Bringing care to Afghan children in Balkh province

MSF’s new project aims to fill critical gaps in pediatric and neonatal care in Afghanistan’s northern provinces.

A small child is checked by an MSF staff member with her mother standing beside her in Afghanistan.

Afghanistan 2023 © Oriane Zerah

“I really don’t know the pain she’s going through, but I am here with her in hopes that she gets better soon,” says Farida, the mother of nine-month-old Hadia, a patient at Mazar-i-Sharif Regional Hospital in Balkh province, Afghanistan.

For two days, Hadia has refused to eat anything—not even her favorite fruit, bananas. Her mother took her to several health facilities and doctors, but her condition never seemed to improve. Desperate to see her baby get well, Farida took Hadia wherever anyone suggested. “Anything people said, I tried. I took her to many doctors and paid a lot for her prescriptions, but she did not get better, and she even developed diarrhea, which got worse,” Farida says. 

Today, Farida is in the pediatric emergency room, which Doctors Without Borders/Médecins Sans Frontières (MSF) supports. Little Hadia has been diagnosed with severe acute malnutrition. The doctors say it may have been caused by the bouts of diarrhea, among other possible reasons. Farida is hopeful that her child will get better.  

An MSF doctor checks on a child patient at the NICU MSF supports at Mazar-i-Sharif Regional Hospital in Afghanistan.
Dr. Obaidullah Asadullah checks vital signs for a child born prematurely two hours prior. Afghanistan 2023 © Oriane Zerah

One floor above the emergency room, Shekiba* holds her baby, Atoosa*, in the prematurity ward where they have been for the last two days after being discharged from the neonatal intensive care unit (NICU). For four weeks, Atoosa had been in an incubator at the NICU after being born at 28 weeks—three months earlier than her due date—weighing only about two and a half pounds.  

“It was difficult for me to see my little girl inside an incubator, with lines running into her nose and wires connected to many parts of her body,” Shekiba says. “I hated the sounds from the constant beeps of the medical equipment, because they kept reminding me that my baby was very sick. She looked so fragile.” 

“The anguish of not knowing if my little girl would get better was as though something was chewing on my insides,” she adds. “I remember the day the doctors told me that my little girl would be transferred from intensive care to the prematurity ward because she was stable. I couldn't believe it. I immediately called my husband and told him to prepare everything because the time to return home was getting closer.”

An Afghan child clutches her mother's veil at Mazar-i-Sharif Regional Hospital in Balkh province, Afghanistan.
A mother hugs her daughter at Mazar-i-Sharif Regional Hospital in Balkh province, Afghanistan.
An Afghan mother and child at Mazar-i-Sharif Regional Hospital in Balkh province, Afghanistan.

Mothers with their children at Mazar-i-Sharif Regional Hospital in Balkh province, Afghanistan. Afghanistan 2023 © Oriane Zerah

MSF intervenes in Balkh province

In August 2023, MSF launched medical services at Mazar-i-Sharif Regional Hospital in collaboration with the Ministry of Public Health, aiming to reduce pediatric and neonatal mortality rates in the northern provinces of Afghanistan. MSF currently runs a NICU and emergency room for children up to the age of 15, which is supported by a triage system to ensure the most critical patients get the care they need. 

Each month, MSF medical teams at Mazar-i-Sharif Regional Hospital admit an average of 3,000 critically ill children to the pediatric emergency room and an average of 546 newborns to the NICU. The average bed occupancy rate has consistently been higher than 140 percent since MSF started activities in the NICU. It currently accommodates 60 infants—more than double its 27-bed capacity. MSF has had to put in place additional resources to ensure that staff can continue to provide personalized care and attention to each infant and reduce the risk of burnout due to the capacity needs and limited space.  

“We intervened in Mazar-i-Sharif to address the critical health care needs of the Afghan people, particularly vulnerable infants and children, in the face of overwhelming demand, strained health care systems, and a shortage of resources,” says MSF’s head of programs at Mazar-i-Sharif, Heidi Hochstenbach. “Our goal is to ensure that every child who comes to the hospital receives the personalized care and support they need, and to reduce the number of children dying from conditions that can be treated. The high bed occupancy rates we see in the departments we support reflects the huge need for such services and the deep gaps in the provision of health care in [Balkh] province.” 

An MSF doctor checks a child patient with the mother watching in Afghanistan.
Seven-month-old Mubashir has pneumonia and was brought in by his mother Sakina.
Afghanistan 2023 © Oriane Zerah

Longterm challenges to health care access in Afghanistan

Afghanistan's health care system has long faced challenges including understaffing, underfunding, and an inadequate response to people’s needs. The health care system has faced additional strain since the change in government in August 2021 and the subsequent reduction of donor funding. This has resulted in the deterioration of health infrastructure and a further shortage of health care workers, leaving many Afghans without access to health care and increasing the risk of health problems and mortality in the country. 

A young mother’s unwavering vigil in Afghanistan

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The experiences of Farida and Shekiba highlight the needs and crucial gaps in access to health care that MSF seeks to fill with specialized care and support at Mazar-i-Sharif Regional Hospital.

“I dream of the future moments I will have with my little girl. To comb her hair, make beautiful braids, play with her, and take her to school,” Shekiba says. 

About MSF’s work in Balkh province 

MSF started working in Afghanistan in 1980 and has continually adjusted its services to align with the evolving context and needs of the Afghan people. The initiation of services in Balkh province adds to seven existing projects that MSF currently manages in the country. MSF is looking into gradually expanding its services to cover the pediatric intensive care unit, inpatient wards for severely malnourished children, and the general pediatric ward of Mazar-i-Sharif Regional Hospital.  

*Names have been changed to protect privacy