurum .
In Van , for instance , two facilities were built with EU funding , one meant to house asylum-seekers waiting for a decision and the other to house individuals waiting to be deported .
But both now function as deportation centers , said Mahmut Kacan , a human rights lawyer in Van who handles cases @ @ @ @ @ @ @ relatives in Turkey .
Afghans being kept in the detention centers , he said , are forced to sign documents saying they are voluntarily returning to their country .
“ They don ’ t understand what they are signing , ” he said .
“ If you go to the deportation centers , you see posters making propaganda for voluntary return , encouraging them to fly back to their country , but there are no posters telling them what their rights are , nothing telling them they can apply for asylum and how @ @ @ @ @ @ @ run by Turkey but financed by the EU .
In September 2018 , the U.N. handed over its authority to register resettlement applications to Turkish immigration authorities , which , human rights groups say , have instituted an illegal practice of not accepting new applications from Afghans .
Qadir , for instance , said he took his family to register for resettlement in Van soon after he arrived .
“ They interviewed each one of us , and I showed them all these documents .
I told them how we are in danger @ @ @ @ @ @ @ “ But it ’ s been two years now , and every time I go back , they tell me they are not taking Afghans now , to just wait.
” The sheer scale of the detentions and deportations , Kacan said , is proof that Afghans are not being given a chance to make their case , neither for staying in Turkey nor for applying to be resettled elsewhere .
“ Afghan refugees and asylum-seekers are living in limbo in Turkey , ” Kacan said .
“ They can not go forward @ @ @ @ @ @ @ home.
” Afghans who worked with U.S. forces like Qadir can apply for a special visa meant to help them relocate to the United States .
But that process takes an average of two and a half years , said Jason S. Gorey of No One Left Behind , an organization started by veterans to help Afghans and Iraqis who worked with U.S. forces bring their families to the United States .
“ There have been numerous issues that have hit the program .
The most recent has been the Trump administration ’ @ @ @ @ @ @ @ program was set to be eliminated altogether last year , if it hadn ’ t been for lobbying by Gorey and others in Congress , which set aside around 4,000 slots for applications for the upcoming year .
With a general ban on Iraqi immigration in place , Gorey said almost all of those will be open to Afghans like Qadir .
Almost every person has “ taken on an arduous journey across many countries , along with other Afghans seeking refugee status in European countries.
” But the processing for the program @ @ @ @ @ @ @ more than 20,000 applications from Afghanistan now in the pipeline .
“ We strongly believe the U.S. government must take on the responsibility and make sure our allies are brought to protection , from both a moral and American national security standpoint , because we are going to be judged on how we treat our current wartime allies by future wartime allies , ” Gorey said .
Of the applicants he helps , Gorey said , almost every person has “ taken on an arduous journey across many countries , along with other @ @ @ @ @ @ @ ” Reaching a country like Turkey no longer guarantees safety for Afghans , Gorey argued , even if they manage to apply for the U.S. visa program , and many are deported back to Afghanistan .
Others have died in Iraq and Afghanistan while waiting to be brought to the United States .
There are few options left for Qadir .
Under Turkish law , he is not allowed to leave the provincial backwater of Van and is technically not even allowed to work , leaving him to take odd jobs to feed @ @ @ @ @ @ @ been washing dishes at a local restaurant , but his bad arm makes that a difficult job as well .
When he left Kabul , Qadir entrusted a stack of documents , many of which he would need to apply for the special visa to the United States , to a friend .
In September 2019 , he said , that friend was killed , along with 19 other civilians , by a Taliban bombing at their residential compound in Kabul .

VAN, Turkey—It’s been two years since Qadir fled Kabul, but the fear that someone will kill him for having worked with U.S. troops still haunts him in the Turkish city where his family has been allowed to stay and wait in hopes of reaching the United States. He doesn’t take the same way home from the odd jobs he can find and hasn’t called his relatives in Afghanistan since leaving. “I am afraid someone there will get my phone number in Turkey. Even my mother doesn’t know if I am alive or dead,” Qadir said.
VAN, Turkey—It’s been two years since Qadir fled Kabul, but the fear that someone will kill him for having worked with U.S. troops still haunts him in the Turkish city where his family has been allowed to stay and wait in hopes of reaching the United States. He doesn’t take the same way home from the odd jobs he can find and hasn’t called his relatives in Afghanistan since leaving. “I am afraid someone there will get my phone number in Turkey. Even my mother doesn’t know if I am alive or dead,” Qadir said.
Slim and clean-shaven, Qadir—a pseudonym, given his concerns for his safety—cradles his right arm as he talks, switching between English, Urdu, and Dari. In his back are metal plates, a reminder of a bombing he survived at Camp Eggers nine years ago, when it served as the headquarters for U.S. forces in Kabul. He can’t lift his arm above his shoulders.
He sits on a raggedy carpet in the city of Van near the Iranian border, offering a plate of Kabuli pulao—fragrant rice and meat with raisons and carrots—cooked by his wife. The city is home to thousands of Afghan families, some new arrivals like Qadir, others who have been waiting for up to a decade to find a permanent place to live. The official number of Afghans waiting for resettlement has hovered at around 170,000 for years, while nearly half a million other Afghans who entered the country illegally, authorities say, were detained between 2015 and 2019.
The ongoing conflict in Afghanistan, now entering its fifth decade, is one of the world’s longest, and it shows no sign of ending soon. More than 2,563 civilians, including 892 women and children, were killed between January and September 2019 in Afghanistan, according to the United Nations, continuing the previous year’s trend of violence. Hundreds of thousands of Afghans flee the country each year, hoping to build stable lives in Europe and other Western countries.
For most of them, including Qadir, the relative stability of Turkey is the first resting point in a long journey they hope will lead to a new life in Europe or the United States. But finding a country to build a new life in is nearly impossible. Neither the bloodletting in Afghanistan nor the droves of refugees showing up on Western doorsteps have prompted sympathy from the world’s wealthiest nations. Afghanistan is a conflict the West would rather forget.
Gulchaman Nowruzi, 65, with her husband, Khodadad Yaqubi, 76, holds a Quran, the only possession they still have from their home in Mazar-e-Sharif, Afghanistan, at their new home in Van, Turkey on March 1, 2019. The Afghan refugees first fled to Iran in 1982 and then to Turkey, where they now live temporarily with their two daughters, in 2018.
Even those who worked with the U.S. Army like Qadir have a slim chance of settling down in a safe country. The extreme vetting of immigrants now enforced by the Trump administration—which has capped annual asylum visas at just 18,000—means it takes several years for people like Qadir to benefit from a special visa program for Afghans who worked alongside U.S. troops.
Turkey does not grant asylum to Afghans, only temporary protection, just as it does for Syrians, Iraqis, and others who make up the country’s refugee population of nearly 5 million.
Turkey does not grant asylum to Afghans, only temporary protection, just as it does for Syrians, Iraqis, and others who make up the country’s refugee population of nearly 4 million. Afghans are expected to register with Turkey’s immigration authorities, which have been delegated the task of sifting through applications for resettlement in a third country by the United Nations. But the Turkish public is increasingly hostile toward the refugees, and Afghans have turned out to be the most politically expedient demographic that authorities can target for deportation.
Turks themselves are largely unaware of the ongoing conflict in Afghanistan. Turkish authorities, meanwhile, have cited a precedent set by Europe, which in 2016 said Afghan asylum-seekers would need to prove personal danger to avoid deportation to the country, reversing decades of policy that granted blanket protection to Afghans on account of the ongoing war there.
Turkey detained 201,000 Afghans living illegally in the country in 2019—twice the number in 2018 and four times the number in 2017. Hundreds are detained in the country each day and then put on flights back to Kabul. Many of those being deported are never given a chance to even make a case for temporary protection, and the lucky few who do manage to register, like Qadir, will languish as they wait for the distant possibility of a Western country ready to take them in. Under the temporary protection status granted to Qadir by Turkey, he and other Afghans cannot leave the city they are registered in nor can they legally work.
Qadir, a refugee from Afghanistan who didn’t want to use his real name, looks out the window of the apartment where he lives with his family in Van, Turkey, on March 3, 2019.
Along with death and destruction, the U.S. invasion of Afghanistan also brought opportunity for Afghans like Qadir. When the United States invaded in 2001, he lived, like millions of others, as a refugee in Pakistan. In Peshawar, he ran a jewelry business, cutting and polishing precious stones like the famed blue lapis. He became friends with the staff at the U.S. Consulate in Peshawar and was granted permission to sell his wares on military bases in Kabul.
It was too dangerous to bring the documents with him when he fled Kabul, but Qadir has copies of some them on his phone. There is a business visa to the United States, from his days as a leader in a merchant’s association in Kabul. There are security badges collected over the last decade from his time working on U.S. bases in Kabul. There is a photo of him with an American officer, a colonel whom Qadir taught to speak Dari. He wonders if the colonel remembers him.
“We were not poor or anything in Kabul,” Qadir said of his family. “We had a good business, and I only left because I thought my life was in danger. Anyone who works with foreigners, especially Americans, the Taliban and ISIS do not leave you alive. They keep asking why you are working with them.”
After several years of going back and forth, by 2008 he had decided to move his family to Kabul. “It was not a good situation in Afghanistan at the time. There were bomb blasts happening all over,” he said. “But I had this [International Security Assistance Force] card, and I could sell inside the U.S. bases, so my business was doing well.”
“I only left because I thought my life was in danger. Anyone who works with foreigners, especially Americans, the Taliban and ISIS do not leave you alive.”
His presence on the bases brought new opportunities, too, as Washington attempted to turn the tide in the war, deploying 30,000 additional troops to the country by 2010. Along with the surge in personnel, Gen. Stanley McChrystal pushed for a deeper integration between U.S. officers and Afghan officials, training hundreds of soldiers who were called “Afghan Hands.” The goal, said Col. Steven Heffington, one of the first batch of Americans to take part, was to “create people who were better at understanding Afghanistan and had some language capacity and training on culture and history.”
Around two dozen interpreters, including Qadir, were involved in teaching him and the other Afghan Hands to speak Dari.
The Afghan Hands program went on to train around 1,000 officers but was largely unsuccessful at turning the tide of the war and is scheduled to be completely wrapped up this year. The U.S. troop presence in Afghanistan fell over the years, but for Afghans like Qadir, being able to do business on U.S. bases was still a lucrative opportunity, albeit a deadly one. Each day he showed his coveted security badge to enter the base in Kabul, bringing along jewelry he would sell from a stand near the entrance.
At one point, a suicide bomber struck Camp Eggers, a blast that killed dozens of people and left Qadir with shrapnel in his body and one arm that no longer worked. In 2015, he left for Pakistan for a few months after the Taliban began calling and threatening to kill him.
The final straw came in 2018, he said. He was picking up his wares as the camp was shutting down for the day when he noticed two men outside waiting for him. “Everyone wears a shawl in Afghanistan in the cold, but these men, I could clearly see the shape of a Kalashnikov under theirs. My only thought was to get away from them. I left everything there, maybe $6,000 in stones, and I ran, my shoes came off, and I kept running through the streets for hours,” he said.
He took his family first to the western Afghan city of Herat, hoping as in the past that the danger would pass, but it did not. In Kabul, someone burned down his house. His relatives there told him they received threats, including phone calls and hand-delivered letters telling them the Taliban were looking for Qadir and that they wanted to kill him.
Believing that his presence in the country was putting his whole family at risk, Qadir took his wife and six daughters and left for Turkey, following a well-worn route through Iran for Afghans looking to build a new life.
Hamdi, a refugee from Afghanistan who didn’t want to use his full name, visits the grave of his 4-year-old daughter, Zehra, in a cemetery for unidentified victims and those who cannot afford a grave plot in Van, Turkey, on March 3, 2019. Zehra died in a traffic accident while her family attempted to travel across Turkey to Europe.
As the snows begin to melt each spring in the mountains along the Turkey-Iran border, local shepherds are greeted by a familiar sight: the bodies of migrants who had frozen to death trying to reach Europe. In the border district of Baskale, 25 migrants’ corpses were found in the space of a month last spring. Some were missing body parts—their hands, legs, or faces gnawed off by wild animals. One had been shot.
Few carried any documents that could identify them, but local officials say the bulk of those crossing the border are Afghans. Authorities conduct an autopsy, collect a DNA sample in case they need to match it in the future, and then bury the dead in paupers’ cemeteries strung along the border.
At one cemetery just outside Van, nearly 100 are buried, with freshly dug graves ready to receive more. Most tombstones only have a number on them, the sequence the body was found in. Scores are marked “Kunduz”—the best guess by Turkish authorities about where they might have come from, based on information from other migrants who survived the trip.
Surrounded by blast walls, and under the shadow of a freshly constructed concrete watch tower, a Turkish military base overlooking the no man’s land between Turkey and Iran stands guard for new arrivals. Visitors to the base are stopped by soldiers who come barreling down the hillside.
“Our job is to fight against terrorist groups here, but lately we keep seeing refugees coming through here, and we end up detaining them as well,” said a soldier clambering out of an armored car to block the path to the base entrance. “We don’t know why they are coming, fleeing a war or whatever, but for us our job is to stop the flow because we don’t know who they are. Maybe they are terrorists, maybe they are wanted criminals in their own countries.”
The soldiers stationed here were initially meant to check the movement of Kurdish fighters across the border, but today they are the front line in the Western effort to keep refugees from Afghanistan out.
Alarmed by the influx of nearly a million migrants and asylum-seekers, in 2016 the European Union made an agreement with Turkey: In exchange for visa-free travel for Turks to Europe and 6 billion euros, Ankara would put an end to the westward flow. The deal has largely worked to stem the flow into Europe from Turkey: In 2019, only 82,564 people illegally crossed the Eastern Mediterranean into Europe. The largest group among them was Afghans, 28,565 of whom European authorities detained last year.
The deal coincided with the declaration by European governments that Afghanistan was now a so-called safe country to which asylum-seekers could be legally returned. Afghans who now seek asylum in Europe must prove individual danger and cannot claim a general threat to their lives simply because they are Afghan.
Afghans who now seek asylum in Europe must prove individual danger and cannot claim a general threat to their lives simply because they are Afghan.
In 2018, Ankara and Kabul reached an agreement to expedite the return of Afghans as well. “Our brothers who have come to Turkey through legal ways are more than welcome here,” then-Turkish Prime Minister Binali Yildirim told Afghan Chief Executive Abdullah Abdullah on a visit to Kabul that April. “But those who come via illegal ways are causing trouble.”
Entering Turkey legally for Afghans is a formidable task though, one that includes providing proof of income and proper documents. In 2018, only about 39,000 Afghans were residing in the country with proper residence permits, according to Turkish immigration authorities, while some 100,000 were detained for illegally entering Turkey that year, a figure that went up to more than 200,000 in 2019.
Meanwhile, Turkish President Recep Tayyip Erdogan regularly threatens to unleash a wave of migrants on Europe if more of the promised 6 billion euros—only half of which has been transferred, according to Ankara—is not turned over. Part of the money goes to the Turkish Red Crescent, which distributes it as cash to refugee families who are properly registered in Turkey: around $20 a month for each child.
Hundreds of millions of euros, meanwhile, are spent on border security. Along the Syrian border, Turkey has built a 566-mile-long, 10-foot wall to keep Syrians out. Turkey has already begun work to build a similar wall along parts of the Iranian border, and in the meantime it has stepped up the presence of soldiers in the region to stop the migrants.
At least 80 million euros ($88 million) was spent on armored vehicles: locally made armored trucks with machine guns mounted on top—the same vehicle the soldiers at the base at the Iranian border use. In November, the EU said it was earmarking an additional 50 million euros ($55 million) for the Turkish coast guard and facilities inside the country to deal with the migrants.
From left, members of the Ahmedzada family, 7-year-old Taiba, 11-year-old Abdolhassan, and 14-year-old Bahara, clean photographs of their mother, Roya, at their home in Turkey on April 20, 2019. The family, originally from Ghazni, Afghanistan, was crossing the Iran-Turkey border when they became separated. Roya handed the two younger children to their father to carry them across a mountain stream before she was swept away. Weeks later, her body was found by Iranian border guards. Authorities said she had been shot and killed.
Those facilities are meant to process asylum-seekers. Officially, the 28 centers across Turkey can hold a total of 20,000 migrants—a fraction of the 454,662 authorities say they detained in 2019. Tens of thousands of Afghans are thought to be kept in makeshift, unlisted locations: military bases along the Iranian border, hastily built camps surrounded by barbed wire in thick forests along the border with Greece, even a stadium in the eastern city of Erzurum.
In Van, for instance, two facilities were built with EU funding, one meant to house asylum-seekers waiting for a decision and the other to house individuals waiting to be deported. But both now function as deportation centers, said Mahmut Kacan, a human rights lawyer in Van who handles cases on behalf of Afghan families searching for relatives in Turkey.
Afghans being kept in the detention centers, he said, are forced to sign documents saying they are voluntarily returning to their country. “They don’t understand what they are signing,” he said. “If you go to the deportation centers, you see posters making propaganda for voluntary return, encouraging them to fly back to their country, but there are no posters telling them what their rights are, nothing telling them they can apply for asylum and how to do so.” The facilities are run by Turkey but financed by the EU.
In September 2018, the U.N. handed over its authority to register resettlement applications to Turkish immigration authorities, which, human rights groups say, have instituted an illegal practice of not accepting new applications from Afghans. Qadir, for instance, said he took his family to register for resettlement in Van soon after he arrived. “They interviewed each one of us, and I showed them all these documents. I told them how we are in danger in Afghanistan,” he said. “But it’s been two years now, and every time I go back, they tell me they are not taking Afghans now, to just wait.”
The sheer scale of the detentions and deportations, Kacan said, is proof that Afghans are not being given a chance to make their case, neither for staying in Turkey nor for applying to be resettled elsewhere.
“Afghan refugees and asylum-seekers are living in limbo in Turkey,” Kacan said. “They cannot go forward, and they cannot go back home.”
European money is not the only factor driving the dismal situation for Afghans in Turkey. The United States was the principle place Afghan asylum-seekers could be resettled from countries like Turkey, at least until a few years ago, when Washington began enforcing strict vetting of asylum applications. In 2018, only 170 Afghans in Turkey were granted resettlement in a third country, 117 of them to the United States, according to the U.N. High Commissioner for Refugees.
Afghans who worked with U.S. forces like Qadir can apply for a special visa meant to help them relocate to the United States. But that process takes an average of two and a half years, said Jason S. Gorey of No One Left Behind, an organization started by veterans to help Afghans and Iraqis who worked with U.S. forces bring their families to the United States. “There have been numerous issues that have hit the program. The most recent has been the Trump administration’s implementation of extreme vetting.”
Golmohammad Jafari, a refugee from Afghanistan, prepares posters for the woodcarving class he teaches in Van on March 2, 2019.
The program was set to be eliminated altogether last year, if it hadn’t been for lobbying by Gorey and others in Congress, which set aside around 4,000 slots for applications for the upcoming year. With a general ban on Iraqi immigration in place, Gorey said almost all of those will be open to Afghans like Qadir.
Almost every person has “taken on an arduous journey across many countries, along with other Afghans seeking refugee status in European countries.”
But the processing for the program has hit a massive backlog, with more than 20,000 applications from Afghanistan now in the pipeline. “We strongly believe the U.S. government must take on the responsibility and make sure our allies are brought to protection, from both a moral and American national security standpoint, because we are going to be judged on how we treat our current wartime allies by future wartime allies,” Gorey said.
Of the applicants he helps, Gorey said, almost every person has “taken on an arduous journey across many countries, along with other Afghans seeking refugee status in European countries.” Reaching a country like Turkey no longer guarantees safety for Afghans, Gorey argued, even if they manage to apply for the U.S. visa program, and many are deported back to Afghanistan. Others have died in Iraq and Afghanistan while waiting to be brought to the United States.
There are few options left for Qadir. Under Turkish law, he is not allowed to leave the provincial backwater of Van and is technically not even allowed to work, leaving him to take odd jobs to feed his family. Lately, he has been washing dishes at a local restaurant, but his bad arm makes that a difficult job as well.
When he left Kabul, Qadir entrusted a stack of documents, many of which he would need to apply for the special visa to the United States, to a friend. In September 2019, he said, that friend was killed, along with 19 other civilians, by a Taliban bombing at their residential compound in Kabul.


foreignpolicy--2020-01-26--新冠病毒来袭：如何自我防护

新冠病毒来袭：如何自我防护

Studies are starting to form a picture of how the virus kills , spreads , and may be stopped .

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foreignpolicy--2020-01-26--The Wuhan Coronavirus: A Tentative Clinical Profile

Until the 21st century , the worst a coronavirus , a large family of viruses capable of infecting humans and animals , could do to humans was to deliver the common cold—annoying but hardly sinister .
But three times so far in the 21st century , novel coronaviruses have emerged that could potentially cause a deadly pandemic—SARS ( severe acute respiratory syndrome ) in 2003 , MERS ( Middle East respiratory syndrome ) in 2012 , and now 2019-nCoV emanating from Wuhan , China .
As of Jan. 26 , the new coronavirus has reportedly infected at least 2,463 people @ @ @ @ @ @ @ Those numbers are certain to mushroom .
Controlling the spread of the virus requires both public health and medical measures—and for that we need a clear clinical profile .
At this stage , that information is only just being put together , but what we do have is disturbing .
So far , the limited clinical information coming out of China means we know only about the mid-to-worst-case outcomes—from moderate to life-threatening pneumonia .
Two studies released on Jan. 24—one about 41 infected patients and the other on a family cluster of six @ @ @ @ @ @ @ concerns .
The official story is that this new coronavirus emerged from a Wuhan wet market , where live animals that would never normally meet in the wild live side by side , facilitating trans-species mutation of pathogens .
Yet the first three known cases from Dec. 1 and 2 were not linked to the market .
Neither were 11 more cases of the 41 reviewed in the recent study .
This early data suggests an evolving virus that surfaced considerably earlier .
Undetected among the plethora of similar chest infections and common @ @ @ @ @ @ @ spread from human to human .
As happened with SARS , new corona may be mutating along the way , gradually becoming more virulent .
The coronavirus is a physically large virus—in relative terms , at just 125 nanometers with a surface of spike projections , too big to survive or stay suspended in the air for hours or travel more than a few feet .
Like influenza , this coronavirus spreads through both direct and indirect contact .
Direct contact occurs through the physical transfer of the microorganism among friends and family @ @ @ @ @ @ @ Indirect contact results when an infected person coughs or sneezes , spreading coronavirus droplets on nearby surfaces , including knobs , bedrails , and smartphones .
As with SARS , droplets generated during medical procedures such as bronchoscopy and respiratory treatment may be aerosolized , infecting multiple medical staff and enabling super-spreading .
Hand hygiene and personal protective barriers—gowns , gloves , masks , and goggles—reduce droplet transmission .
The incubation period , however , is unknown but currently very roughly estimated as between one and 14 days .
To complicate matters further @ @ @ @ @ @ @ the new coronavirus spreads .
Can transmission take place before the onset of symptoms ?
( Measles , one of the most contagious diseases on Earth , is infectious two to four days beforehand . )
Do people who never become symptomatic nonetheless spread the disease ?
Do symptomatic people become less contagious over time , like SARS , or is it like Ebola , which becomes increasingly contagious as the disease progresses ?
These are all unanswered questions .
Like its siblings SARS and MERS , the new coronavirus causes pneumonia—the infection @ @ @ @ @ @ @ that may be only one potential syndrome , which is one of the factors making it difficult to spot .
In fact , it probably causes a spectrum of disease , from asymptomatic to lethal .
Even in deadly cases , new coronavirus infections start off much like many other less dangerous diseases .
Initial symptoms are fever , dry cough , myalgia ( muscle pain ) , and fatigue .
Productive cough ( a cough that produces phlegm ) and headache are infrequent , hemoptysis ( coughing up blood ) and diarrhea @ @ @ @ @ @ @ week before an infected person feels sick enough to seek medical care .
After this deceptively slow start , the disease progresses rapidly during the second week—in a similar fashion to SARS .
Hypoxemia caused by increasing lung injury leads to difficulty breathing and the need for oxygen therapy .
ARDS ( acute respiratory distress syndrome ) is a common complication .
Between 25 and 32 percent of cases are admitted to the intensive care unit ( ICU ) for mechanical ventilation and sometimes ECMO ( pumping blood through an artificial lung for @ @ @ @ @ @ @ shock , acute kidney injury , and virus-induced cardiac injury .
The extensive lung damage also sets the lung up for secondary bacterial pneumonia , which occurs in 10 percent of ICU admissions .
( This may also be the case for the Spanish flu of 1918 , which killed 50 million people ; the fatalities attributed to the viral influenza may be more because of the bacterial pneumonia that followed . )
Pneumonia from any cause severe enough to require ICU admission is associated with high morbidity and mortality .
Defined as @ @ @ @ @ @ @ , it was already considered an ancient disease in Hippocrates ’ s time .
In 1881 , pneumococcus—the main cause of bacterial pneumonia—was finally identified .
Over the next century , medical advances and the development of antibiotics made treatment possible , honed by intensivists to reduce the mortality rate to single figures .
In contrast , because few respiratory viruses cause more than mild infection , adult intensive care physicians generally have relatively little experience with viral pneumonia .
Yet infection by SARS , H1N1 , and MERS can lead to severe @ @ @ @ @ @ @ , possibly because of an exaggerated inflammatory reaction .
( Corticosteroids , the go-to anti-inflammatory drug , are ineffective and not recommended by the World Health Organization , or WHO . )
The lack of effective antivirals and treatment options means viral pneumonia has a high mortality rate .
We do not know how lethal the new coronavirus is .
While the single figures of deaths in early January seemed reassuring , the death toll has now climbed to above 3 percent .
This may indicate better reporting—or the lethal lag time ( @ @ @ @ @ @ @ ) .
Another big unknown is the risk factors that would lead infection in a deadly direction .
Certainly , some adults have compromised immune systems due to chronic illnesses .
Of these , 15 percent have died , with higher fatality rates among older patients and those with co-morbidities of diabetes , hypertension , or coronary artery disease .
However , most patients with severe illness were healthy to begin with , including a 30-year-old man who recently died .
Even trickier than treatment is detecting the virus .
In quarantined Wuhan @ @ @ @ @ @ @ out anyone with a fever of 99.1 degrees Fahrenheit or above—the cardinal sign for 98 percent of pneumonia cases—and then interviewing them about possible exposure to the coronavirus .
In theory , this sounds reasonable .
In practice , it is the screening from hell .
Early symptoms of fever and cough are clinically indistinguishable from the usual winter suspects , such as influenza , while fever is an undifferentiated sign , common to hundreds of noninfective diseases from allergies to arthritis .
Even pregnancy elevates body temperature .
Because 110,000 people ( @ @ @ @ @ @ @ in Wuhan might have a febrile illness at any given time , clinics , hospitals , and medical personnel are overwhelmed , short on lab tests and personal protective equipment .
And as all those with a fever are detained until lab tests are back , nosocomial infection—transmission of disease in crowded clinics—becomes more likely .
Exit and entry screenings at international airports have been successful in picking up cases in Thailand and South Korea but have missed cases still incubating in the United States and Australia that were later detected in hospital @ @ @ @ @ @ @ that several cases have been identified without a fever .
This includes detection of coronavirus in a 10-year-old girl who exhibited no symptoms at all .
If the coronavirus can be spread before symptoms appear , it will greatly complicate screening efforts even beyond the inadequacies of the fever test .
One puzzling aspect so far is the thankful lack of child victims .
Usually , children , with less developed immune systems than adults , come down with one illness after another .
A particularly severe example is RSV viral pneumonia , @ @ @ @ @ @ @ deaths annually .
( Adults are not seriously affected . )
Yet few children have yet been reported with coronavirus symptoms .
That does not mean that no children have been infected .
A similar pattern of benign disease in children , with increasing severity and mortality with age , was seen in SARS and MERS .
SARS had a mortality rate averaging 10 percent .
Yet no children , and just 1 percent of youths under 24 , died , while those older than 50 had a 65 percent risk of dying @ @ @ @ @ @ @ factor per se ?
If so , what is it about childhood that confers protection ?
It may be the nonspecific effects of live vaccines such as for measles and rubella , which already have been found to provide protection from diseases beyond their immediate target .
That may also explain why more men than women have been infected by the coronavirus , because women routinely are given a rubella vaccine booster in their teens to guard against the dangers of having rubella while pregnant .
While we wait for an accelerated coronavirus @ @ @ @ @ @ @ immunity in adults be boosted by giving measles vaccines ?
The virus itself is not the only risk .
Fewer than half the patients hospitalized so far for the coronavirus ended up having the underlying disease .
As hundreds more cases , many of them likely to be false positives , are picked up during aggressive screening , fewer patients can receive adequate support care .
This compounds the clinical and ethical burden on medics working 24-hour shifts , working alongside colleagues who then become patients and living in hospitals because they are @ @ @ @ @ @ @ going home .
The risk of hospitals themselves becoming sites of infection is considerable : In March 2003 , it was the infection of scores of medical staff that led the WHO to declare a global alert for SARS .
This time , while only 16 medics are reported to have been infected , this is a likely underestimate—and the first case of a doctor dying from the virus has just been reported .
Fever clinics and screening are an exercise in clinical insanity , attempting to discern corona patients from every other @ @ @ @ @ @ @ no rapid diagnostic test , screening has focused on whether people have a fever , quickly overwhelming medical facilities until more time-consuming laboratory tests can be performed .
Moreover , if nonsymptomatic people can spread the coronavirus , the focus on symptoms may be causing dangerous oversights .
The most powerful measures may be public education about the best ways to avoid infection , such as avoiding physical contact with people known to be infected , and to minimize spread from unidentified infections , wearing masks and hand hygiene .
China is taking @ @ @ @ @ @ @ broadcast through multiple means , from state-run television to the village loudspeakers that usually blare propaganda .
These steps can protect everyone , including families as they care for members who come down with typical flulike symptoms and may not seem to require more intensive treatment for several days .
A more targeted approach can also ensure that medical facilities can focus on the people who really need intensive care rather than the far greater numbers who may simply have a fever but are kept in effective detention until laboratory tests can clear @ @ @ @ @ @ @ gives rise to panic .
But experience with other epidemics has shown us that a targeted approach can contain and arrest the spread of a virus—even more effectively than sweeping quarantines .

Until the 21st century, the worst a coronavirus, a large family of viruses capable of infecting humans and animals, could do to humans was to deliver the common cold—annoying but hardly sinister. But three times so far in the 21st century, novel coronaviruses have emerged that could potentially cause a deadly pandemic—SARS (severe acute respiratory syndrome) in 2003, MERS (Middle East respiratory syndrome) in 2012, and now 2019-nCoV emanating from Wuhan, China. As of Jan. 26, the new coronavirus has reportedly infected at least 2,463 people and caused at least 80 deaths. Those numbers are certain to mushroom.
Until the 21st century, the worst a coronavirus, a large family of viruses capable of infecting humans and animals, could do to humans was to deliver the common cold—annoying but hardly sinister. But three times so far in the 21st century, novel coronaviruses have emerged that could potentially cause a deadly pandemic—SARS (severe acute respiratory syndrome) in 2003, MERS (Middle East respiratory syndrome) in 2012, and now 2019-nCoV emanating from Wuhan, China. As of Jan. 26, the new coronavirus has reportedly infected at least 2,463 people and caused at least 80 deaths. Those numbers are certain to mushroom.
Controlling the spread of the virus requires both public health and medical measures—and for that we need a clear clinical profile. At this stage, that information is only just being put together, but what we do have is disturbing.
So far, the limited clinical information coming out of China means we know only about the mid-to-worst-case outcomes—from moderate to life-threatening pneumonia. Two studies released on Jan. 24—one about 41 infected patients and the other on a family cluster of six separate from those 41—provide both clues and concerns.
The official story is that this new coronavirus emerged from a Wuhan wet market, where live animals that would never normally meet in the wild live side by side, facilitating trans-species mutation of pathogens. Yet the first three known cases from Dec. 1 and 2 were not linked to the market. Neither were 11 more cases of the 41 reviewed in the recent study. This early data suggests an evolving virus that surfaced considerably earlier. Undetected among the plethora of similar chest infections and common symptoms, it honed its capacity to spread from human to human. As happened with SARS, new corona may be mutating along the way, gradually becoming more virulent.
The coronavirus is a physically large virus—in relative terms, at just 125 nanometers with a surface of spike projections, too big to survive or stay suspended in the air for hours or travel more than a few feet. Like influenza, this coronavirus spreads through both direct and indirect contact. Direct contact occurs through the physical transfer of the microorganism among friends and family through close contact with oral secretions. Indirect contact results when an infected person coughs or sneezes, spreading coronavirus droplets on nearby surfaces, including knobs, bedrails, and smartphones.
As with SARS, droplets generated during medical procedures such as bronchoscopy and respiratory treatment may be aerosolized, infecting multiple medical staff and enabling super-spreading. Hand hygiene and personal protective barriers—gowns, gloves, masks, and goggles—reduce droplet transmission. The incubation period, however, is unknown but currently very roughly estimated as between one and 14 days.
To complicate matters further, we do not know how easily the new coronavirus spreads. Can transmission take place before the onset of symptoms? (Measles, one of the most contagious diseases on Earth, is infectious two to four days beforehand.) Do people who never become symptomatic nonetheless spread the disease? Do symptomatic people become less contagious over time, like SARS, or is it like Ebola, which becomes increasingly contagious as the disease progresses? These are all unanswered questions.
Like its siblings SARS and MERS, the new coronavirus causes pneumonia—the infection of one or both lungs. But that may be only one potential syndrome, which is one of the factors making it difficult to spot. In fact, it probably causes a spectrum of disease, from asymptomatic to lethal. Even in deadly cases, new coronavirus infections start off much like many other less dangerous diseases. Initial symptoms are fever, dry cough, myalgia (muscle pain), and fatigue. Productive cough (a cough that produces phlegm) and headache are infrequent, hemoptysis (coughing up blood) and diarrhea occasional. It can take about a week before an infected person feels sick enough to seek medical care.
After this deceptively slow start, the disease progresses rapidly during the second week—in a similar fashion to SARS. Hypoxemia caused by increasing lung injury leads to difficulty breathing and the need for oxygen therapy. ARDS (acute respiratory distress syndrome) is a common complication. Between 25 and 32 percent of cases are admitted to the intensive care unit (ICU) for mechanical ventilation and sometimes ECMO (pumping blood through an artificial lung for oxygenation).
Other complications include septic shock, acute kidney injury, and virus-induced cardiac injury. The extensive lung damage also sets the lung up for secondary bacterial pneumonia, which occurs in 10 percent of ICU admissions. (This may also be the case for the Spanish flu of 1918, which killed 50 million people; the fatalities attributed to the viral influenza may be more because of the bacterial pneumonia that followed.)
Pneumonia from any cause severe enough to require ICU admission is associated with high morbidity and mortality. Defined as an infection of one or both lungs, it was already considered an ancient disease in Hippocrates’s time. In 1881, pneumococcus—the main cause of bacterial pneumonia—was finally identified. Over the next century, medical advances and the development of antibiotics made treatment possible, honed by intensivists to reduce the mortality rate to single figures.
In contrast, because few respiratory viruses cause more than mild infection, adult intensive care physicians generally have relatively little experience with viral pneumonia. Yet infection by SARS, H1N1, and MERS can lead to severe pneumonitis, ARDS, and respiratory failure, possibly because of an exaggerated inflammatory reaction. (Corticosteroids, the go-to anti-inflammatory drug, are ineffective and not recommended by the World Health Organization, or WHO.) The lack of effective antivirals and treatment options means viral pneumonia has a high mortality rate.
We do not know how lethal the new coronavirus is. While the single figures of deaths in early January seemed reassuring, the death toll has now climbed to above 3 percent. This may indicate better reporting—or the lethal lag time (the time for those infected to die). Another big unknown is the risk factors that would lead infection in a deadly direction. Certainly, some adults have compromised immune systems due to chronic illnesses. Of these, 15 percent have died, with higher fatality rates among older patients and those with co-morbidities of diabetes, hypertension, or coronary artery disease. However, most patients with severe illness were healthy to begin with, including a 30-year-old man who recently died.
Even trickier than treatment is detecting the virus. In quarantined Wuhan, dozens of fever clinics are singling out anyone with a fever of 99.1 degrees Fahrenheit or above—the cardinal sign for 98 percent of pneumonia cases—and then interviewing them about possible exposure to the coronavirus. In theory, this sounds reasonable.
In practice, it is the screening from hell. Early symptoms of fever and cough are clinically indistinguishable from the usual winter suspects, such as influenza, while fever is an undifferentiated sign, common to hundreds of noninfective diseases from allergies to arthritis. Even pregnancy elevates body temperature.
Because 110,000 people (about 1 percent of the population) in Wuhan might have a febrile illness at any given time, clinics, hospitals, and medical personnel are overwhelmed, short on lab tests and personal protective equipment. And as all those with a fever are detained until lab tests are back, nosocomial infection—transmission of disease in crowded clinics—becomes more likely.
Exit and entry screenings at international airports have been successful in picking up cases in Thailand and South Korea but have missed cases still incubating in the United States and Australia that were later detected in hospital after symptoms manifested.
More worrying is that several cases have been identified without a fever. This includes detection of coronavirus in a 10-year-old girl who exhibited no symptoms at all. If the coronavirus can be spread before symptoms appear, it will greatly complicate screening efforts even beyond the inadequacies of the fever test.
One puzzling aspect so far is the thankful lack of child victims. Usually, children, with less developed immune systems than adults, come down with one illness after another. A particularly severe example is RSV viral pneumonia, which results in an estimated 118,200 child deaths annually. (Adults are not seriously affected.)
Yet few children have yet been reported with coronavirus symptoms. That does not mean that no children have been infected. A similar pattern of benign disease in children, with increasing severity and mortality with age, was seen in SARS and MERS. SARS had a mortality rate averaging 10 percent. Yet no children, and just 1 percent of youths under 24, died, while those older than 50 had a 65 percent risk of dying. Is being an adult a risk factor per se? If so, what is it about childhood that confers protection? It may be the nonspecific effects of live vaccines such as for measles and rubella, which already have been found to provide protection from diseases beyond their immediate target. That may also explain why more men than women have been infected by the coronavirus, because women routinely are given a rubella vaccine booster in their teens to guard against the dangers of having rubella while pregnant. While we wait for an accelerated coronavirus vaccine to be ready, could innate immunity in adults be boosted by giving measles vaccines?
The virus itself is not the only risk. Fewer than half the patients hospitalized so far for the coronavirus ended up having the underlying disease. As hundreds more cases, many of them likely to be false positives, are picked up during aggressive screening, fewer patients can receive adequate support care. This compounds the clinical and ethical burden on medics working 24-hour shifts, working alongside colleagues who then become patients and living in hospitals because they are unwilling to risk infecting their families by going home. The risk of hospitals themselves becoming sites of infection is considerable: In March 2003, it was the infection of scores of medical staff that led the WHO to declare a global alert for SARS. This time, while only 16 medics are reported to have been infected, this is a likely underestimate—and the first case of a doctor dying from the virus has just been reported.
Fever clinics and screening are an exercise in clinical insanity, attempting to discern corona patients from every other common winter illness. Because there is no rapid diagnostic test, screening has focused on whether people have a fever, quickly overwhelming medical facilities until more time-consuming laboratory tests can be performed. Moreover, if nonsymptomatic people can spread the coronavirus, the focus on symptoms may be causing dangerous oversights.
The most powerful measures may be public education about the best ways to avoid infection, such as avoiding physical contact with people known to be infected, and to minimize spread from unidentified infections, wearing masks and hand hygiene. China is taking these measures, with public health information broadcast through multiple means, from state-run television to the village loudspeakers that usually blare propaganda. These steps can protect everyone, including families as they care for members who come down with typical flulike symptoms and may not seem to require more intensive treatment for several days. A more targeted approach can also ensure that medical facilities can focus on the people who really need intensive care rather than the far greater numbers who may simply have a fever but are kept in effective detention until laboratory tests can clear them.
Any new deadly pathogen inevitably gives rise to panic. But experience with other epidemics has shown us that a targeted approach can contain and arrest the spread of a virus—even more effectively than sweeping quarantines.


foreignpolicy--2020-01-25--How to Tell What’s Really Happening With the Wuhan Virus

How to Tell What ’ s Really Happening With the Wuhan Virus It ’ s Lunar New Year , usually a time of celebration in China , but instead of heading into the streets to let off fireworks , people are staying at home out of fear of contracting a fast-spreading coronavirus .
The quarantine in China has now extended to nearly 50 million people , as sweeping restrictions on travel are expanding daily out from the epicenter of the outbreak in the city of Wuhan .
These include bans on tour groups across the country , on long-distance travel @ @ @ @ @ @ @ transport in the center of Wuhan itself .
The number of officially confirmed cases has reached 2,018 , and continues to rise fast , with at least 56 dead , mostly elderly .
China is struggling to cope with its worst health crisis since SARS in 2003 , amid fears that Lunar New Year travel has already spread the infection far and wide .
Every province and region in China , barring Tibet which is geographically and politically isolated , has had cases of the virus .
The United States has sent charter @ @ @ @ @ @ @ and consular staff from the quarantine zone .
It ’ s too soon to tell , but quite probably not .
The confirmed numbers may be just a fraction of the real total of infected victims , with many not yet diagnosed or even showing symptoms .
But the biggest problem is that the long incubation period means hundreds of thousands of people left Wuhan long before the virus was seen as a major problem—especially as the Lunar New Year , when hundreds of millions of people return to their families across China @ @ @ @ @ @ @ now depends on where they ended up .
The constant expansion of the quarantine zone , which now covers a huge chunk of the central Chinese province of Hubei , suggests that local transmission may have been fierce and fast , outrunning the authorities .
Modeling by foreign scientists is producing disturbing results—250,000 or more infected inside Wuhan and large outbreaks elsewhere , with 60 percent or more of possible transmissions needing to be blocked to contain the outbreak .
[ The authors of the original paper have since revised their estimations of @ @ @ @ @ @ @ not yet produced new figures for likely infections . ]
The quarantine creates its own problems .
Feeding and supplying the population inside , with regular logistical links severed , is a huge , though not impossible , task .
China has exceptional logistics companies such as Alibaba , and they may be brought in , along with the military , to make sure shops stay supplied and people fed ; long lines of trucks are heading into Wuhan to supply the population .
That ’ s good , since price gouging and @ @ @ @ @ @ @ , Jan. 27 , at 11 a.m. ET—Join us for a timely FP Insider conference call on the Wuhan coronavirus .
What can be done to stop the epidemic ?
What are the business and political impacts ?
And how can regular people stay safe ?
FP managing editor Ravi Agrawal and expert guests Laurie Garrett , Pulitzer Prize-winning FP science columnist , and James Palmer , FP senior editor and China Brief newsletter author , will give answers and take your questions .
Reserve your spot now . ]
So are we @ @ @ @ @ @ @ .
The coronavirus is highly worrying , but so far it lacks the pandemic properties of influenza and has a relatively low—experts believe—mortality rate .
The deaths so far have been mostly , but not exclusively , confined to older people , most of whom had preexisting conditions .
The World Health Organization has declined to declare a global emergency , pointing to the relatively small number of cases outside China , although that could well change .
That said , many people remain in serious condition , and the virus has already @ @ @ @ @ @ @ could evolve further .
At least one super-spreader—someone who passes the virus to an unusually high number of other victims—has already emerged in a Wuhan hospital .
And while cases of infection appear to have been largely caught in foreign countries , thanks mostly to the victims being relatively well-off people who had access to health care resources , they ’ ve been popping up all over the place from Washington state to Malaysia .
Given what seems to be a relatively long incubation period of seven to 12 days , during which @ @ @ @ @ @ @ symptoms , it ’ s hard to tell just how far the virus has already reached .
On top of that , the range of symptoms is long , and some victims haven ’ t shown the most characteristic signs—and the ones being tested for—such as fever .
The world could well see multiple outbreaks , especially if it reaches poorer and more vulnerable countries , as Laurie Garrett has highlighted .
Reports so far have been confined to developed nations like South Korea , France , and the United States , but @ @ @ @ @ @ @ elsewhere have simply gone undetected .
Can we trust the government figures right now ?
No , for a variety of reasons .
The first is that China has a record of concealing the numbers around disaster events for political reasons , from the initial cover-up around SARS to the regular underreporting of the number of dead from floods , landslides , industrial explosions , and other relatively routine disasters .
In Wuhan ’ s case , it seems very likely that the leap to human-to-human transmission , and the sudden explosion in @ @ @ @ @ @ @ keen not to risk the local economy or to disturb the smooth progress of the “ two sessions , ” important mid-January political meetings .
The number of cases stayed at 41 for weeks and then suddenly jumped to more than 200 after the virus reached other countries a week ago .
Meanwhile , Wuhan officials were scheduling large-scale public events right up until the quarantine was imposed .
There ’ s less reason for the central government to squash the numbers , and the enormous leap from 41 to nearly 2,000 cases @ @ @ @ @ @ @ the sudden interest by Beijing in the epidemic .
But government officials are also in the routine—and hard-to-break—habit of concealing information from the public , especially negative information .
Huge amounts of resources are put into controlling and suppressing information in China , and doctors , reporters , and ordinary people have already been threatened or arrested for posting independently about the outbreak .
A sudden flood of online posts today praised the government and criticized people for posting unauthorized information .
Chinese media is enjoying a short burst of relative freedom , @ @ @ @ @ @ @ excellent and critical reporting .
But that ’ s common in the aftermath of disaster in China ; the sudden impetus of the news creates several days of comparative openness before the propaganda authorities decide and enforce new lines .
( I saw it happen after the Sichuan earthquake and again after the Tianjin explosions when I worked in Chinese newsrooms. )
.
Papers are already being forced to issue apologies if their reporters speak out of line .
The internet might well be cut at some point , as happened in Xinjiang @ @ @ @ @ @ @ Even if the government doesn ’ t want to distort data , its ability to gather information is also limited .
Diagnostic test kits are in short supply , the population potentially affected is huge , and many poorer Chinese—those most affected—are out of reach for the state .
The scientific community in China is genuinely extremely concerned and attempting to share information as rapidly and transparently as it can with foreign counterparts .
But it is also working within an environment where everything , even scientific research , is politicized .
Since @ @ @ @ @ @ @ to dictatorial status , many scientific papers begin with routine encomiums to Xi Jinping Thought , for instance .
I keep seeing all these videos of dead bodies and people flooding Wuhan hospitals .
What ’ s up with that ?
Several videos have emerged from Wuhan showing disturbing scenes at hospitals , such as bodies abandoned in corridors .
But this doesn ’ t mean they ’ re victims of the virus—except indirectly .
Wuhan has 11 million people : Using the average mortality rate for China , that means approximately 213 @ @ @ @ @ @ @ any large city .
Add in that it ’ s winter , and it ’ s flu season , and the conventional rate of death is even higher .
Some of the videos are also mislabeled , or fakes ; there ’ s a useful list being maintained here .
Now remember that Wuhan ’ s health care system is completely flooded right now .
Everyone with a cold is heading to the hospital to get checked , and medical staff are exhausted and overwhelmed .
450 army medical staff have been sent @ @ @ @ @ @ @ hospital using prefabricated materials are being erected , but that ’ s unlikely to be enough .
Those corpses are very likely people who died of regular causes but who simply haven ’ t been processed as they would in calmer times .
As anyone who has been through Chinese health care knows , hospitals there are often chaotic places where patients regularly find themselves sitting with IVs in corridors , on the floor , or even in the parking lot ; add in epidemic and quarantine , and everything falls apart .
@ @ @ @ @ @ @ most of the time .
There ’ s one scary possibility here , though .
Hospitals themselves could be becoming vectors for the virus .
They ’ re already known to have infected at least 14 health care workers , and there are reports of widespread infection among medical staff who are running out of masks and gloves .
Add to that patients crowding to get help , and even those whose symptoms are the result of ordinary colds rather than the virus might end up walking away infected .
Inside the quarantine @ @ @ @ @ @ @ of fear is emerging in the patchy picture we get through social media .
But there are no accounts of riots or disturbances or of clashes with police or attempts to escape the quarantine zone .
That ’ s hopefully a good sign .
Outside of Wuhan , people seem worried but calm .
This is where some of China ’ s advantages , such as extensive networks of block workers and community centers , can come into play in keeping people informed without panic .
There are runs on masks and hand @ @ @ @ @ @ @ .
The most disturbing aspect may be the measures taken by some villages and townships , which are posting their own blockades to keep travelers out .
That could get quite nasty , as anyone who has passed through a village gate late at night—where locals sometimes set up informal tollbooths , enforced by thugs—knows .
The control on information is probably helping to reduce potential panic and unjustified rumor , even as it may also be concealing vital facts .
Chinese-language chat groups and forums in the United States , which lack @ @ @ @ @ @ @ than those inside China itself , with extreme concern being shown over , for instance , visiting school groups from Wuhan and people warning others to stockpile medical supplies from CVS .
There are also widespread rumors among the Uighur diaspora—the Turkic minority persecuted by China in the Western region of Xinjiang ; they ’ re expressing both fears that the original virus might have been a byproduct of Chinese bio-experimentation on Uighurs and more grounded worries that if the virus reaches the detention camps in which over a million Uighurs are held @ @ @ @ @ @ @ infection .
What about the political fallout ?
It ’ s still very early days , but heads will almost certainly roll over the initial delay or cover-up .
The central government has already made ominous noises .
Given the usual pattern , this may well involve suddenly discovering that the Wuhan mayor , or local party leaders , was corrupt all along .
If the outbreak can be controlled , then this may be spun as a success for the system and a justification of authoritarian powers .
If it isn ’ @ @ @ @ @ @ @ serious threat—not to Communist Party rule itself but to Xi .
He ’ s already facing private dissent from members of the political-economic elite who believe he has mishandled national affairs .
The disruption of a full-scale epidemic would be a perfect opportunity for his opponents to reveal themselves and move against him .
The top levels of the propaganda media—People ’ s Daily and the Xinwen Lianbo news broadcast—were still heavily downplaying the story until late in the week .
People ’ s Daily hasn ’ t yet mentioned it on the @ @ @ @ @ @ @ entirely to praise of Xi and national prosperity ; the story was buried on Page 4 on Wednesday , while it took the nightly news 22 minutes to reach the story .
On Saturday , however , the broadcast led with a seven-minute meeting of the Central Committee , showing Xi in a leadership role .
That ’ s a contrast with previous disasters under Hu Jintao and Wen Jiabao , where the media led with images of national leadership and personal appearances .
Wen , in particular , became sardonically nicknamed “ @ @ @ @ @ @ @ but stern appearances in disaster zones , ordering local officials around and representing the paternal control of the party .
Neither Xi nor premier Li Keqiang has visited Wuhan or announced plans to do so .
That might be simply because it ’ s far more difficult to protect a leader from a virus than from fire or flood .
But it might also be a real fear that the epidemic will run out of control—and thus a desire to disassociate themselves from it as much as possible .

It’s Lunar New Year, usually a time of celebration in China, but instead of heading into the streets to let off fireworks, people are staying at home out of fear of contracting a fast-spreading coronavirus. The quarantine in China has now extended to nearly 50 million people, as sweeping restrictions on travel are expanding daily out from the epicenter of the outbreak in the city of Wuhan.
It’s Lunar New Year, usually a time of celebration in China, but instead of heading into the streets to let off fireworks, people are staying at home out of fear of contracting a fast-spreading coronavirus. The quarantine in China has now extended to nearly 50 million people, as sweeping restrictions on travel are expanding daily out from the epicenter of the outbreak in the city of Wuhan. These include bans on tour groups across the country, on long-distance travel in some cities, and on private transport in the center of Wuhan itself. The number of officially confirmed cases has reached 2,018, and continues to rise fast, with at least 56 dead, mostly elderly. China is struggling to cope with its worst health crisis since SARS in 2003, amid fears that Lunar New Year travel has already spread the infection far and wide. Every province and region in China, barring Tibet which is geographically and politically isolated, has had cases of the virus. The United States has sent charter planes to evacuate its approximately 1,000 citizens and consular staff from the quarantine zone.
Is the quarantine working?
It’s too soon to tell, but quite probably not. The confirmed numbers may be just a fraction of the real total of infected victims, with many not yet diagnosed or even showing symptoms. But the biggest problem is that the long incubation period means hundreds of thousands of people left Wuhan long before the virus was seen as a major problem—especially as the Lunar New Year, when hundreds of millions of people return to their families across China, was coming up. A lot now depends on where they ended up. The constant expansion of the quarantine zone, which now covers a huge chunk of the central Chinese province of Hubei, suggests that local transmission may have been fierce and fast, outrunning the authorities. Modeling by foreign scientists is producing disturbing results—250,000 or more infected inside Wuhan and large outbreaks elsewhere, with 60 percent or more of possible transmissions needing to be blocked to contain the outbreak. [The authors of the original paper have since revised their estimations of the transmission rate down, though have not yet produced new figures for likely infections.]
The quarantine creates its own problems. Feeding and supplying the population inside, with regular logistical links severed, is a huge, though not impossible, task. China has exceptional logistics companies such as Alibaba, and they may be brought in, along with the military, to make sure shops stay supplied and people fed; long lines of trucks are heading into Wuhan to supply the population. That’s good, since price gouging and shortages have already started.
So are we all going to die?
Probably not. The coronavirus is highly worrying, but so far it lacks the pandemic properties of influenza and has a relatively low—experts believe—mortality rate. The deaths so far have been mostly, but not exclusively, confined to older people, most of whom had preexisting conditions. The World Health Organization has declined to declare a global emergency, pointing to the relatively small number of cases outside China, although that could well change.
That said, many people remain in serious condition, and the virus has already mutated to pass from human to human—and could evolve further. At least one super-spreader—someone who passes the virus to an unusually high number of other victims—has already emerged in a Wuhan hospital.
And while cases of infection appear to have been largely caught in foreign countries, thanks mostly to the victims being relatively well-off people who had access to health care resources, they’ve been popping up all over the place from Washington state to Malaysia. Given what seems to be a relatively long incubation period of seven to 12 days, during which victims can spread the virus without showing symptoms, it’s hard to tell just how far the virus has already reached.
On top of that, the range of symptoms is long, and some victims haven’t shown the most characteristic signs—and the ones being tested for—such as fever. The world could well see multiple outbreaks, especially if it reaches poorer and more vulnerable countries, as Laurie Garrett has highlighted. Reports so far have been confined to developed nations like South Korea, France, and the United States, but it’s entirely possible that cases elsewhere have simply gone undetected.
Can we trust the government figures right now?
No, for a variety of reasons. The first is that China has a record of concealing the numbers around disaster events for political reasons, from the initial cover-up around SARS to the regular underreporting of the number of dead from floods, landslides, industrial explosions, and other relatively routine disasters. In Wuhan’s case, it seems very likely that the leap to human-to-human transmission, and the sudden explosion in numbers, was concealed by local authorities keen not to risk the local economy or to disturb the smooth progress of the “two sessions,” important mid-January political meetings. The number of cases stayed at 41 for weeks and then suddenly jumped to more than 200 after the virus reached other countries a week ago. Meanwhile, Wuhan officials were scheduling large-scale public events right up until the quarantine was imposed.
There’s less reason for the central government to squash the numbers, and the enormous leap from 41 to nearly 2,000 cases this week may be the result of the sudden interest by Beijing in the epidemic. But government officials are also in the routine—and hard-to-break—habit of concealing information from the public, especially negative information. Huge amounts of resources are put into controlling and suppressing information in China, and doctors, reporters, and ordinary people have already been threatened or arrested for posting independently about the outbreak. A sudden flood of online posts today praised the government and criticized people for posting unauthorized information.
Chinese media is enjoying a short burst of relative freedom, with Caixin and other outlets producing some excellent and critical reporting. But that’s common in the aftermath of disaster in China; the sudden impetus of the news creates several days of comparative openness before the propaganda authorities decide and enforce new lines. (I saw it happen after the Sichuan earthquake and again after the Tianjin explosions when I worked in Chinese newsrooms.). Papers are already being forced to issue apologies if their reporters speak out of line. The internet might well be cut at some point, as happened in Xinjiang in 2009 after the riots there.
Even if the government doesn’t want to distort data, its ability to gather information is also limited. Diagnostic test kits are in short supply, the population potentially affected is huge, and many poorer Chinese—those most affected—are out of reach for the state.
The scientific community in China is genuinely extremely concerned and attempting to share information as rapidly and transparently as it can with foreign counterparts. But it is also working within an environment where everything, even scientific research, is politicized. Since the ascent of Chinese President Xi Jinping to dictatorial status, many scientific papers begin with routine encomiums to Xi Jinping Thought, for instance.
I keep seeing all these videos of dead bodies and people flooding Wuhan hospitals. What’s up with that?
Several videos have emerged from Wuhan showing disturbing scenes at hospitals, such as bodies abandoned in corridors. But this doesn’t mean they’re victims of the virus—except indirectly. Wuhan has 11 million people: Using the average mortality rate for China, that means approximately 213 people die there daily, as in any large city. Add in that it’s winter, and it’s flu season, and the conventional rate of death is even higher. Some of the videos are also mislabeled, or fakes; there’s a useful list being maintained here.
Now remember that Wuhan’s health care system is completely flooded right now. Everyone with a cold is heading to the hospital to get checked, and medical staff are exhausted and overwhelmed. 450 army medical staff have been sent to help, and two emergency field hospital using prefabricated materials are being erected, but that’s unlikely to be enough. Those corpses are very likely people who died of regular causes but who simply haven’t been processed as they would in calmer times. As anyone who has been through Chinese health care knows, hospitals there are often chaotic places where patients regularly find themselves sitting with IVs in corridors, on the floor, or even in the parking lot; add in epidemic and quarantine, and everything falls apart. The regular medical number—120—is producing no response most of the time.
There’s one scary possibility here, though. Hospitals themselves could be becoming vectors for the virus. They’re already known to have infected at least 14 health care workers, and there are reports of widespread infection among medical staff who are running out of masks and gloves. Add to that patients crowding to get help, and even those whose symptoms are the result of ordinary colds rather than the virus might end up walking away infected.
Are people panicking?
Inside the quarantine zone, perhaps. A tremendous amount of fear is emerging in the patchy picture we get through social media. But there are no accounts of riots or disturbances or of clashes with police or attempts to escape the quarantine zone. That’s hopefully a good sign.
Outside of Wuhan, people seem worried but calm. This is where some of China’s advantages, such as extensive networks of block workers and community centers, can come into play in keeping people informed without panic. There are runs on masks and hand sanitizer, which you’d expect. The most disturbing aspect may be the measures taken by some villages and townships, which are posting their own blockades to keep travelers out. That could get quite nasty, as anyone who has passed through a village gate late at night—where locals sometimes set up informal tollbooths, enforced by thugs—knows.
The control on information is probably helping to reduce potential panic and unjustified rumor, even as it may also be concealing vital facts. Chinese-language chat groups and forums in the United States, which lack those controls, seem far more panicked than those inside China itself, with extreme concern being shown over, for instance, visiting school groups from Wuhan and people warning others to stockpile medical supplies from CVS.
There are also widespread rumors among the Uighur diaspora—the Turkic minority persecuted by China in the Western region of Xinjiang; they’re expressing both fears that the original virus might have been a byproduct of Chinese bio-experimentation on Uighurs and more grounded worries that if the virus reaches the detention camps in which over a million Uighurs are held, the results could be a devastating infection.
What about the political fallout?
It’s still very early days, but heads will almost certainly roll over the initial delay or cover-up. The central government has already made ominous noises. Given the usual pattern, this may well involve suddenly discovering that the Wuhan mayor, or local party leaders, was corrupt all along.
If the outbreak can be controlled, then this may be spun as a success for the system and a justification of authoritarian powers. If it isn’t, it’s a genuinely serious threat—not to Communist Party rule itself but to Xi. He’s already facing private dissent from members of the political-economic elite who believe he has mishandled national affairs. The disruption of a full-scale epidemic would be a perfect opportunity for his opponents to reveal themselves and move against him.
The top levels of the propaganda media—People’s Daily and the Xinwen Lianbo news broadcast—were still heavily downplaying the story until late in the week. People’s Daily hasn’t yet mentioned it on the front pages, which have been devoted entirely to praise of Xi and national prosperity; the story was buried on Page 4 on Wednesday, while it took the nightly news 22 minutes to reach the story. On Saturday, however, the broadcast led with a seven-minute meeting of the Central Committee, showing Xi in a leadership role.
That’s a contrast with previous disasters under Hu Jintao and Wen Jiabao, where the media led with images of national leadership and personal appearances. Wen, in particular, became sardonically nicknamed “the best actor” for his kind but stern appearances in disaster zones, ordering local officials around and representing the paternal control of the party. Neither Xi nor premier Li Keqiang has visited Wuhan or announced plans to do so.
That might be simply because it’s far more difficult to protect a leader from a virus than from fire or flood. But it might also be a real fear that the epidemic will run out of control—and thus a desire to disassociate themselves from it as much as possible.