Navigating conflict and crisis in Afghanistan

An MSF project coordinator reflects on how his team kept medical activities going amid political upheaval.

When Mamman Mustapha joined the Doctors Without Borders/Médecins Sans Frontières (MSF) team in Afghanistan, it was for a short assignment in a relatively calm part of the country. In his nine months there, he went on to witness an escalating conflict, a change in government, and a growing humanitarian crisis. Here, he shares his story of witnessing historic events unfold and keeping medical activities running throughout this chaotic period. 

I arrived in Herat, in western Afghanistan, on December 31, 2020. My assignment was meant to be short, just three months initially. I was there to work as the project coordinator—responsible for coordinating our medical operations, negotiations with authorities, and security management of the team. 

Working in Herat

MSF has been working in Herat since 2018. We run a 74-bed therapeutic feeding center for malnourished children in Herat regional hospital.

On the outskirts of a camp for internally displaced people (IDP) we run a clinic that offers general medical consultations, including for noncommunicable diseases, ante and post-natal care, childhood vaccinations, and malnutrition screening and treatment. We also support the COVID-19 pandemic response by triaging suspected cases at the regional hospital and running a COVID-19 treatment center.

In those early months of 2021, the armed conflict was ongoing in Afghanistan, but Herat was relatively safe compared to other provinces in the country.

I decided to extend my assignment by another six months: I wanted to better understand the environment and the health needs of communities here.

Inpatient Therapeutic Feeding Centre (ITFC) at Herat Regional Hospital

The entrance of the MSF’s inpatient therapeutic feeding center at Herat Regional Hospital. Afghanistan 2021 © Sandra Calligaro

Everything changed

However, on May 1, 2021, almost everything began to change. By July, the conflict had reached several major cities.

Negotiation was part of my daily job, and we regularly explained to all the parties in the conflict that we are here to provide emergency medical services, we are neutral to the conflict, and we are independent in of our actions. We care for patients irrespective of their religion, gender, or political affiliation, based on their medical needs alone.

Throughout the fighting, our staff was able to keep coming to work and our doors remained open, providing lifesaving assistance to the sick and wounded even during the height of the conflict. It still makes me incredibly happy that we were able to do this.

Inpatient Therapeutic Feeding Centre (ITFC) at Herat Regional Hospital

A child receives treatment in MSF’s inpatient therapeutic feeding center at Herat Regional Hospital. Afghanistan 2021 © Sandra Calligaro

Political transition

By mid-August, the fighting was over and Afghanistan had a new government [led by the Islamic Emirate of Afghanistan, also known as the Taliban].

The safety and security of my team, patients, and caretakers remained my number one priority. I had to rapidly establish new contacts with the government starting every relationship from scratch. It was challenging but fruitful.

I met the new health representative the morning after the [Taliban] takeover. This was my first meeting with the new government, and it gave my team courage to continue our work without hindrance.

But even though the fighting had ended, there were still huge challenges. Airports and banks were closed, and throughout August and September many other medical organizations were scaling down their work, as funding was suspended by the European Union, World Bank, and others. The assets of the Afghan Central Bank were frozen by the US Federal Reserve.

A Nigerian man reads a book in a room.

Mamman Mustapha had to handle multiple challenges during a complicated government transition to make sure medical activities continued to best serve patients. Afghanistan 2021 © MSF

Lack of supplies and equipment

As a result, the health care system almost collapsed. For some time, in the regional hospital where we work, non-MSF staff weren’t paid their salaries, and many left their jobs because they needed to earn money. Staff in Herat Regional Hospital are now receiving salaries again, but some health facilities across the country still lack sufficient medical supplies and functional equipment. People are still in need of medical care.

As an organization funded directly by private donations, we didn’t face the same funding challenges, so we were able to keep working, though under increased pressure. The medical and non-medical needs in Herat are enormous, especially in the context of the current economic crisis.

There is no armed conflict in Herat, but people are still dying, as many cannot afford to buy food. In September, October, and November, the number of malnourished children arriving at our inpatient therapeutic feeding center was significantly higher than the same months last year. This is an indicator of poverty, hunger, and a general malnutrition crisis.

Leaving Herat

I finished my assignment in Afghanistan in October, saying goodbye to my Afghan colleagues, whose dedication and zeal had encouraged me a lot throughout my time there, as well as making our patients smile.

The work was challenging, incredibly intense, and demanding, but seeing the results kept me positive. And the work is continuing. In December, the team started pediatric services in Herat Regional Hospital, improving access to medical care for the sickest children in the district.

Herat is a fulfilling place to come and work, and it is a place that most people would like. However, the humanitarian situation is complex and needs to be addressed without delay, otherwise there will be a catastrophe.

The future in Afghanistan

The future of almost everything is uncertain, and our activities are still under pressure. The challenges we face will evolve, and the security of our teams and patients remain a concern. What is clear to me is that we are needed there, that our team is motivated and dedicated, and that we are doing our best—as much as we can.