Despite intensifying conflict in Afghanistan, Doctors Without Borders/ Médecins Sans Frontières (MSF) is providing vital medical services across all five of its projects in Lashkar Gah, Kunduz, Kandahar, Herat, and Khost.
Since the beginning of the year, fighting has steadily increased across the country, with a considerable deterioration in security since May. United States and NATO forces are withdrawing troops, and Afghan government forces and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban) are fighting for territory.
MSF teams are witnessing the impacts of the conflict first-hand. People are being killed and injured in the crossfire or by explosions. A UNAMA report published in July stated that the number of civilian casualties during May and June was the highest for those months since it began systematic documentation in 2009. Many people also find it increasingly difficult to reach medical facilities due to heavy fighting. When people cannot travel safely, they often delay going to the hospital until they are severely ill. MSF is urging all parties to the conflict to take all necessary measures to ensure that health facilities, patients, and staff are not attacked or threatened, and that patients can safely access medical care.
Thousands of people are being forced from their homes. The Afghan Independent Human Rights Commission estimates that as many as 938,000 people have been newly displaced from their homes by conflict over the past three months, and approximately five million people have been internally displaced in total.
The mass movements of people and increasing numbers of casualties are putting health structures under increased pressure, meaning patients cannot access the care they need. The Afghan health system was already underfunded and under-resourced, but now it is at the breaking point.
MSF operations in Afghanistan
The situation in Lashkar Gah is very tense, and fighting has entered this capital city of Helmand province. On August 9, a rocket exploded in the compound of MSF-supported Boost hospital, very close to the emergency room. Fortunately there were no casualties.
The main trauma facility has at times been overwhelmed by the number of war wounded people. More recently, many people have fled the city, and there are fewer patients arriving at the hospital. The MSF team are currently living in the basement of the hospital and continuing to treat patients. Staff are working amid the sounds of shelling, gunfire, war planes, and helicopters.
War-wounded people and regular patients are finding it increasingly difficult to access health care. People are forced to wait for a lull in the fighting before trying to reach the hospital, which results in sudden influxes of patients with severe conditions.
Between May and the end of July, the MSF team treated 482 war-wounded people, nearly all (92 percent) for injuries caused by shells and bullets, and around a quarter (26 percent) aged under 18. In one day in early August, 23 surgeries were performed.
- 652 war-wounded people treated from May 3 to August 6; 170 war-wounded treated between August 1 and 6
- 71 surgical interventions between August 1 and 6
MSF has been supporting Boost provincial hospital in Lashkar Gah since 2009. The hospital serves a population of approximately 1.3 million and is the only referral hospital in the province.
MSF supports the emergency room, surgical unit, inpatient department, maternity department, neonatology unit, laboratory and radiology department, the 82-bed pediatric department, and an inpatient therapeutic feeding center.
Fighting had also been taking place around the outskirts of the city of Kunduz until August 7, when the IEA made large territorial gains. Fighting then moved into the city itself, with gunfire, rocket-propelled grenades, mortars, and airstrikes in densely populated areas. On August 8 the city came under control of the IEA, apart from the airport, which remained under government control. MSF activities continue.
To address the most immediate needs, MSF opened a temporary clinic on July 6 to provide care for people displaced by the fighting. We provided outpatient consultations for women, children, and wounded people in the Sar Dawra area of Kunduz city. The clinic saw around 300 patients per day. Those who needed further care were referred to the Kunduz regional hospital. The teams also provided safe drinking water. These activities were handed over to another organization in early August, so that the team could focus on providing trauma care.
On July 26, the MSF office space was transformed into the Kunduz Emergency Trauma Unit (KETU), providing emergency surgical care to people injured by the fighting. The facility, with an initial capacity of 25 beds, has an emergency room, operating theater, inpatient department (including high dependency beds), dressing and procedure room, and pharmacy. MSF supports the regional hospital with supplies for sterilization, surgery, and wound care. Our support to the District Advanced Post located outside of Kunduz city also continues, and there has also been an increase in the number of wounded people in recent weeks. An MSF team provides first aid and stabilization to trauma patients and ensures referrals for those with more severe health needs.
- 126 patients treated in the District Advanced Post between August 1 and 8
- 127 patients treated in the KETU between August 1 and 9, including 27 children aged under 16. 48 surgeries were performed over the same period
Kandahar has seen an increase in fighting in recent weeks, and MSF has adapted its activities to respond. We continue to run the drug-resistant tuberculosis (DR-TB) project in partnership with the Ministry of Public Health. Patients have been offered remote consultations and provided with buffer stocks of medication so they can avoid crossing the frontlines to access care.
The fighting has also displaced thousands of people, and many have sought shelter inside the city. MSF has set up a temporary clinic in Haji camp, Kandahar city, where 500 people are currently living. We are offering primary health care for children under 5 years old. The team is also rehabilitating water points and working to ensure access to showers and toilets.
- 170 patients under five treated in the temporary clinic since July 28
The MSF-run TB center includes a laboratory, outpatient clinic, and 10 beds for inpatients who are suffering from DR-TB. MSF provides mental health support and undertakes health promotion activities.
Fighting has not yet entered the city center but continues to be intense in areas along the periphery. The level of violence has forced MSF to put its outreach activities on standby. MSF activities are continuing in the inpatient therapeutic treatment center (ITFC) in the Gazar Gah COVID-19 treatment center in Herat city, and in the primary health care clinic in Kahdestan camp for internally displaced people.
We have begun to see the consequences of the fighting on our patients. Some people have delayed bringing their children to the ITFC due to the violence. The Kahdestan clinic has seen a large reduction in the number of people arriving for consultations, with around 160 per day rather than the 450 we would expect previously.
Since December 2019, MSF has been supporting the Herat regional hospital’s 40-bed inpatient therapeutic feeding center. The majority of patients and caretakers travel more than 15 kilometers to come for care, and some from as far away as Badghis, Ghor, and Farah.
MSF has also been running a clinic for internally displaced people and the local community in Herat since December 2018. The clinic offers general consultations, including for noncommunicable diseases, screening, and treatment of malnutrition, pre- and post-natal consultations, as well as childhood vaccinations and health promotion sessions to displaced people living in Shaidayee (currently on standby) and Kahdestan.
MSF has been assisting the COVID-19 pandemic response by triaging cases in Herat regional hospital since April 2020. (Due to the fighting, we recently scaled down this part of the activity to reduce our teams’ exposure.) We also established a COVID-19 treatment center in Gazar Gah. This center helps to increase the region’s bed capacity for patients in need of oxygen and has so far been operational three times, opening in response to different waves of the pandemic. The center provided treatment to patients with severe COVID-19 symptoms from June to September 2020, December 2020 to February 2021, and most recently from June 9, 2021.
MSF activities continue at the maternity hospital in Khost, and in the eight supported comprehensive health centers (CHCs). In July there were 1,450 deliveries in the Khost maternity hospital and over 870 in the health centers supported by MSF.
MSF opened the hospital in 2012 to provide safe, high-quality, and free maternal and neonatal care to women and their babies in the southeastern part of the country. MSF has also worked with the Ministry of Public Health to support the CHCs. Increasing the capacity of these centers will allow them to stay open 24/7, and also means they can assist with non-complicated deliveries, enabling more patients to give birth closer to home.
The hospital services comprise an inpatient department of 60 beds, a 10-bed delivery unit, a 28-bed newborn unit—which includes a 10-bed neonatal intensive care unit and a dedicated kangaroo mother care area—two operating theaters, vaccinations for newborn babies, family planning, and health promotion.
MSF is a medical humanitarian organization operating under the principles of independence, impartiality, and neutrality. Since the 1980s, MSF has provided medical care throughout Afghanistan in areas under the control of a variety of political and armed factions. In Afghanistan, MSF relies solely on private funding and does not accept funds from any government for its work.