The improved security situation that allows people to move freely could be contributing to the rise in the number of malnourished children coming to our facilities. Our ITFCs should be the last resort for malnourished children, yet many patients come to us having received no other health care, such as outpatient treatment for malnutrition or treatment for underlying health conditions that could help to prevent hospitalization. The lack of available care in the community also means we often see children return within weeks of being discharged from our ITFCs as they were not able to access follow-up care. People are also traveling long distances to reach us, further demonstrating the lack of options for those in need of health care.
A rapid increase in measles
MSF is treating a high number of patients with measles in our projects in Helmand and Herat. Our teams are concerned about how the situation will progress unless more children are vaccinated against the disease. In Herat, we saw a rapid increase in cases towards the end of January, and the infection rate continues to increase—we are currently seeing approximately 45 new measles cases in Herat regional hospital each day. In January, the MSF-supported Boost hospital in Helmand province treated over 600 measles patients. We are also seeing high numbers of patients in both locations presenting with malnutrition and measles, which increases vulnerability to severe illness.
The Afghan heath system has been under-funded, under-staffed and dysfunctional for years. Most health facilities in Afghanistan remain under great pressure due to shortages of staff and equipment—some are barely functioning or are closed altogether. This has left many patients unable to access the care they need in public health facilities, while private health care is unaffordable for millions of people.
Despite announcements by the United Nations (UN) and several international donors that some temporary international funding channels would reopen, the Afghan health system is receiving far less funding than it did prior to the change of government in August 2021, and the funding is only guaranteed until June 2022—making the future of the health system even more uncertain. Various donors have re-routed suspended development funding to the humanitarian response to merely keep the system afloat—but humanitarian organizations will never be a substitute for a well-functioning public health system.
The ripple effect of pre-existing sanctions and the financial measures against Afghanistan’s new government are being felt nationwide. The country faces near economic and institutional collapse and tens of thousands of people have lost their jobs and are struggling to find work. The banking sector is paralyzed preventing people from accessing their savings and making it harder for organizations providing health care, including MSF, to pay salaries and cover the operating costs of health facilities.
MSF will pay for additional staff to be recruited at Kunduz regional hospital to assist with treating the high number of measles cases and improve infection prevention and control measures. We are also paying the salaries for staff working in the COVID-19 ward at Khost provincial hospital and in six wards treating patients with multidrug-resistant tuberculosis (MDR-TB) in Balkh, Herat, Kunduz, and Paktia provinces. These facilities used to receive international funding that was withdrawn after the change in government.
MSF continues to be concerned about people’s access to health care in Afghanistan. Every year our teams have witnessed people’s health deteriorate over the winter months. Increased cases of respiratory illnesses exacerbate health problems for people with underlying health conditions and comorbidities.
MSF operations in Afghanistan
Our ITFC in Herat continued to operate above capacity in January: Our teams saw a 40 percent increase in admissions compared to December.
On December 10, 2021, MSF began supporting the intensive care unit (ICU) and emergency room (ER) of Herat Regional Hospital’s pediatric department. In January, we triaged over 14,600 patients and admitted over 3,500 to the emergency room. The most common conditions treated in the ER were respiratory tract infections, abdominal pain, convulsions, sepsis, acute watery diarrhea, and measles.