Doctors Without Borders/Médecins Sans Frontières (MSF) began working in Afghanistan in 1979. After the Soviet invasion MSF medical teams undertook clandestine cross-border operations to provide assistance to people stranded in areas hardest-hit by the turmoil. MSF continued to develop programs over the next 24 years: conducting surgery as fighting raged in Kabul during the mujahedeen wars; providing medical care to women and advocating on their behalf during the rise of the Taliban; and running clinics for people displaced by fighting during the Taliban years and in the aftermath of the United States-led military intervention.

On June 2, 2004, five MSF aid workers were assassinated while traveling in a clearly marked MSF vehicle. At the time, 80 MSF international aid workers and 1,400 Afghan staff were providing health care in 13 provinces. These teams faced an increasingly violent and chaotic environment, in which aid workers had become targets for military factions, and where the lines between military and humanitarian action had become increasingly blurred. Unable to ensure the security of its teams, MSF closed all of its medical programs in Afghanistan in July 2004.

Soviet Occupation (1979-1989)

Following the Soviet invasion of Afghanistan, MSF sent a medical team to Pakistan to assess the needs of Afghan refugees. When MSF was refused access to provide assistance at refugee camps in Pakistan, the assessment team, led by Dr. Juliette Fournot and Dr. Kohout, decided to enter Afghanistan and document critical conditions inside the country demanding a response from the organization. At first, small teams of MSF international aid workers did their work in makeshift clinics. The operation rapidly expanded its scope and reach in an effort to match the immense needs caused by the conflict.

From logistical bases in Peshawar and Quetta, Pakistan, Dr. Fournot, head of mission between 1983 and 1989, negotiated security agreements with various local mujahedeen commanders. Small teams of doctors and nurses were sent, after learning rudimentary Farsi, the local Afghan language, along with mule caravans transporting several tons of medicines and medical supplies. Some caravans were sent to Paktia and Nuristan, close to the Afghanistan-Pakistan border, while others journeyed for several weeks to the extreme west (Herat Province), northeast (Badakhshan Province), northwest (Mazar Province), and central region (Hazaradjat) to provide medical care and train local medical staff. In these remote locations, the teams were stranded by snow in winter and rotated every 14 months.

Throughout the Soviet-Afghan conflict, MSF ran about 15 assistance programs providing services ranging from medical care and training, to heavy war-surgery in Mazar and Herat Provinces, to immunization campaigns staffed by more than 35 international staff and hundreds of Afghans. In each location, teams of three to nine international volunteers, including nurses, physicians, surgeons, anesthetists, and lab technicians, worked alongside five to 15 local medics plus Afghan support staff. Throughout this period, Soviet forces frequently bombed medical facilities and attacked MSF supply caravans. The MSF facilities were placed in areas difficult to target with aerial bombardment or were surrounded by bomb shelters in which patients and staff sought refuge during air attacks.

This period also included many threats to MSF’s independence. In 1984, Afghan political parties established in Pakistan, the primary contacts for MSF, requested that MSF stop sending female staff throughout Afghanistan. The request followed mounting pressure from conservative Arab Islamic groups who were funding much of the relief efforts in the Afghan refugee camps in Pakistan. MSF decided to cease its operations under these constraints, given the threat to its operational independence and the impact removing female staff would have on access to medical care for women and children. The reasons for the cessation of MSF’s operations were communicated widely to the affected Afghan populations; discontent soon began to brew inside Afghanistan over the loss of MSF’s medical services. The pressure from the Afghan communities forced Afghan exile groups to relinquish their ban on female staff working with MSF inside the country the following spring. MSF quickly resumed its operations.

The dangers faced by MSF teams were not limited to Soviet MiG fighter jets or attack helicopters. In 1987, two MSF teams with a total of 12 international staff transporting tons of medical supplies were kidnapped by militant Islamic extremist groups with the alleged motive of trading them to Soviet forces in exchange for weapons to fight the mujahedeen commander Ahmad Shah Massoud. The extremists killed five Afghan MSF staff in the team. Given that MSF’s medical programs spanned various regions of Afghanistan, often home to opposing factions within the mujahedeen, the organization’s impartiality was demonstrated towards all sides. Pressure mounted on the kidnappers and the two teams were finally freed.

By 1986, after Pakistan finally granted MSF permission to work in some of its border regions, MSF began to assist Afghan refugees in the Chitral and Baluchistan regions of Pakistan, where 3.5 million Afghans had sought sanctuary from the fighting.

Civil War (1989-1996)

After the last Soviet soldiers left Afghanistan in February 1989, the mujahedeen set their sights on overthrowing the Communist government in Kabul. With the killing of MSF logistician Frederic Galland in April 1990 in Badakhshan, MSF suspended all operations.

In 1992, fighting raged in Kabul as the mujahedeen launched their final offensive against the government. Reacting to the mounting casualties, MSF airlifted a surgical team and 20 tons of medical supplies into the capital to treat war-wounded. In northern Afghanistan, MSF teams assisted Tajik refugees fleeing civil war in their country.

After the ouster of the government, mujahedeen commanders turned against one another in a grab for power. With fighting taking place in Kabul and elsewhere, MSF expanded its medical programs to the hardest-hit areas. Activities included primary health care, water-and-sanitation programs, mother-and-child health care, malaria and cholera treatment, vaccination campaigns, and hospital support and rehabilitation.

Taliban Regime (1996-2001)

In September 1996, the Taliban seized control of Kabul and instituted an extreme interpretation of Islamic law. At the time, MSF was operating in 11 provinces across the country, working in internally displaced persons camps and camps for Turkmen refugees, training local staff, and supplying hospitals.

MSF volunteers treated increasing numbers of landmine victims and provided information from the frontlines to an international advocacy movement aimed at banning these weapons. The organization clashed with the Taliban in certain regions of the country over edicts restricting women’s access to medical care. However, in other areas of Taliban control, such as Ghazni, where a female Afghan pediatrician ran several wards of the hospital, MSF did not face the same constraints experienced by other teams and had significant space to carry out its work, exemplifying the varying degrees of restrictions on humanitarian aid in areas under Taliban rule.

Against a backdrop of ongoing conflict, Afghans endured food shortages, drought, and epidemic outbreaks of cholera and scurvy. MSF teams responded continually to emergencies and assisted people in as many as 15 provinces and in refugee camps in Pakistan. Conditions worsened as the Taliban and Northern Alliance fought ferocious battles in the north, displacing more Afghans.

U.S. Intervention (2001-2004)

In the days after the September 11, 2001, attacks, all MSF international aid workers working in Taliban-controlled areas evacuated, while programs continued in the hands of Afghan staff. In November, MSF volunteers were among the first to return after US forces dislodged the Taliban.

In 2002, the return of more than two million Afghan refugees exceeded the war-ravaged country’s capacity to absorb them. More than 100 MSF international volunteers and 1,000 Afghan staff treated 45,000 patients in 16 provinces. In the north, teams cared for 4,000 children in feeding centers and distributed food to people at risk of malnutrition.

As war continued in the south, insurgents deliberately killed aid workers and other civilians as a strategy of war against US-led coalition forces and the government of President Hamid Karzai. At the same time, the US government’s strategy of combining relief and military operations increased the vulnerability of humanitarian aid workers, whose work was perceived as a component of the military effort.

In June 2004, five MSF aid workers were killed in a targeted attack on their vehicle in Baghdis Province. With the government of President Karzai unable or unwilling to prosecute the perpetrators of the killings, and an open threat remaining against MSF teams, the organization withdrew from the country, after 24 years of assisting the Afghan people.

Doctors Without Borders/Médecins Sans Frontières (MSF) is an international independent medical humanitarian organization that delivers emergency aid to people affected by armed conflict, medical catastrophes, natural disasters, and malnutrition in more than 60 countries. The organization was awarded the Nobel Peace Prize in 1999.