Fifteen-year-old Naqibullah became the primary caretaker for his mother when she fell ill. Of his 32-member family, 16 were diagnosed with drug-resistant tuberculosis (DR-TB) in the span of one month and admitted to the Doctors Without Borders/Médecins Sans Frontières (MSF) DR-TB hospital in Kandahar, southern Afghanistan.
“I had all the symptoms—I was coughing, I had a headache, I had pain in my legs and in my whole body, and I had a fever during the night,” said Naqibullah. “My grandmother was the first to suffer from TB and she was on medication, but she died earlier this year. We're 32 people living in a two-room house. This number of people infected with TB is because of a lack of space.”
MSF has been treating patients with DR-TB in Kandahar since 2016. MSF runs a hospital with a laboratory, an outpatient clinic, and a 24-bed inpatient department for patients diagnosed with DR-TB and those who develop adverse side effects from DR-TB medications. Many patients come from the nearby provinces of Helmand, Uruzgan, Nimroz, and Zabul, but some travel over 200 miles from provinces further away, including Daikundi, Badghis, Ghazni, and Paktika.
MSF works in close collaboration with the National Tuberculosis Control Program in Afghanistan, and provides some medical supplies and financial incentives to staff involved in the diagnosis and treatment of drug-sensitive TB patients in other Ministry of Public Health facilities in southern Afghanistan, including Mirwais Regional Hospital, provincial TB centers in Kandahar and Zabul, and Sarpoza Prison.
Zarif
First, our brother’s wife fell sick. She was coughing, with sweats and fever during the night, so we took her to the hospital in Ghazni and doctors advised her and myself to both do tests for tuberculosis. After testing, they found that she was infected with drug-resistant TB and referred us to the MSF hospital in Kandahar. The doctors told us to bring all the members of the family in for testing and checkups. After the tests, 16 members of our family were diagnosed with TB. Those who tested negative went back home.
We’ve all been here for the past month under treatment. MSF has provided us with food and free medication. We’re improving and my brother’s wife even gained 7 kg [15 lbs.] ... Before we had coughs, fever, and headaches and now we don’t have them. The children have also gained weight and their health is improving. We will be under treatment for six months—every month we will come to pick up our medications and then go back home. MSF will cover our transport costs.
Barriers to TB care in Afghanistan
According to the World Health Organization, more than 10 million people continue to fall ill with TB every year around the world. In Afghanistan, where many people rely on humanitarian aid, increasing poverty prevents patients from accessing TB treatment, along with the widespread lack of knowledge about TB.
Nazika, a mother of six, sought medical care when she became sick: “They said I was infected with Brucellosis [a bacterial infection] and I was given medication prescribed for the treatment of Brucellosis. I took that medication for one year, but I didn’t improve. When my health condition got worse, I was taken to the provincial hospital in Ghazni where doctors found that I was infected with TB.”
Another patient, 18-year-old Zainab from Nangarhar province, explained that doctors told her she had “malaria or a microbial disease” before she was taken to the Jalalabad Regional Hospital and diagnosed with TB. Both she and Nazika were then referred to MSF for care.
To improve people’s understanding of TB, MSF teams carry out regular health promotion activities in Kandahar’s local communities in addition to the information about TB that we provide patients and caretakers at the MSF hospital.
Improving TB response
Shorter treatment regimens
In 2024, 95 percent of patients enrolled for TB treatment at the MSF hospital successfully completed their treatment. This is in large part because of the six-month treatment regimen that was put in place in 2023. A shorter regimen means fewer side effects and complications, so it's easier for patients to cope and complete their treatment.
Patients with DR-TB usually stay at the MSF facility until they are no longer contagious and are then sent home with treatment, returning every month for the duration of their treatment for a check-up and a medication refill. MSF covers patients’ transportation costs and offers health promotion and psychosocial support to them and their family. Patients who require more complex treatment can stay at the facility as long as they need.
Contact tracing
Contact tracing plays a very important role in DR-TB treatment, ensuring that we can reach more people and track the spread of the disease. Because TB is highly transmissible, MSF screens patients’ family members, particularly when many people live close together in houses with limited airflow.
“We diagnose quite a number of TB cases in children, especially in the malnutrition department,” said Purity Kinyua, MSF project medical referent in Kandahar. “TB is one of the reasons why children would end up with malnutrition, and we are very rigorous when it comes to screening for TB in children. Immunity in children is lower, and so they are more susceptible to TB infection than adults.”
Female patients face additional barriers to care
Globally, more men than women have TB, but in Afghanistan this is not the case. In 2024, 66 percent of the patients diagnosed with TB were adult women and children under the age of 15, while 34 percent were adult men.
“Women and children stay at home in poorly ventilated rooms for longer periods of time than men,” said Kinyua. “And if a woman gets infected, the children are likely to catch the disease as well.”
An additional challenge for female patients is that they are required to be accompanied by a male family member to the hospital. This, coupled with economic barriers, can significantly reduce their access to timely health care.
Nazika
This is my third month in hospital, and I feel that I’m improving. I’m also happy about the services being provided here. The nurses and doctors visit me regularly and are taking care of me. I remember those days when I couldn’t walk, I had no appetite, I had a fever, and I coughed a lot. Now I do have appetite, I can walk, and I’m feeling better day by day. I hope I’ll go home soon.
Access to proper care remains a major challenge for many patients, mainly due to insufficient medical infrastructure, length of treatment, and financial obstacles. To help address this issue, MSF collaborates with the national TB program and other medical facilities in the region to facilitate easier referrals for patients with DR-TB, enhancing access to lifesaving care.
“The doctors in the public hospital referred me to Kandahar for treatment,” said Zainab. “I’m improving and recovering with each passing day. When I first came here, I didn’t think I would survive.”
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About MSF’s DR-TB hospital in Kandahar
MSF’s DR-TB hospital in Kandahar provides patients with quality, free, and effective treatment. In 2024, MSF staff started 85 patients on treatment for DR-TB, and more than 380 MSF patients have completed treatment for DR-TB since the project started. We provide patients with mental health support, carry out health promotion activities in the hospital and in the surrounding area, and deliver technical and financial support to provincial laboratories that offer TB testing. In 2024, MSF also provided some medical supplies and financial incentives to staff involved in the diagnosis and treatment of DR-TB in several Ministry of Public Health facilities in southern Afghanistan. Those teams provided 44,940 consultations for patients DR-TB.
