Violence has surged in Afghanistan since May, with conflict in and around provincial capitals between Afghan forces and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban). The fighting is impeding access to medical care, increasing the numbers of people killed and wounded by bullets and explosions, and causing widespread displacement. In the areas where Doctors Without Borders/Médecins Sans Frontières (MSF) works—Lashkar Gah in Helmand province, Kandahar, Kunduz, and around Herat—the consequences of the conflict have been felt acutely.
“The situation in the country has deteriorated to a point that, in some cities like Lashkar Gah and Kunduz, the medical facilities are on the front lines,” explains Laura Bourjolly, MSF humanitarian affairs manager in Afghanistan. “MSF staff continue to treat patients in all of our projects, under dire circumstances, and we have adapted our medical activities to respond to the acute needs.”
Hospital staff pushed to the limit
Lashkar Gah, where MSF supports Boost hospital, has been convulsed by intense fighting for more than a week. Boost hospital serves a population of approximately 1.3 million and is the only referral hospital in the province. Normal life here is at a standstill, and health care staff are scrambling to treat medical, obstetric, and surgical emergencies. The MSF team is staying in the hospital to care for patients as shelling, mortar and rocket attacks, and airstrikes are landing extremely close by. On August 9, a rocket exploded in the hospital compound, very close to the emergency room. Fortunately there were no casualties.
The sounds of war make it difficult to sleep, yet so far the staff have kept all departments of the hospital open. Last week MSF teams in Boost cared for many war-wounded patients and performed as many as 20 surgeries on one day. 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. An additional 170 war-wounded patients were treated between August 1 and 6.
Many people have now fled the city, and in recent days there has been a significant reduction in the number of patients coming to the hospital for care.
Fighting also surged recently in and around Kunduz, and at the end of last week the city fell to the IEA. When the violence intensified in July, the MSF team converted office space into a 25-bed trauma unit providing care to people injured by explosions, bullets, and shrapnel. From August 1 to 9, the MSF team treated 127 patients for bullet and blast injuries, including 27 children under the age of 16.
MSF continues to provide care in this ad hoc trauma unit but has started to transfer outpatient services to the new Kunduz Trauma Center (KTC), which has been under construction since 2018. We also continue to support the district advanced post in Chahar Dara, a stabilization unit outside Kunduz city, which received 126 war-wounded patients from August 1 to 8.
Adapting to the ebb and flow of conflict
Afghanistan’s health system was struggling before the conflict intensified, and the current violence is making it even more difficult for people to access care. In areas with heavy fighting it is too dangerous for people to leave their homes for medical treatment, or they delay seeking care until they are very sick. We have noted that the numbers of patients in our emergency rooms, COVID-19 treatment center, and outpatient clinics decrease as the violence increases and are adapting accordingly. In Kandahar, where MSF treats patients with drug-resistant tuberculosis (DR-TB), we provide patients with remote consultations and extra supplies of medication so they can avoid having to cross front lines.
Medical emergencies, births and chronic conditions do not stop during times of war. During a lull in the fighting in Lashkar Gah, the number of pregnant women seeking care at Boost hospital grew. “We only had one pregnant woman in the hospital,” explains Sarah Leahy, MSF’s Helmand project coordinator. “But the next day, after the fighting died down for a bit, 10 pregnant women managed to reach us, so we know the needs are out there. We’re really worried that women are having to give birth at home with no medical help available if they have complications.”
Clashes between the warring parties have forced hundreds of thousands of people from their homes. Some have sought safety in urban areas and are living in informal settlements with little access to basics like food, shelter, and medical care. In July, MSF opened a small clinic in Kunduz to provide outpatient consultations for displaced women and children in Sar Dawra, and began providing safe drinking water to internally displaced people.
Staff at the clinic cared for about 300 people a day, and in early August MSF handed over activities to another organization to shift our focus to trauma care. In Kandahar city, MSF set up a temporary clinic providing medical care to children under five in Haji camp, an informal settlement where 5,000 displaced people are currently living. We are also rehabilitating water points and ensuring access to toilets and showers. Since July 28, more than 170 children had been treated at the clinic, mostly for respiratory illnesses, diarrhea, and anemia.
The conflict remains very dynamic, with violence flaring in different areas of the country. MSF will continue to adapt as much as possible to address the changing needs. But medical staff around Afghanistan are contending with fighting in the streets around medical facilities and little respite. Many constantly worry about the families they have left at home. As fighting enters cities, hospitals are still functioning, but the danger of indiscriminate violence is ever-present. With humanitarian needs growing across Afghanistan, the safety of medical staff, facilities and patients must be respected.