When fighting escalated across Afghanistan last May, Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Shah* and his colleagues at Boost hospital made the difficult choice to keep working. This 300-bed hospital in Lashkar Gah, Helmand province, is a lifeline for people here.
The team spent 12 days sleeping in a bunker under the hospital, leaving only to treat patients. “When patients came in, we would wake up and run to the emergency room,” Dr. Shah said. “We stayed in the hospital to treat our patients. It was very dangerous outside.” As the United States accelerated its military withdrawal, the Taliban (also known as the Islamic Emirate of Afghanistan, or IEA) mounted a major military offensive and eventually took power in Kabul in mid-August. The Taliban declared that the war was over. But MSF’s work wasn’t over when the fighting stopped. In the weeks that followed, MSF teams around the country were inundated with patients. Many of these people had long delayed seeking medical care for fear of being caught in the crossfire.
*Name has been changed to protect anonymity.
Keeping patients and staff safe
“MSF had an advantage because we had worked there for decades before the US military operations began,” said Ella Watson-Stryker, MSF’s humanitarian representative in the United States. “We maintained a very consistent line with all authorities and armed groups, which is that we are not there for political reasons. We are there for medical humanitarian reasons—to provide medical aid to the people most in need. The politics are not relevant to us.”
In Afghanistan, as in all conflict areas around the world, MSF operates with the agreement of both sides in the conflict. We seek to communicate directly with governments or armed groups engaged in military operations. “We’ve invested long-term in dialogue with the Taliban,” said Watson-Stryker. “We maintained this relationship independently of the United Nations (UN) or any other organization or government.”
This enabled MSF to continue to work even through the height of violence. “It was a huge sacrifice from our staff. The risk to them was very real but we were able to keep hospitals open safely,” said Watson-Stryker. “A few times when the fighting was unacceptably close to the hospital, or an aircraft was flying very low over the hospital, we were able to, in real time, remind the parties to the conflict to protect the humanitarian space.”
A crippling economic crisis
When the Taliban took power, they faced an immediate economic crisis. International aid was sharply reduced. Afghanistan’s central bank assets held abroad were frozen. Foreign banks stopped transferring money to the country. Facing a cash crisis, Afghan banks put strict limits on withdrawals. People were not able to access their savings. The health sector had already struggled to pay medical staff in a timely manner and now many health facilities could not pay salaries. And while the crisis put new strain on Afghanistan’s health system, it has been under-funded, under-staffed, and dysfunctional for years.
Most medical facilities in Afghanistan that were able to stay open remain under great pressure due to shortages of staff and supplies. Many people still can’t access the care they need in public health facilities, while private health care is unaffordable for millions of people.
“Since MSF maintained operations, we were able to negotiate and use existing routes for supplies and existing relationships with financial institutions,” said Watson-Stryker. “But we also had to expand to fill the spaces that were left.” For example, in Khost maternity hospital, where we provided care to women with high-risk pregnancies or obstetric complications, the team expanded the admission criteria to include all pregnant women.
An uncertain future
More than eight months since the end of the war, MSF teams continue to see high numbers of patients in most of our programs. Our inpatient therapeutic feeding centers in Herat and Helmand provinces continue to be extremely busy as many of the factors that cause malnutrition remain: People struggle to afford sufficient food, and persistent drought and displacement caused by the conflict have left people with fewer reserves. MSF is also seeing very high numbers of measles cases in Herat, Helmand, and Kunduz, a disease that is particularly dangerous for malnourished children.
Boost hospital has been over capacity all year. Each month more than 2,400 people are admitted to the hospital and over 20,000 people are triaged in the ER. Despite announcements earlier this year by the UN and several international donors that some temporary international funding channels would reopen, the Afghan health system is receiving less funding than it did prior to August 2021, making its future even more uncertain. Additionally, little has been done by the global financial institutions to address the larger problems affecting the financial sector, which are critical for Afghan people to receive salaries, buy food, and meet basic needs.
“Regrettably, we cannot meet the medical needs of everyone, and Afghanistan’s health system has long been propped up by foreign assistance,” said Watson-Stryker. “But we’ve done the best we can to meet those additional needs.” While we continue to face challenges on the ground, MSF is committed to continuing to provide free, high-quality health care to people in Afghanistan.