Countries experiencing conflict often are increasingly susceptible to the spread of infectious disease as their health systems become disrupted or even collapse. A prime example of this phenomenon is in Afghanistan - a country at war for the past seven years and experiencing frequent conflict over the past few decades. But as Rose Hoban reports, many nongovernmental organizations are working to curb the spread of infectious disease within Afghanistan and across its borders into Pakistan, Iran and Tajikistan.

Fred Hartman works with one group, Management Sciences for Health, focusing on controlling six communicable diseases - HIV, tuberculosis, cholera, malaria, polio and avian influenza. He says, for example, avian influenza hit Afghanistan in 2006.

Groups like Management Sciences for Health work to control the spread of communicable diseases in Afghanistan and neighboring countries

"We know that came in from the northwest areas of Pakistan," Hartman says. "In 2007,Pakistan reported human deaths with human-to-human transmission, which heightens the concern in Afghanistan."

One project Hartman worked on was with the Ministry of Health in Kabul. He helped them convene a regional conference to draft basic principles to curb the spread of disease. That included agreeing on border controls - and in the wake of flu outbreaks, Kabul and Islamabad implemented new procedures.

"For example, in 2006 when avian influenza broke out in Pakistan, the poultry farmers would quickly ship all of their chickens to Afghanistan, and of course it was bred in Afghanistan," he says. "Both governments have worked together to seal the borders, knowing it's not in anybody's best interests to start shipping sick chickens around the region."

The impetus behind the regional conference wasn't limited to strictly medical matters. Delegates realized that containing disease and developing their economies were intertwined. So along with tighter border control, they also agreed on better disease surveillance.

Hartman says this kind of cooperation has led to fewer cases of avian influenza moving between Afghanistan and Pakistan. Another positive result has been the reduction of the number of people with malaria on the Afghan-Tajik border.

Canadian soldiers with NATO-led force inspect site of suicide attack in Kandahar, 12 Mar 2008. Experts say continuing violence hampers efforts to control disease

However, Hartman says there is still much work to be done, especially when it comes to controlling the spread of polio. Despite a worldwide effort by UNICEF and the World Health Organization, the disease is still appearing in remote places in Afghanistan.

"We have to conclude that despite serious cross-border efforts of notification of any cases of acute polio, immunization at the border for all children under five who are passing back and forth, that we have been unable to control transmission of the disease in that area," Hartman says.

He notes that the continuing violence in Afghanistan hampers efforts at controlling disease. In one tragic case, three Ministry of Health doctors who were vaccinating children in Kandahar province were assassinated earlier this year.

But Hartman says there's also reason for hope. He reports that local authorities - even those in Taliban-controlled areas - recognize the need to control the spread of infectious disease.

Hartman presented a paper on his experiences and his findings in October at the annual meeting of the American Public Health Association in San Diego, California.