Afghanistan: Providing urgent medical care to severely malnourished children in Herat

Each month, Doctors Without Borders/Médecins Sans Frontières (MSF) sees hundreds of sick children admitted to the intensive care unit (ICU) of the MSF-supported pediatric department at Herat Regional Hospital and the MSF-run inpatient therapeutic feeding center (ITFC) next door. Many are severely malnourished and fighting for their lives.

Eight-month-old Nyayesh has been in a coma for three days. Her mother sits with her and strokes her, softly humming a song. "Nyayesh has pneumonia that has overwhelmed her weakened body," says pediatrician Solveig Köbe, who has worked for MSF in Herat for six months. "She went into shock and was unconscious when she was brought to us. She had severe shortness of breath, and her circulation and heart were extremely weak.”

The MSF team in the ICU gave Nyayesh an infusion of adrenaline for shock, oxygen, fluids, and antibiotics to fight against infection. But she remains unconscious. "We are very worried about her, she could suffer brain damage," said Köebe.

Köbe and her team treat a lot of very sick children. Like Nyayesh, most are severely malnourished. They have complications such as respiratory infections, pneumonia, or measles. A congenital heart defect makes it even harder for Nyayesh's body to cope with malnutrition and inflammation.

A food crisis

Access to food was precarious in Afghanistan long before the political upheaval in August 2021. Harvests were reduced because of persistent drought and as people fled their homes to escape the conflict. After the conflict ended and the Taliban took power, international donors withdrew funding that had propped up the Afghan economy. Sanctions and other measures against the new government led to an economic crisis. Banks were paralyzed and people could no longer access their savings. Thousands of people lost their jobs and food prices skyrocketed. "We have no wheat or anything else to eat," said a woman whose granddaughter is being treated by the team in Herat. "There is no work for us. My granddaughter is so sick because of hunger and poverty.”

The health system threatened to collapse after the change of power. “It was already underfunded and dependent on international aid,” said Köbe “Then the [minimal] help was suddenly no longer there.” Even though international financial aid has been restored to the health system, it is less than before, doesn’t fund all health facilities, and has only been pledged until June. Many state institutions can no longer pay the salaries of the staff or afford operating costs. "People also have to pay for medicines and materials such as infusion needles and compresses themselves. Most of them aren't able to," said Köbe.

Two patients to a bed

In September 2021, when the health care system was at its weakest, MSF hired more doctors for its outpatient clinic for pregnant women, children, and people with non-communicable diseases in Kahdestan, a suburb of Herat. More and more people came, and the team sometimes treated up to 200 patients a day.

In October, MSF set up containers to make extra beds available at its ITFC. In December, MSF also started supporting the emergency room and ICU in the pediatric department at Herat Regional Hospital. In the first few weeks, the number of patients increased fivefold compared to the previous year. "At the moment we have 50 children in 20 beds," said Köbe. “There are two children in most cots, and sometimes three. Their mothers stay with them around the clock and sleep next to their children on fold-out armchairs at night.”

The team does everything they can to help the patients. The medics stabilize the children, treat their infections, and provide them with high-calorie therapeutic milk to build up their strength. "It's incredibly stressful, but it also feels good that together as a team we are giving these children a chance.”

Treatment brings hope

Nyayesh finally wakes up after four days in a coma. She is recovering, no longer requiring oxygen through a tube, and is breastfeeding again. Her progress gives the team hope, even if concerns about her future remain. “Nyayesh can live with her heart defect. But her chances of staying healthy would be even better if she could [receive surgery],” saidKöbe. But in Afghanistan, it is difficult to get treatment for her condition. Nevertheless, Köbe remains confident in Nyayesh’s recovery. “The therapeutic food strengthens Nyayesh and her immune system. Her body can better cope with infections now. When I [visited] her in the morning, she sat on her mom's lap and laughed at me. That's when I knew that she was over the worst."