Political instability and covid-19 are straining Afghanistan’s already fragile health system, and organizations like MSF cannot meet people’s health needs on their own, writes Tankred StÃ¶be
One of my MSF colleagues described the health system in Afghanistan today as going from catastrophic to apocalyptic. If that sounds too pessimistic, we must not forget that healthcare in this war-stricken country has been on life support for decades. It has been underfunded, underfunded and understaffed, and has failed to meet the critical needs of the population. It is also very dependent on foreign donors.
At the height of the fighting and since the Taliban took control of the country on August 15, MSF has maintained its operational presence and has continued to receive and treat patients in the five sites of our projects: in Herat, Kandahar, Khost , Kunduz and Lashkar Gah. Now that the situation has calmed down, we are able to take stock of the changes that have taken place and how they are affecting people’s health and access to care. A few months ago, our hospitals in Lashkar Gah and Kunduz were on the front lines of the conflict and we treated many patients injured by the fighting. Now, with increased security, people can access hospitals more easily and therefore we treat a wider range of health issues. In Lashkar Gah, we saw up to 750 patients a day in our emergency room: sick children, people injured by traffic accidents and other conditions. Our 300 bed hospital has been full on several occasions over the past few weeks.
In Herat, where I worked as a medical coordinator, many other health facilities in the province are closed or malfunctioning, leaving us with a large number of patients to see as people have few other options. In our clinic on the outskirts of the city, where around 70,000 internally displaced Afghans live in three camps, we treat 400 patients a day. We have treated around 57,000 people since the start of 2021, almost 50% more than the same period last year.
Of particular concern is the impact of food insecurity on children’s health, as it can mean that children have weakened immune systems and are less resistant to endemic diseases such as measles. Our 40-bed feeding center in HÃ©rat, which had already been expanded to 60 beds to cope with the seasonal influx, now accommodates up to 100 malnourished children, which far exceeds its bed capacity. This puts enormous pressure on patients and resources, and staff have to work overtime to take care of everyone. We see a 40% increase in the number of patients in the center compared to 2020.
The covid-19 pandemic has further increased the country’s health burden. The third wave hit Afghanistan harder than previous ones, with too few vaccines, hospital beds, oxygen supplies and ventilation devices available to prevent unnecessary deaths. We run a triage center at Herat Regional Hospital where we have seen 56,000 patients suspected of covid since it opened in April 2020: around 10% of these cases typically require hospital treatment. Now our covid treatment center at Gazer Gah Hospital, Herat sees around 100 patients per day with covid-19. We admit severe cases to our 75-bed covid center, where we offer treatment including medication, oxygen and mask ventilation.
Basic medical services are unevenly distributed across the country and scarce in rural areas where a valued 75% percent of the population live. Afghans have consistently struggled to overcome barriers to healthcare related to distance and the cost of transportation and medical care, and this will only worsen as the socio-economic situation in Afghanistan continues to deteriorate. As people lose their jobs and businesses are forced to shut down, food prices will continue to rise even as purchasing power declines. The shortage of female doctors, nurses and midwives in Afghanistan is also particularly problematic for women’s access to health care. MSF has witnessed and communicated on several occasions these disturbing trends in Afghan access to health care, with reports in 2014, 2020, and 2021.
Today, Afghanistan needs to improve and expand public health facilities throughout the country (including in hard-to-reach rural areas); train additional health workers, including female doctors, nurses and midwives, to improve women’s access to health care; and ensure the necessary supply of drugs, equipment and materials in public health establishments, free of charge for patients. MSF started working in Afghanistan in 1980 and now has an allocated budget of $ 47 million for the country in 2021. We rely only on private donations and do not accept government funding. However, others are not so fortunate, and the recent funding suspensions for Afghanistan will have a dramatic impact on healthcare providers who rely on donor resources to continue their projects. An additional challenge is the number of professionals, such as medical staff, who left the country in August, further increasing staff shortages.
But there may be glimmers of hope for Afghanistan. At a health meeting with all high-level medical representatives in Herat in mid-September, chaired by non-medical members of the Taliban, the best news was probably that with the fighting over, the resources that were previously needed to keep the war going can now be given health care. Unfortunately, even if this is true, it will not cover the urgent needs of the Afghan people. And organizations like MSF cannot afford the country’s health care alone.
Tankred StÃ¶be, medical coordinator, MSF-Afghanistan.
Competing interests: none declared.