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Afghanistan

Medical needs urgent as ever in Afghanistan after Taliban takeover

More than 40 years of conflict and instability have left Afghanistan’s economy and infrastructure in ruins, and many people dependent on humanitarian assistance. 

After a US military airstrike destroyed its trauma centre in Kunduz, killing 42 people, in October 2015, MSF engaged in negotiations regarding the neutrality of medical care with all parties to the conflict.

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Afghanistan: 2021

Our medical teams have continued to provide care to the people of Afghanistan throughout the current crisis.

Since May 2021, fierce clashes between Afghan forces and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban) took place in and around provincial capitals claiming thousands of lives.

Hospitals and medical facilities were caught in the crossfire, cutting off healthcare and emergency treatment for people wounded by bullets and explosions. At the same time, hundreds of thousands of people were forcibly displaced from their homes in the space of three months.

Now, as the clashes stop, there are mounting concerns about the availability of medical supplies and other humanitarian assistance for a healthcare system that has been on the brink of collapse for years.  

Throughout the crisis, Médecins Sans Frontières / Doctors Without Borders (MSF) has continued to provide life-saving medical care to people caught in the chaos.

In five locations across Afghanistan, our teams are treating emergency trauma cases, supporting people with chronic conditions and welcoming new life into uncertain times.

"On 21 August we treated 862 people in our emergency room, which I think is the most we've ever received. Some patients are coming in critical condition because they waited until the fighting had stopped."

MSF MEDIC, BOOST HOSPITAL, LASHKAR GAh

In four of the areas where MSF teams were already working before this surge in violence, the consequences of the conflict have been acute.

This includes the provincial capitals of Lashkar Gah and Kandahar, both in the south, Herat in the west and Kunduz in the north. MSF also runs another project in Khost, in the southeast.

The situation on the ground is extremely fast-moving. The information about our response, below, is correct as of 21 September 2021 and is likely to change.

Increase of patients in Herat clinic

Governmental healthcare staff and their implementers working for other organisations in Herat have not received salaries for months. Many Ministry of Public Health staff are looking for work in private clinics, in addition to their regular jobs, to make ends meet.

The third wave of COVID-19 is on a downward trend, but we are looking at how we can prepare for the inevitable fourth wave. Vaccination coverage remains low. Discussions to increase the capacity of the MSF COVID-19 treatment centre to 1,00 beds are currently underway.

Our in-patient therapeutic feeding clinic (ITFC) at Herat Regional Hospital is facing a critical situation. The facility was initially set up with 40 beds, but to cope with the seasonal increase in malnutrition we set up temporary wards in tents outside the regional hospital to increase the bed capacity to 60. The number of hospitalisations has, however, now reached 200 per cent of our bed capacity. We would have expected the number of admissions to decrease by now as the seasonal fluctuation comes to an end, but instead we are consistently admitting between 90 and 100 children every day.

This is most likely representative of the lack of functioning health services in the area, the economic downturn, inflationary pressures in the marketplace and persistent drought conditions faced by the population. The team are working on installing insulated containers to increase capacity and to prepare for the winter, which is fast approaching.

On the outskirts of Herat, MSF continues to provide outpatient care, treatment for non-communicable diseases, and sexual and reproductive health services at the Kahdestan clinic. Once the fighting ended, we witnessed a significant increase in people coming to the clinic, as others in the area suspended their activities. There were up to 400 patients per day, compared to 300 per day in July. We now see the number reducing as other providers are returning and reopening, meaning there is a slight increase in the offer of health services.

Latest figures

Between 6 and 12 September:

  • The Kahdestan clinic carried out over 1,900 consultations, including 111 for antenatal care (48 of which were first antenatal consultations). Children under 5 accounted for over 25 per cent of all consultations, mostly for acute watery diarrhoea and respiratory tract infections.
  • Over 60 new ITFC admissions for the third week in a row.
  • 695 suspected COVID-19 cases triaged at the Herat Regional Hospital, an average of around 100 per day down from nearly 300 per day during the peak of the third wave.

Trauma care in Kunduz

We are continuing to gradually expand the capacity of the Kunduz Trauma Centre, which opened earlier than initially planned. We are mostly seeing people injured in road traffic accidents and people injured by the fighting who have complications.

Emergency room of the MSF Kunduz Emergency Trauma Unit, a medic treats a patient who has suffered a complicated fracture of their upper and lower leg due to a bomb blast

The health system in Kunduz continues to be strained as experienced medical staff continue to leave the province, including senior health administration officials. The staff who remain have not been paid for several months and often come to work for only a few hours a day. Medical and logistical supplies continue to be lacking in the public health system, and the main regional referral hospital continues to rely on donations from the few humanitarian actors that retain some presence in the country.

Latest figures

Between 6 and 12 September:

  • 153 patients triaged in the trauma centre
  • 102 patients treated in the inpatient department
  • 34 surgical procedures

Accessing maternity care in Khost

The MSF Khost maternity hospital previously concentrated on women with complicated deliveries but is continuing with its widened admission criteria, to ensure that pregnant women from across Khost province have access to medical care in order to give birth safely. We are seeing an increase in patients and deliveries each week.

Private clinics are seeing significantly fewer patients than a month ago, as the deteriorating economic situation means that people aren’t able to afford to pay for treatment.

MSF supports eight comprehensive health centres (CHC) run by an organisation that is funded by the World Bank, which has suspended its funding to Afghanistan. This lack of funding means that those people running the CHCs are unable to pay staff or buy medication and supplies. Staff are continuing to work but it is getting more and more difficult. 

Latest figures

Between 6 and 12 September:

  • 481 admissions to Khost maternity hospital (68 per day)
  • 407 deliveries (58 per day)
  • 35 babies admitted to our neonatal ward

Displaced people in Kandahar

During the fighting, MSF was able to continue its care for drug-resistant tuberculosis (DR-TB) outpatients by providing remote consultations and buffer stocks of medication to avoid them having to cross frontlines to access care. TB care is continuing today and we have a small number of inpatients in our DR-TB centre. At Mirwais Regional Hospital, MSF is screening patients for TB.

In early September the team started running a mobile clinic for people living in informal settlements near the border with Pakistan, in the town of Spin Boldak.

In the last two weeks the teams have provided 540 consultations, nearly half for children under five. The majority of people are presenting with respiratory infections, diarrhoea, and gastrointestinal problems.

On 14 September, water trucking and water chlorination started as well, to help provide clean water.

Latest figures

Between 6 and 12 September:

  • 33 DR-TB outpatient consultations for follow up and contact tracing: 4 DR-TB in patients receiving treatment in our TB centre
  • 131 patients screened for TB at Mirwais Regional Hospital
  • 540 consultations through mobile clinics at Spin Boldak

Addressing a spectrum of needs in Lashkar Gah

The hospital in Lashkar Gah remains very busy, and on some days our Emergency Room has been receiving around 800 patients. The 300 inpatient beds are full.

This high number of patients is in large part caused by the fact that other facilities are not, or hardly, functioning. Including those funded by the World Bank.

This was already an issue during the fighting in August, but with international funding being suspended the situation keeps deteriorating. 

Mahmood was shot while he and his family fled their home outside Lashkar Gah. Afghanistan, May 2021.

Another contributing factor to the large influx of patients is that people for whom before it was difficult to reach the hospital because they would have to cross frontlines can now more easily access healthcare.

Latest figures

Between 6 and 12 September:

  • 5,387 Emergency Room consultations (around 770 per day)
  • An average of 77 malnourished children receiving treatment in the ITFC each day

MSF’s work in Afghanistan: 2020

On 12 May 2020 the Médecins Sans Frontières (MSF) maternity ward in Dasht-e-Barchi hospital, Kabul, was attacked. Gunmen killed 24 people, including 16 mothers, two children and an MSF midwife.

MSF started running the maternity and neonatology departments of the 100-bed Dashte-Barchi hospital in 2014 and provided ante- and postnatal care and family planning. We also supported maternity care in another hospital in the area with staff, training and essential drugs.

The attack rocked MSF to the core, and when no information emerged about the perpetrators or the motive behind it, we made the very difficult decision to withdraw from Dasht-e-Barchi in mid June. To support the Ministry of Public Health after our departure, we donated medications and medical equipment.

The end of MSF’s activities in Dasht-e-Barchi will likely have devastating consequences for the more than one million people, predominantly Hazara, who live in the area.

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BOOST HOSPITAL, LASHKAR GAH

Helmand province has been the scene of violent clashes between government and opposition forces for more than a decade.

In October, when intense fighting broke out around Lashkar Gah, the main trauma hospital in the city was overwhelmed with casualties within 24 hours, and our team at Boost hospital started to receive an influx of people wounded in the crossfire.

MSF supports several departments in Boost hospital, including the emergency room, which saw around 300 patients a day in 2020, most with trauma injuries, respiratory tract infections or acute watery diarrhoea. Our teams found that, due to a combination of insecurity and COVID-19, many patients delayed seeking care and arrived in a critical condition.

From April, we also managed a COVID-19 isolation ward for vulnerable patients such as pregnant women, children, people with tuberculosis (TB) and those who had undergone surgery. All other patients were referred to Malika Suria COVID-19 hospital.

In February, MSF started supporting the outpatient department of Fatima Bayat hospital with training and drug supplies, in order to reduce the number of people with non-urgent medical problems coming to Boost’s emergency room.

COVID-19 IN KABUL AND HERAT

The first case of COVID-19 in Afghanistan was confirmed in Herat at the end of February. Kabul and Herat became the epicentres of the outbreak but the true number of people infected with the virus across the country is unknown due to lack of testing.

In Kabul, MSF supported infection prevention and control in the Afghanistan-Japan referral hospital and trained local health staff. These activities ceased after the attack on Dasht-e-Barchi. In early April, we set up a COVID-19 triage system in Herat regional hospital. Then in June, we opened the 32-bed MSF Gazer Ga COVID-19 treatment centre, focusing on oxygen therapy for severely affected patients referred from the regional hospital. The centre closed in September when the number of cases reduced but reopened on 2 December for the second wave.

In all MSF projects in Afghanistan, infection prevention and control measures were reinforced to reduce COVID-19 transmission.

OTHER ACTIVITIES IN HERAT

In 2018, MSF opened a clinic for displaced people in the Kadhestan and Shadayee settlements on the outskirts of the city. Our team offers medical consultations, treatment for malnutrition, vaccinations, ante- and postnatal care and family planning, conducting an average of 266 consultations a day. Outreach activities started in December 2020. We also run an inpatient therapeutic feeding centre in the paediatric hospital.

Dr Bart Scharuwen, nursing  activity manager Jane Hancock, and nurse Marzia, perform  cardiopulmonary resuscitation on a malnourished baby with asthma,  who sadly passed away, in the operating room of Herat regional hospital. Afghanistan, 2020.

Khost maternity hospital

Since 2012, MSF has been running a dedicated 24-hour maternity hospital in Khost, eastern Afghanistan. In 2020, to reduce possible transmission of COVID-19, the admission criteria for the maternity hospital were tightened and women in labour were no longer allowed to be accompanied by a caregiver.

This led to a significant drop in the number of women giving birth in the facility and put more pressure on Khost provincial hospital; our deliveries dropped by 38 per cent, while those in the provincial hospital increased beyond their capacity. To address this negative impact on the population and other health providers, towards the end of the year we loosened the admission criteria and female caregivers were once again allowed to accompany patients.

As a result, the number of births in the facility started to increase, rising to 1,000 in December. We also resumed family planning consultations at the hospital, and health promotion activities in the five community health centres we support in the districts. 

Drug-resistant tuberculosis (DR-TB) in Kandahar

DR-TB is a major concern in Afghanistan, exacerbated by a lack of knowledge about the disease and poor availability of treatment. MSF has been supporting the national tuberculosis programme in the diagnosis and treatment of DR-TB in Kandahar province since 2016. 

MSF drug-resistant TB patient Badro has a blood sample taken at our TB treatment centre in Kandahar. Afghanistan, July 2020.

In December 2019, we introduced a nine-month oral regimen allowing DR-TB patients to change from injectable drugs to pills and reduce their number of consultations at the hospital. The results are promising so far, with no-one defaulting from the short-course treatment. Since insecurity makes it difficult for patients to visit the centre for follow up, they are provided with a buffer stock of medicine in case they cannot travel.

We also continued to support the health ministry in Mirwais regional hospital and at the provincial TB centre, by providing medical care for drug sensitive TB patients. In 2020, we supported the Ministry of Public Health to detect TB and manage care for patients in Sarpoza prison.

Trauma care in Kunduz

Kunduz Activities in Kunduz were hard hit by COVID-19 and they were all suspended in April.

However, construction of the new trauma centre resumed in September, with increased infection prevention and control measures to guard against the virus. Stabilisation activities in Chardara for patients with trauma injuries are due to resume in early 2021. The wound care clinic will not reopen. 

Hear from Dr Kathleen Thomas, who was in Kunduz on the night of the attack, on our Everyday Emergency podcast.

© Andrea Bruce/Noor Images

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