Conflict in Afghanistan continues to limit access to quality healthcare services.
People in need of healthcare must often travel long distances, across insecure areas, to reach public medical facilities. A lack of trained medical staff, particularly female doctors and nurses, further restricts access for many.
Doctors Without Borders/Médecins Sans Frontières (MSF) is expanding its work at several hospitals, aiming to meet some of the most urgent needs.

Trauma care in Kunduz
The trauma center run by MSF in Kunduz is unique in northern Afghanistan, providing free, high-quality surgical care to victims of general trauma such as those resulting from traffic accidents, as well as people with conflict-related injuries. Before the hospital opened, most people with life-threatening injuries had to travel to the capital, Kabul, or to Pakistan for treatment.
MSF developed the trauma centre in 2012 with a new emergency room, including more beds for resuscitation and observation. The center now has a new, larger outpatient clinic, better physiotherapy services and improved infection control and sterilization procedures, in preparation for the introduction of internal fixation in orthopedic procedures. Staff in the intensive care unit also implemented new protocols.

When multiple patients arrive at a health facility at the same time, emergency medical staff use triage so that those with the most critical needs get immediate attention. This type of ‘mass casualty response’ is a significant part of MSF’s work in Afghanistan,and took place on average once per month in 2012 in Kunduz, sometimes involving large numbers of people with life-threatening injuries. During civil unrest in February, 50 patients were brought to the hospital: more than 15 were severe, urgent cases.

In August, 20 people were seriously injured in an explosion in the north of the province, and in September staff tended to 33 casualties from a bus collision. Over the year, 10,000 patients were treated in the emergency department and surgeons carried out 1,500 operations.

Ahmad Shah Baba hospital, Kabul
The population of Kabul has swelled to more than three million as people migrate or are displaced due to conflict, and refugees return from Pakistan. MSF began working in Ahmad Shah Baba clinic in eastern Kabul in 2009, upgrading it to a district hospital with an emergency department, operating theatre, outpatient clinic, maternity ward and tuberculosis clinic. In 2012, emergency obstetric care, including surgery, was extended to offer services round the clock. Staff developed mental health and health promotion services to complement medical care at the hospital, particularly in maternity, nutrition, emergency and outpatient services. A system was put in place to register complaints, in order to increase transparency and improve communication with patients.

Boost hospital, Lashkargah
MSF continued to support one of the only two functioning referral hospitals in southern Afghanistan, Boost hospital in Lashkargah. It provides surgery, internal medicine, and maternity, pediatric and emergency services. Staff in the outpatient clinic saw over 7,000 patients per month, many of whom had travelled long distances to obtain medical assistance.

The number of patients has grown as people have learned about the hospital and its services. The total number of surgical procedures increased to more than
3,000, over a third of them trauma-related orthopedic operations.
The hospital also has an inpatient unit specializing in care for severely malnourished children, where some 900 children were treated. By the end of the year, the hospital was equipped with 250 beds, and an extension to the pediatric and neonatology departments was completed with MSF support. About 2,000 people were admitted to the hospital each month, a 15-fold increase in patients since MSF started work in this hospital in 2009.

Ensuring safety at Khost maternity hospital
Khost, near the border with Pakistan, is a very insecure province, with minimal medical services. The one general hospital, located outside the city of Khost, is understaffed. As a significant proportion of the surgical staff is male, women are deterred from seeking healthcare.

In March, MSF opened a maternity hospital in the city center, staffed only by female doctors and nurses. Equipped with 56 beds, the hospital has the capacity to assist more than 1,000 women to give birth every month and to deal with obstetric emergencies. Just six weeks after it opened, the hospital was targeted in a bomb attack. The explosion wounded seven people and MSF suspended activities because of the security risks to staff and patients. After several months of extensive talks with community leaders and other relevant parties, MSF was assured of support and safety for its medical activities and reopened the hospital at the end of December. Before the incident, the team assisted over 600 births. MSF continues to enforce a strict no-weapons policy at all locations where it works.

At the end of 2012, MSF had 1,111 staff in Afghanistan. MSF started working in the country in 1981.