© Kadir Van Lohuizen/Noor

Afghanistan

We are still reeling from the attack on our Kunduz trauma centre, in which 42 people were killed

Médecins Sans Frontières (MSF) focuses on improving access to emergency, paediatric and maternal healthcare in Afghanistan, which has one of the highest maternal mortality rates in the world.

Map of MSF's activities in Afghanistan, 2015

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.

At the end of 2016, MSF finally obtained commitments that its staff and patients would be respected, and care could be provided to everyone in need, regardless of their ethnicity, political beliefs or allegiances. Although hard to guarantee in an active conflict zone, MSF believes these commitments will allow it to evaluate the possibility of resuming trauma care activities in Kunduz in 2017.

The conflict in Afghanistan continued to intensify in 2016. MSF’s other projects in the country remained operational, with the number of patients increasing due to growing medical needs. A quarter of all the births assisted by MSF worldwide are in

Afghanistan, and teams helped deliver more than 66,000 babies this year.

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Kunduz attack

On Saturday, 3 October 2015, 42 people were killed in sustained airstrikes on our hospital in Kunduz, Afghanistan.

Twenty-four patients and 14 staff were killed, along with four caretakers.

As we grieve the loss of our colleagues and patients, we are left with the question: is it still possible to safely provide medical care on the frontline? Between October 2015 and October 2016, there have been a further 77 attacks on medical facilities run and supported by MSF in Syria and Yemen

"There have been no impartial investigations carried out by an independent international body into any of the seven aerial attacks on hospitals that have occurred over the past year. This is because there is zero political will among governments to have their military conduct examined from the outside."

Christopher StokesMSF General director

The United States' government has admitted to carrying out the bombing of our hospital.

It was the destruction of the Kunduz Trauma Centre, and the devastating assault on health facilities in Syria and Yemen that led to UN Security Council Resolution 2286 being passed in May 2016.

The resolution strongly condemned attacks on medical facilities and demanded that all parties to armed conflict comply fully with their obligations under international law. 

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

MSF’s work in Afghanistan: 2015

On 3 October 2015, the Médecins Sans Frontières/Doctors Without Borders (MSF) Trauma Centre in Kunduz, Afghanistan, was destroyed in an aerial attack, during which 42 people were killed, including 14 MSF staff, 24 patients and four patient caretakers.

MSF opened the hospital in Kunduz in August 2011, in order to provide free, high-quality surgical care to victims of general trauma, such as traffic accidents, as well as patients with conflict-related injuries. It was the only facility of its kind in the whole northeastern region of Afghanistan.

Independently run by MSF, the 84-bed hospital had an emergency room, an intensive care unit, three operating theatres, outpatient and inpatient departments (with separate surgical wards for male and female patients), a physiotherapy department, a laboratory, an X-ray room and a pharmacy.

Other services included mental healthcare and health promotion. The hospital offered services not only to the residents of Kunduz province but also to patients from neighbouring provinces such as Badakhshan, Takhar, Baghlan, Balkh and Samangan. The hospital’s capacity reached 92 beds by September 2015, just before it was bombed.

Between January and August, more than 2,400 patients were admitted to the centre, most of whom (88 percent) had been injured in road or domestic accidents.

Twelve percent presented with injuries caused by explosions, gunshots or bombings. Over the same period, MSF staff carried out 18,088 outpatient consultations and 4,667 surgical interventions, including orthopaedic surgery involving internal fixation techniques to repair bones.

Kabul

Ahmad Shah Baba hospital

The capital Kabul has experienced a massive population growth and the city’s public health services cannot fulfil the medical needs. At Ahmad Shah Baba district hospital in eastern Kabul, which serves more than 1.2 million people, MSF supports the Ministry of Public Health to deliver outpatient and inpatient care, with a focus on maternal health and emergency services. The team also provides paediatric care, treatment for malnutrition, family planning, health promotion and vaccinations, and supports the hospital’s laboratory, X-ray services and tuberculosis (TB) treatment programme. 

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MSF has increased the capacity of the hospital from 46 to 62 beds and this year started to rehabilitate the buildings. Staff conducted 100,000 consultations and assisted 18,966 deliveries, almost 20 per cent more than in 2015.

In 2016, MSF started a new programme for the treatment of chronic non-communicable diseases such as diabetes, hypertension, chronic obstructive pulmonary disease, asthma and epilepsy. Around 600 patients were enrolled.

Dasht-e-Barchi hospital

MSF collaborates with the Ministry of Public Health to provide around-the-clock care at Dasht-e-Barchi hospital, the only facility for emergency and complicated deliveries in a district with a rapidly increasing population. MSF runs the labour and delivery rooms, an operating theatre for caesarean sections and other complicated deliveries, a recovery room, a 30-bed maternity unit, a 20-bed neonatology unit and a five-bed ‘kangaroo room’, which provides specialist care for sick babies in their first days of life. In addition, MSF offers vaccinations and runs the laboratory, blood bank and sterilisation unit. In 2016, teams assisted 15,627 deliveries, almost 27 per cent of which were complicated cases. The team is now aiming to increase referrals for simple deliveries, in order to focus on complicated cases and maintain a high quality of care. Working at full capacity, the neonatology unit admitted 1,342 babies with complications such as clinical sepsis, hypoglycemia and perinatal asphyxia.

Helmand

Lashkar Gah

Much of the area surrounding Lashkargah was the scene of active fighting in 2015, although MSF’s Boost hospital continued to function in the provincial capital as normal. For the past six years, MSF has been supporting Boost hospital, one of only three referral hospitals in southern Afghanistan. A new 54-bed maternity ward, a 24-bed neonatal intensive care unit and a 10-bed paediatric intensive care unit were also built. By the end of the year, 12,721 babies had been delivered in the hospital.

MSF supports the hospital with surgery, internal medicine, emergency services and intensive care. In mid-2015, the team also began supporting the diagnosis and follow-up of TB patients, addressing a major yet under-reported public health concern in Afghanistan, and 181 patients started first-line treatment. At the end of the year, an MSF surgical burns specialist provided training to improve treatment for the high number of burns patients seen at the hospital.

Malnutrition continues to be one of the main causes of child mortality in the region, and the hospital’s intensive therapeutic feeding centre treated 2,281 children this year, many of whom were suffering from severe malnutrition.

Khost

Maternity hospital

Afghanistan is considered one of the most dangerous places in the world to give birth, due to the high number of women who die during pregnancy or labour.

In 2012, MSF opened a maternity hospital in Khost, in eastern Afghanistan, to address the lack of obstetric care in the area. The hospital helps reduce maternal mortality by offering a safe environment for women to deliver their babies, in the care of predominantly female medical staff, free of charge. 





© Andrea Bruce/Noor Images

The number of deliveries has increased by 40 per cent in two years, from 15,204 in 2014 to 21,335 in 2016. In December, the number of deliveries reached 1,905, an average of over 60 per day. In 2016, 1,746 newborns were admitted to the neonatology unit, a 15 per cent increase compared to the previous year. This year, MSF began supporting three health centres in outlying districts in Khost province to increase their capacity to assist normal deliveries. The aim is to reduce the number of simple deliveries at Khost maternity hospital, so that the medical team there can focus on assisting complicated births.

Boost hospital, Lashkar Gah

Since 2009, MSF has supported Boost provincial hospital in Lashkar Gah, Helmand province, one of only three referral hospitals in southern Afghanistan. Over the years, MSF has significantly increased the number of staff at the hospital and carried out major construction works. This year, the team completed the rehabilitation of the entire original hospital building and extended the maternity department. The hospital has grown from 150 to 327 beds, with the number of patients admitted monthly increasing from around 120 in 2009 to an average of 2,750 in 2016. Staff assisted 10,572 deliveries in 2016.

The hospital has a neonatology unit, as well as a 109-bed paediatric department, which includes an inpatient therapeutic feeding centre, where 2,431 children were treated for malnutrition in 2016. MSF also supports the internal medicine department, intensive care unit and emergency room. MSF teams monitor TB cases and work in the isolation ward for infectious diseases. Intense fighting in 2016 in Helmand province hampered access to the hospital for many patients. Still, 20 per cent of them came from outside the city, exposing themselves to significant risks due to active fighting and dangerous roads.

Kandahar TB activities

In 2016, MSF started supporting the diagnosis and treatment of drug-resistant TB (DR-TB) in Kandahar province, and opened a laboratory and facilities to host patients during their treatment in Kandahar city. MSF also provided additional staff at Mirwais hospital, and organised training for other facilities to improve case detection. During the last quarter of 2016, 13 patients were diagnosed with multidrug-resistant TB.

find out more in our international activity report

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