As the war in Afghanistan escalated in 2009, Afghan civilians endured increasing levels of violence throughout the country. The insecurity has damaged an already beleaguered health-care system, leaving only a few poorly functioning hospitals and clinics in provincial capitals. Afghans in need of any health care must now make an impossible choice: risk traveling hundreds of miles through a war zone to seek a medical care or allow a condition to worsen until it becomes life-threatening only to arrive at a health structure where services are greatly diminished.
MSF has returned to Afghanistan after nearly five years of absence following the murders of five of our colleagues in June 2004. At that time, many had hoped that Afghanistan was in a post-conflict situation. Today that hope has been crushed and the need for emergency medical assistance remains acute.
In eastern Kabul, MSF began supporting a wide range of medical services at Ahmed Shah Baba hospital in an area where the influx of returnees from Pakistan and displaced people fleeing war in the eastern provinces has nearly quadrupled the population. Despite the needs and low health-care coverage, this area has so far been neglected because it is not a priority in counter-insurgency aid policies. MSF has also started working in the only public general hospital still functioning in Lashkargah, the capital of Helmand Province. Because the hospital’s staff mostly works in the private sector, and the medicine is too expensive, few people have so far been seeking care there.
Unfortunately, as needs increase it has become more and more difficult for impartial and neutral aid organizations to convince all parties involved that their only objective is to provide assistance. The once clear distinction between armies, reconstruction and development activities and humanitarian aid has become confused to the point where health care has become part of the battlefield: international coalition forces have co-opted assistance for “hearts and minds” initiatives, occupied hospitals, and arrested patients in their beds while armed opposition groups have targeted health care workers and health structures because of the presence of international forces providing relief.
In order to be accepted by all parties involved in a conflict, a private medical-humanitarian organization like MSF must demonstrate, and clearly communicate, complete impartiality, neutrality, and independence by, for instance, not take any side in the conflict, refusing to accept funds from any governments for our work in Afghanistan or Pakistan, and ensuring all national, international, and opposition military forces, do not enter the hospitals with their guns.