Why are we there?
- Armed Conflict
- Access to health care
Afghanistan: Latest MSF Updates
- Slideshow: A Trauma Center in Kunduz, Afghanistan
- MSF Response to Spurious Claims That Kunduz Hospital Was "A Taliban Base"
- "Unspeakable": An MSF Nurse Recounts the Attack on MSF's Kunduz Hospital
- MSF Staff Killed, Hospital Partially Destroyed in Kunduz
- MSF Hospital Overwhelmed With Wounded After Heavy Fighting in Kunduz
- Treating A Boy and His Father After Bomb Blast
- Maternity Care in Afghanistan: "We Help Them Give Birth Safely"
UPDATE: OCTOBER 5, 2015
MSF Response to Pentagon Claim That Afghan Forces Called For Kunduz Airstrike
"Today the US government has admitted that it was their airstrike that hit our hospital in Kunduz and killed 22 patients and MSF staff. Their description of the attack keeps changing—from collateral damage, to a tragic incident, to now attempting to pass responsibility to the Afghanistan government. The reality is the US dropped those bombs. The US hit a huge hospital full of wounded patients and MSF staff. The US military remains responsible for the targets it hits, even though it is part of a coalition. There can be no justification for this horrible attack. With such constant discrepancies in the US and Afghan accounts of what happened, the need for a full transparent independent investigation is ever more critical."
—Christopher Stokes, General Director, Médecins Sans Frontières
Statement on Kunduz Hospital Bombing
Kabul/Brussels, October 4: Doctors Without Borders/Médecins Sans Frontières (MSF) issued the following statement today from Christopher Stokes, MSF General Director, on the bombing of MSF's hospital in Kunduz, Afghanistan:
"Under the clear presumption that a war crime has been committed, MSF demands that a full and transparent investigation into the event be conducted by an independent international body. Relying only on an internal investigation by a party to the conflict would be wholly insufficient.
"Not a single member of our staff reported any fighting inside the MSF hospital compound prior to the U.S. airstrike on Saturday morning. The hospital was full of MSF staff, patients and their caretakers. It is 12 MSF staff members and 10 patients, including three children, who were killed in the attack.
"We reiterate that the main hospital building, where medical personnel were caring for patients, was repeatedly and very precisely hit during each aerial raid, while the rest of the compound was left mostly untouched.We condemn this attack, which constitutes a grave violation of International Humanitarian Law."
MSF Demands Explanations After Deadly Airstrikes Hit Hospital in Kunduz
Kabul/Brussels, October 3: The international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) condemns in the strongest possible terms the horrific aerial bombing of its hospital in Kunduz, Afghanistan. Twelve staff members and at least seven patients, including three children, were killed; 37 people were injured including 19 staff members. This attack constitutes a grave violation of International Humanitarian Law.
All indications currently point to the bombing being carried out by international Coalition forces. MSF demands a full and transparent account from the Coalition regarding its aerial bombing activities over Kunduz on Saturday morning. MSF also calls for an independent investigation of the attack to ensure maximum transparency and accountability.
“This attack is abhorrent and a grave violation of International Humanitarian Law,” said Meinie Nicolai, MSF President. “We demand total transparency from Coalition forces. We cannot accept that this horrific loss of life will simply be dismissed as ‘collateral damage’.”
From 2:08 AM until 3:15 AM local time today, MSF’s trauma hospital in Kunduz was hit by a series of aerial bombing raids at approximately 15 minute intervals. The main central hospital building, housing the intensive care unit, emergency rooms, and physiotherapy ward, was repeatedly hit very precisely during each aerial raid, while surrounding buildings were left mostly untouched.
“The bombs hit and then we heard the plane circle round,” said Heman Nagarathnam, MSF head of programs in northern Afghanistan. “There was a pause, and then more bombs hit. This happened again and again. When I made it out from the office, the main hospital building was engulfed in flames. Those people that could had moved quickly to the building’s two bunkers to seek safety. But patients who were unable to escape burned to death as they lay in their beds.”
The bombing took place despite the fact that MSF had provided the GPS coordinates of the trauma hospital to Coalition and Afghan military and civilian officials as recently as Tuesday, September 29, to avoid that the hospital be hit. As is routine practice for MSF in conflict areas, MSF had communicated the exact location of the hospital to all parties to the conflict.
In the aftermath of the attack, the MSF team desperately tried to save the lives of wounded colleagues and patients, setting up a makeshift operating theater in an undamaged room. Some of the most critically injured patients were transferred to a hospital in Puli Khumri, a two hour drive away.
“Besides resulting in the deaths of our colleagues and patients, this attack has cut off access to urgent trauma care for the population in Kunduz at a time when its services are most needed,” said Nicolai. “Once again, we call on all warring parties to respect civilians, health facilities, and medical staff, according to International Humanitarian Law.”
Since fighting broke out on Monday, MSF had treated 394 wounded. At the time of the aerial attack there were 105 patients and their caretakers in the hospital, alongside more than 80 international and national MSF staff. MSF expresses its sincere condolences to the families and friends of its staff members and patients who have tragically lost their lives in this attack.
MSF’s hospital is the only facility of its kind in the north-eastern region of Afghanistan. For four years it has been providing free high level life- and limb-saving trauma care. In 2014, more than 22,000 patients received care at the hospital and more than 5,900 surgeries were performed. MSF treats all people according to their medical needs and does not make any distinctions based on a patient’s ethnicity, religious beliefs or political affiliation.
MSF is an international medical organization and first worked in Afghanistan in 1980. MSF opened Kunduz Trauma Center in August 2011 to provide high quality, free medical and surgical care to victims of trauma such as traffic accidents, as well as those with conflict related injuries from bomb blasts or gunshots.
In Afghanistan, MSF supports the Ministry of Public Health in Ahmad Shah Baba hospital in eastern Kabul, Dasht-e-Barchi maternity in western Kabul and Boost hospital in Lashkar Gah, Helmand province. In Khost, in the east of the country, MSF runs a maternity hospital. MSF relies only on private funding for its work in Afghanistan and does not accept money from any government.
UPDATE ON HOSPITAL BOMBING CASUALTIES:
It is with deep sadness that we confirm so far the death of 12 MSF staff members during the bombing of MSF’s hospital in Kunduz on October 3. At least ten patients from the Intensive Care Unit were also killed, among them three children. Latest casualty figures report 37 people seriously wounded, of whom 19 are MSF staff, and 18 patients and caretakers. Some of the most critically injured are being transferred for stabilization to a hospital in Puli Khumri, two hours’ drive away. There are many patients and staff who remain unaccounted for.
UPDATE: Fighting in Kunduz October 2nd, 2015
A Doctors Without Borders/Médecins Sans Frontières' (MSF) trauma hospital has been overwhelmed with wounded patients since heavy fighting between government and opposition forces engulfed Kunduz city on Monday.
Since early Monday morning, MSF's medical teams have treated 337 wounded people, including 59 children. The majority of patients had sustained gunshot wounds and surgeons have been treating severe abdominal, limb, and head injuries. Eighty-nine patients arrived in critical condition, and 44 were dead on arrival.
MSF's international and Afghan medical team has been working nonstop to provide the best possible care, performing 109 surgeries since Monday. Wounded patients continued to arrive and critical patients were also referred to the hospital from MSF's stabilization clinic in Chardara District, about 10 miles away. To accommodate these new patients, the team had increased the trauma center's bed capacity from 92 to 150. A number of patients were discharged early Thursday morning, reducing pressure on the medical team.
"MSF’s hospital is the only facility of its kind in the whole north-eastern region of Afghanistan providing free high level life- and limb-saving trauma care. Our doctors treat all people according to their medical needs and do not make distinctions based on a patient’s race, ethnicity, religious beliefs, or political affiliation,” said Guilhem Molinie, Country Representative, MSF Afghanistan.
The team continues to run full medical activities in the MSF hospital despite the continued insecurity and fighting nearby.
2014 Operational Highlights
This is an excerpt from MSF's 2014 International Activity Report, published annually looking back on our work in the previous year.
After more than a decade of international aid and investment, access to basic and emergency medical care in Afghanistan remains severely limited and ill-adapted to meet the growing needs created by the ongoing conflict.
In February 2014, MSF published a report entitled Between Rhetoric and Reality: The Ongoing Struggle to Access Healthcare in Afghanistan, which revealed the serious and often deadly risks that people are forced to take to access medical care. It found that the majority of the 800 patients interviewed could not reach critical medical assistance due to insecurity, distance, and cost. Of those who reached MSF hospitals, 40 percent told us they had faced fighting, landmines, checkpoints, or harassment on their journey. Their testimonies exposed a wide gap between what exists on paper in terms of health care and what is actually available.
Map taken from MSF's 2014 International Activity Report.
Dasht-e-Barchi Hospital, Kabul
At the end of November, MSF opened a maternity department in the district hospital of Dasht-e-Barchi, western Kabul.
Over the past decade, Kabul has become one of the world’s fastest-growing cities but services have not kept pace with the rapid increase in population. The area of Dasht-e-Barchi has over one million inhabitants but only one public hospital and three public health centers. In a bid to reduce maternal and neonatal mortality, MSF opened a new obstetric department within the hospital, providing free, around-the-clock care for women presenting with complications in pregnancy or labor, and for seriously ill newborns. Just over a month after opening, the department was already functioning at maximum capacity, and there had been 627 deliveries by the end of December, including 33 Caesarean sections.
The 46-bed facility includes a delivery room, an intensive care unit for women and newborns, an inpatient department, and an operating theater. Vaccinations, laboratory services, and a blood bank are also available. There is even a ‘kangaroo room’, where mothers carry their newborns on their chest, skin to skin, so that their warmth acts as a natural incubator, regulating the baby’s temperature.
Ahmad Shah Baba Hospital, Kabul
In eastern Kabul, MSF continued to upgrade Ahmad Shah Baba Hospital, by increasing bed capacity and training staff. Providing free and high-quality medical care, with a particular focus on emergency and maternity services, the hospital is now the most important maternal health facility in Bagrami and surrounding districts, with operating theaters and surgeons available at all times. This year, the team assisted 14,968 deliveries, performed 949 surgical procedures, and carried out 10,094 antenatal consultations.
Trauma Center, Kunduz
In the northern province of Kunduz, the MSF trauma center provides free surgical care to those with conflict-related injuries, as well as to victims of general trauma such as traffic accidents, and people with moderate and severe head injuries. Construction and refurbishment work continued in 2014: the intensive care unit was expanded and the total bed capacity in the hospital was increased to 70.
The number of patients visiting the center rose in 2014. Staff treated a total of 22,193 people and performed 5,962 surgical procedures. About 54 percent of the patients admitted for more prolonged treatment had conflict related injuries—from explosions, gunshots, or rocket attacks. As it is the only trauma center in the northern region, patients come from surrounding provinces such as Baghlan, Takhar, and Badakhshan. During intense periods of fighting, people traveling to the trauma center are at risk of being caught in crossfire and they are also delayed at checkpoints. For some patients, arriving within an hour of the incident can save their limbs or even their lives.
MSF’s study published in February showed that in Kunduz more than one in five people had waited over 12 hours before going to the hospital, either because they could not travel at night for security reasons, or because there was fighting or they simply could not find transport.
Khost Maternity Hospital
The hospital in Khost is the only specialized maternity hospital in the area, and it aims to provide a safe environment for women to give birth. It focuses on assisting with complicated deliveries and reducing the high number of maternal deaths in the province. Many patients travel long distances to access the free, high-quality care on offer. Staff assisted in the delivery of 15,204 babies; approximately one in three children born in Khost province was delivered in the MSF hospital this year.
Video | Afghanistan: Addressing Huge Medical Needs in the Outskirts of Kabul
Emergency Assistance in Gulan Refugee Camp
At the beginning of the summer, tens of thousands of people fleeing a military offensive in the Pakistani region of North Waziristan crossed the border into Afghanistan, seeking refuge in Khost, Paktia, and Paktika provinces. From July to September, MSF teams provided assistance with medical care and water and sanitation in Gulan refugee camp, 11 miles from Khost city. In view of the low vaccination coverage in North Waziristan, teams focused on measles vaccinations for children aged six months to 15 years—more than 2,900 were vaccinated. A clinic was also set up in the camp, where a medical team treated on average 100 patients per day. Once the basic services were up and running, MSF handed over the medical and sanitation activities to other humanitarian organizations who could provide longer-term support to the refugees.
Boost Hospital, Lashkargah, Helmand Province
An MSF team continued to support Boost Hospital with surgery, internal medicine, emergency services, and maternal, pediatric, and intensive care. The 285-bed facility admitted around 2,480 patients and performed 300 surgical procedures each month. The maternity wards capacity was expanded from 40 to 60 beds and 9,207 babies were delivered in 2014. Helmand is one of the provinces most severely affected by the ongoing conflict. People have to deal with landmines, bombs, and outbreaks of fighting on an almost daily basis. MSF’s February report revealed that as a result of insecurity, some patients had waited more than a week before seeking medical help. These delays are particularly dangerous for children, many of whom are very sick by the time they arrive at the hospital. Malnutrition remains one of the main causes of child mortality in Helmand province and the hospital’s therapeutic feeding center treated 2,200 severely malnourished children this year.
At the end of 2014, MSF had 1,738 staff in Afghanistan. MSF first began working in the country in 1980.
In 2014, MSF staff in Afghanistan had assisted with 39,600 births
Fatima, 30 years old, Dasht-e-Barchi
“I feel very tired but so happy. It’s my first baby. I have been pregnant four times before but never had a baby. I lost each of them, after three months, four months, and five months. The last one after six months . . . When I got pregnant again, I went to a small private clinic for antenatal care. I never did before because we don’t have money to spend for that. But this time, we really thought it was important and I went three times . . . My husband had to work a lot to pay for the medical care. Our neighbors told us to come [to the MSF clinic] once the baby came. They said I would be taken care of.”
This page was last updated October 5, 2015.