With crucial elections approaching and the drawdown of foreign troops imminent, Afghanistan's future —and its health— are anything but certain. Over the past decade, Afghanistan has been pulled in many directions at once, not all of them good.
It is still plagued by insecurity and poor governance, and it ranks distressingly low in many categories of the UN’s human development index, such as infant mortality. At the same time, however, access to both education and health care, particularly for girls and women, has increased exponentially, and opportunities exist now that past generations could not have imagined. In some areas, people are rushing into tomorrow at breakneck speed; in others, age-old cultural traditions dictate much of life. There are also some very big questions about what will happen after this April’s presidential elections, and after the US military completes a partial or full withdrawal of forces over the next year.
As a medical organization, MSF sees this through the prism of access to health care. Having returned to Afghanistan in 2009 after a five-year absence that followed the murder of five MSF staff members in the country’s interior, the organization now runs a hospital and other programs in Kabul, the capital; a trauma center in Kunduz, one of the largest cities in the north; a full service hospital in Lashkar Gah, in long-embattled Helmand province; and a maternity program in Khost, the capital of a province of the same name that borders Pakistan.
In recent months, our teams in the country carried out extensive surveys, asking people about their medical needs and their access to medical care. Herewith, along with a selection of striking images from Afghanistan, we present some of the findings, some information about MSF’s work, and some words from Afghans themselves.
Excerpts from testimony given to MSF researchers by a 50-year-old farmer from Kapisa Province
“There is no sleep in my village. We experience harassment from every side. Each night helicopters and planes circle overhead. There are constant roadblocks, checkpoints, and attacks. Sitting or resting, we live in fear, from everyone. We are all affected, with two or three people killed, injured, or traumatized in every home.
I am a farmer; we harvest pomegranates. But when my wife and I go to our crops in our fields, we are in danger. Always at risk, always afraid.
It is too insecure to go out at night. So we can’t bring someone to the doctor at night, even if their sickness or injury is serious. We can’t drive at night, as then all of us would be killed on the road. So, we prefer if they die quickly rather than suffer through the night only to die the next day on the way. This is the reality.
In our village there are no public doctors, and there is no big public hospital in our district either. There is a public hospital at the provincial level, but there are no female doctors. What good is that to our women when our culture means they have to be seen by a female doctor for certain problems?
It’s normal because we are used to this. All this violence. But it is no life, we are just existing. Surviving the insecurity—which is the mother of all our problems.”