Why are we there?
- Armed Conflict
- Access to health care
This is an excerpt from MSF's 2013 International Activity Report, published annually looking back on our work in the previous year.
Conflict in Afghanistan continues to limit access to quality health care services.
In 2013, the ongoing war and its consequences continued to restrict people’s access to quality medical services – in particular to specialist healthcare.
Private clinics are unaffordable for most Afghans and many public hospitals are understaffed and overburdened. Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent. Insecurity can also prevent entire communities from travelling to hospitals. Afghanistan has some of the worst health indicators in the world according to the World Health Organization, and is still one of the riskiest places to be a pregnant woman or a young child. MSF focuses on ensuring people have better access to free, quality healthcare in some of the most conflict affected areas.
Ahmad Shah Baba hospital, Kabul
The number of people in Kabul has increased significantly as a result of migration, displacement and repatriation. In eastern Kabul, MSF has been upgrading Ahmad Shah Baba hospital to become a reliable district hospital, and has trained Afghan staff from the Ministry of Health and MSF so that they can provide emergency and maternity services around the clock.
Major work completed in 2013 included a new waiting area, the relocation of the female outpatient department and the opening of a new maternity ward with 21 beds offering labor, delivery, and post-delivery care. This year, staff assisted approximately 1,000 births every month. The hospital also provided treatment for malnourished children, admitting 500 children to the therapeutic feeding program.
In January, MSF launched a mobile clinic to assist displaced people suffering as a result of Kabul’s harsh winter. The team worked in six camps and conducted 2,000 consultations over a three-month period. From April, MSF operated mobile clinics in the Ahmad Shah Baba area to carry out antenatal and postnatal consultations, and vaccinations for children.
Trauma care in Kunduz
In the northern province of Kunduz, the MSF trauma center which opened in 2011 continued to provide free surgical care to victims of general trauma such as traffic accidents, as well as conflict-related injuries like gunshot wounds. As of this year, the hospital also admitted patients with moderate and severe head injuries. It was equipped in January with internal fixation facilities, and staff members were trained in the relevant medical protocols and techniques.
Extensive construction continued, and refurbishment of the old hospital building allowed the emergency room and operating theaters to be accommodated under one roof. More space was made available enabling better triage and treatment, and a third operating theater was also completed. The outpatient and physiotherapy departments were also moved into the building, facilitating access for patients returning for follow-up visits. More than 12,000 physiotherapy sessions were conducted during the year.
A mental health program was launched in 2013 to provide psychological support to patients and families coping with traumatic events and bereavement. MSF also started health promotion activities in the hospital for patients and their caregivers.
The number of patients visiting the center continued to increase. Staff treated a total of 17,000 people, about 10 percent of whom were suffering from conflict-related injuries, and performed 4,500 surgical procedures, three times more than in 2012.
Ensuring safety at Khost maternity hospital
The 83-bed hospital in Khost is the only specialized maternity hospital in the area, and it aims to provide a safe and healthy environment for women to give birth. It focuses in particular on assisting with complicated deliveries and on reducing the high number of maternal and neonatal deaths in the province. Many patients travel long distances to access the free, high-quality care on offer. Staff assisted in the delivery of 12,000 babies and helped more than 2,000 women who had complications during pregnancy or labor.
The recruitment of qualified female medical staff in Khost has been a challenge. There is a general lack of skilled female medical staff in Afghanistan and many qualified specialists prefer to live and work in the big cities. MSF international staff help fill the gap and also provide training.
Boost hospital, Lashkargah, Helmand province
An MSF team continued to support Boost hospital, one of only two functioning referral hospitals in southern Afghanistan, with surgery, internal medicine, and maternal, pediatric, intensive care, and emergency services. The 250-bed hospital admitted an average of 1,300 patients monthly. A total of 66,000 patients were treated in the emergency room and 5,600 surgical procedures were performed.
Malnutrition remains one of the main causes of child mortality in Helmand province. The hospital’s therapeutic feeding center treated 3,200 malnourished children in 2013. Despite extensions in 2010 and 2011, the 90-bed pediatric ward overflowed with patients and approximately 200 children were admitted monthly. Following an evaluation of healthcare resources in the Lashkargah area, MSF decided to close the hospital’s general outpatient department at the end of 2013, as basic health services were now available.
In February 2014, MSF published a report entitled Between Rhetoric and Reality: The Ongoing Struggle to Access Healthcare in Afghanistan, based on information collected in locations where teams operated in 2013.
At the end of 2013, MSF had 1,526 staff in Afghanistan. MSF first began working in the country in 1981.
In 2013, MSF staff at the Khost maternity center delivered nearly 13,000 babies.
Abdullah*, 40, Helmand province
Our houses are destroyed. Our children are hurt. Even our wounded are helpless.
One is putting bombs under our feet. The other is dropping them on our heads. Where can we go?
Vaccination is needed everywhere, but there is a war in Afghanistan. There is no peace. Sometimes it’s quiet, but then the fighting starts again. What we need is a proper clinic in a safe place.
We had to leave our homes. It’s been one year since we’ve been to our village.
Two months ago we arrived in this new place. Still there is fighting. This is our reality.
* The patient’s name has been changed.