Cases of a deadly hemorrhagic fever are growing along the border with Afghanistan and could spread more rapidly if war forces more Afghans to flee their homeland.
The latest victim, Lal Mohammed, a 40-year-old truck driver, died Thursday, hours after reaching the hospital. Eleven people have died in the past four months of the disease, known as Crimea-Congo hemorrhagic fever, according to doctors, and 63 people have been hospitalized with the virus. In September, it killed two sisters, ages 6 and 7.
"We are very much scared," said Dr. Akhlaq Hussain, director of Fatima Jinnah Hospital, which has set up a makeshift isolation ward. "We don't know how bad it is in Afghanistan or what refugees will bring here."
The disease — which is found in Africa, Asia, the Middle East and Eastern Europe, and has nothing to do with bioterrorism — has taken 34 lives in the border area from Kandahar, Afghanistan, to Quetta over the past 18 months, Hussain said.
Medical researchers say the death rate from the disease is about 30 percent when care is available, making it less deadly than the better-known Ebola virus, another hemorrhagic fever. In 1998, however, an outbreak of Crimea-Congo in Afghanistan killed 12 of the 19 people infected.
The virus is transmitted by a tick, hyaloma marginata, which thrives on sheep and cattle. Infected humans can spread the disease by blood, saliva or droplets from sneezing.
The disease causes a dramatic drop in platelets, which allow the blood to clot. Without rapid treatment by antiviral drugs and replacement of platelets, victims bleed to death through every body opening.
With the threat of war looming, refugees and their tick-infested livestock are streaming along the road from Afghanistan to Quetta. Their numbers are expected to soar if a military assault begins.
"Conditions are so terrible now in Afghanistan, nobody can imagine," Hussain said. "Who knows how many have died there without treatment? They have nothing. They can't even treat malaria."
Although Pakistani authorities have closed the border crossing at Chaman, many refugees are getting through, either by bribery or by following rugged trails through unpatrolled mountains.
Hussain said his hospital is desperately short of resources. He said he appealed to the U.N. World Health Organization three months ago, but got no reply.
He asked for equipment and medicine worth $150,000, including a platelet separator necessary to fortify weakened blood. Now he uses a machine at a military hospital 10 miles away.
In Geneva, WHO spokesman Ian Simpson said he was unaware of any request but that specialists were watching the situation. So far, he said, there has been no alarming cluster of cases.
He said the approaching winter should substantially reduce the number of ticks.
Bob Swanepoel of the National Institute of Virology in Johanneburg, South Africa, who has examined blood samples sent from Quetta, confirmed the outbreak.
The disease first surfaced in 1944 among Russian troops in the Crimea and later in the Congo and is endemic in parts of Central and South Asia, he said.
Normally, ticks live on livestock and avoid humans, he said, but in the Afghans' situation, where people sleep crowded into outdoor spaces with their animals, the danger is substantially increased.
"It's perfectly possible that you'll have outbreaks," he said, adding that there was reason for "great concern," but not alarm.
Hussain had hoped to keep hospital space free in case of a retaliatory U.S. strike, but has now switched priority to the hemorrhagic fever.
"We have only 10 beds," he said. "If we get more cases, what will we do?"
Dr. Saeeda Sultana, who works in the ward, said the short-lived virus was normally active for only eight to 10 days, which means that patients kept alive for that crucial period are likely to recover.
But, she added, by the time bleeding starts and relatives attempt to find medical help, it is often too late.
In the simple, white-painted ward, 9-year-old Mohammed Ismail hangs onto life with an intravenous tube taped to his nose, one of four patients in the ward. His grandmother waits outside.
Three doctors share round-the-clock shifts, helped by several nurses and an orderly.
For now, they are managing, says Dr. Sultana, wearing only a face mask, gown and bags on her shoes. With a philosophic shrug, she says: "I think we have built up an immunity."