Outside the Hospital Walls: Mobile Clinics in Kabul, Afghanistan

MSF is using mobile clinics to provide care to marginalized minority groups in the Afghan capital of Kabul.

The population of Kabul has tripled over the past decade and is now estimated at more than five million. The newer residents are a varied mix of internally displaced persons fleeing conflict in more insecure regions of Afghanistan, economic migrants seeking better opportunities in the capital, returnees from refugee camps in Pakistan, families without land, and members of marginalized minority groups who struggle to find a place within mainstream Afghan society. Many of them live in the outskirts of the city and have little access to health care.

In April of this year, Doctors Without Borders/Médecins Sans Frontières (MSF) started conducting preventive mobile clinics in ten locations on Kabul’s periphery in order to reach out to these isolated communities. The clinics focus on women and children under the age of two and staff have seen almost 2,900 patients since the activities began. The team provides pre- and postnatal care and family planning for women, as well as vaccination and malnutrition screening for children. Since there is a high incidence of tuberculosis in the country, patients with the disease are also encouraged to bring their family members to the clinic for screening.

“The feeling is quite strange,” says Lajos Jecs, an MSF nurse who leads the mobile clinic team. “Even though we are in Kabul, in the capital, it looks like we are really very far from the city. The preventive care approach is important as there are a lot of Afghan women who don’t know about the need for antenatal checkups. There is no health education for them at all. A lot of mothers don’t know how to breastfeed their babies and so we see a lot of malnourished children.”

Patients who need a follow up examination or treatment are referred to the Ahmad Shah Baba District Hospital in eastern Kabul, where MSF has been working with the Afghan Ministry of Public Health since 2009.

“While we are treating an increasing number of patients in Ahmad Shah Baba and our other hospitals in Helmand, Kunduz, and Khost, we know that many more people cannot even make it to the hospitals or other health structures because of distance, insecurity or the cost of transport,” says Benoit De Gryse, MSF’s country representative in Afghanistan. “That’s why we want to go beyond our hospital walls and reach out to some of these isolated communities.”

People like 25-year-old Mina are exactly who De Gryse is talking about. She and her family walked for an hour from her village to reach MSF’s mobile clinic in Buthkak to get her children vaccinated. “We only have private doctors in our village, and it costs quite a lot of money for us to go to see them,” she says.

The mobile clinics in Kabul are the first step, but De Gryse acknowledges that this was not a simple undertaking. “The negotiation process for launching the mobile clinics took quite some time. We had to talk to different community and religious leaders and explain the preventive mobile clinic concept to them. Since then however, we have gained a lot of trust from them. They help us promote and explain the mobile clinics to their communities and we even use their houses to see patients."

“Another challenge is to ensure the security of our staff as well as our patients when we reach out to these areas. That is why the acceptance from the community is critical."