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MSF in Afghanistan, 2010
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Humanitarian needs grew in Afghanistan in 2010, as the war spread to almost all provinces. Health structures throughout the country lack medical staff and essential supplies. Unregulated and expensive private health services are often the only option. The roads are dangerous and people often risk their lives in travelling to seek medical care. Sometimes, by the time a person reaches hospital, a condition that may have initially been relatively easy to treat has become life-threatening.
This general deterioration in healthcare provision motivated MSF’s return to Afghanistan in 2009. MSF secured agreements with the different parties involved in the conflict to begin activities in two hospitals: Ahmed Shah Baba hospital in east Kabul, the capital, and Boost hospital in Lashkargah, the capital of Helmand province in the south.
Hospital care in Kabul
The population of Kabul has tripled over the last ten years. Many people have fled conflict-torn areas for the relative safety of the capital; others have been pushed by poverty to try and make a living in the city. Returnees from Pakistan and other provinces of Afghanistan have also made their way to Kabul. As a result, the fragile health system has been stretched to its limit, leaving many people without access to medical care.
In Ahmed Shah Baba hospital, MSF doctors, midwives, nurses and surgeons worked with the hospital’s existing medical staff. MSF focused on the emergency department, maternity services and treatment protocols, increasing the medical services available so that fewer patients would have to be referred elsewhere. Improvements were made to the maternity and emergency departments, and to the laboratory and X-ray services. More than 50 newly recruited hospital staff were also given training and support. By October, an operating theatre and a small inpatient department had been put in place. The first surgery was performed at the end of October, and 40 more operations had been carried out by the end of the year.
Throughout the year, patient numbers increased significantly. Nearly 10,240 medical consultations took place in October, compared with 5,500 in October 2009, when MSF started its activities. In 2010, maternity staff held almost 7,400 antenatal consultations, assisted more than 4,070 births, and carried out more than 1,500 family planning sessions. Overall, more than 118,200 patients were seen in the various departments of Ahmed Shah Baba hospital.
Boost hospital, Helmand
In November 2009, MSF started to support Boost provincial hospital in Lashkargah. Helmand’s one million inhabitants are among those who have suffered most from the ongoing conflict. Many rural health clinics are now dysfunctional, as qualified health staff have left the insecure areas, and supplying drugs and medical materials has become increasingly difficult. Insecurity has also made it difficult for people to reach specialist health services.
In 2010, MSF worked to return the 155-bed hospital to a functioning referral hospital – one of only two in southern Afghanistan. MSF extended its medical support to all wards, including the maternity, paediatric, surgical and emergency departments. Medicines and medical equipment were also provided. As a condition of its support, MSF requested that the hospital implement a “no weapons” policy, which means all weapons must be left at the entrance, making the hospital less of a potential target and allowing patients to feel less threatened.
Halfway through the year, a nearby hospital for the war-wounded, operated by the Italian organisation Emergency, closed for four months. Boost was able to cope with the increase in trauma cases requiring surgery. Around 1,500 surgical operations were performed in 2010, nearly 400 of which were for war-related injuries. From May, the upgraded emergency department was able to stabilise critical cases around the clock before transferring them to Boost’s other departments for more specialised care. From May to December, around 26,000 patients – ten per cent of whom were in critical condition – received treatment. Services that had been virtually non-existent before 2010 were approaching full capacity. Some 2,500 babies were born in the expanded maternity department: 480 deliveries were complicated.
Children accounted for 25 to 30 per cent of hospital patients. In September, a 16-bed extension of the paediatric ward meant children were no longer obliged to share beds. Overall, around 2,200 children were treated at the hospital in 2010, 550 of whom were newborns.
MSF first worked in Afghanistan in 1984.