On August 15, 2021, the hospital widened its admission criteria to improve access to obstetric care during that period of uncertainty and assisted 1,649 deliveries in September, the highest number up to that point that year. While the total number of patients increased, the ratio of complicated deliveries and number of newborn admissions decreased in comparison with previous months: expectant mothers who could have had normal deliveries with good neonatal outcomes at primary health care facilities may have chosen to give birth at the MSF hospital for lack of adequate services elsewhere in the province.
Construction work is underway on the Kunduz Trauma Center with the aim of launching trauma activities including emergency, surgical, and post-operative care before the end of 2021. The wound care clinic and physiotherapy services opened on the site of the new hospital in May 2021. On October 8, the trauma center received 90 patients following an explosion at a mosque. By November 2021, MSF treated 554 patients for trauma injuries including 173 surgeries. Compared with August of the same year, the number of violent injuries fell considerably while accidental injuries more than doubled.
MSF began supporting the District Advanced Post (DAP) in Chardara in 2015 and continues to do so today. The DAP is located in the west of the city in Opposition-controlled territory. An MSF team treats trauma patients with first aid care, stabilization, and referrals for those with more severe needs.
Boost hospital, Helmand province
MSF has been supporting Boost provincial hospital in Lashkar Gah, the capital of Helmand province, since 2009. The hospital serves a population of approximately 1.3 million people and is the only referral hospital in the province. MSF currently supports the emergency room, surgical unit, inpatient department, maternity department, neonatology unit, laboratory, and radiology department, as well as the 82-bed pediatric department and an inpatient therapeutic feeding center. In February 2020, we also started supporting the outpatient department of Fatima Bayat hospital with medications and training, aiming to reduce the number of people in Boost hospital’s emergency room by referring less severe cases.
In recent years, southern Helmand province has been affected by the ongoing conflict in Afghanistan. In October 2020, and again in May 2021, violence flared, and Boost hospital admitted the overflow of injured people from the city's main trauma hospital. The conflict is ongoing in the districts surrounding Lashkar Gah, and teams treat an average of 34 war-wounded patients on a weekly basis. Access to health care remains a significant challenge, with people forced to wait for the fighting to subside or risk their lives traveling to the city.
In September 2021, the hospital faced a steep increase in patients as road safety in the province improved and people could travel more easily, but most medical facilities remained closed or inoperative. This increase continued through the end of the year. A yearly record high of 22,400 patients presented to Boost, about 4,500 more than the previous peak in March. MSF provided an average of 550 consultations per day in the ER compared with an average of 426 per day between January and August. The 300-bed hospital exceeded capacity throughout the month of September with a daily average of 327 hospitalized patients; the previous eight-month daily average was 281. The intensive therapeutic feeding center operated at over 200 percent bed occupancy throughout the month, with an average of 91 patients admitted per week.
Emergency support in Herat
Since December 2019, MSF has supported Herat Regional Hospital’s 40-bed inpatient therapeutic feeding center (ITFC). Most patients and caretakers travel more than nine miles to come for care, and some come from as far away as Badghis, Ghor, and Farah. Between June and September 2021, the number of malnourished children increased by over 40 percent compared with the same period last year. MSF increased the number of beds from 42 to 75; still, the ITFC was under significant pressure in September, during the busiest days there were 87 patients admitted at the same time. In December 2021, MSF started supporting the pediatric department of Herat Regional Hospital. The first phase sees our teams working in the emergency room and the intensive care unit. We plan to also support the IPD and OPD.
MSF has also run a clinic for both internally displaced people and the local population in Herat since December 2018. The clinic offers general consultations, including for non-communicable diseases, screening and treatment of malnutrition, pre- and postnatal consultations, and childhood vaccinations and health promotion sessions for displaced people living in Shaidayee and Kahdestan.
Drug-resistant tuberculosis (DR-TB) in Kandahar
In Kandahar, MSF works in partnership with the Ministry of Public Health to diagnose and treat patients with drug-resistant tuberculosis (DR-TB). We run a TB center that includes a laboratory, an outpatient clinic, and 10 beds for inpatients suffering from DR-TB. MSF provides mental health support and health promotion activities. There is also an MSF guesthouse to accommodate patients who come from far away for the duration of their treatment.
A nine-month oral short-course TB treatment regimen was introduced in November 2019. This shorter regimen involves fewer side effects and improves patients’ quality of life, encouraging adherence to treatment. Of the patients on the new regimen, so far none have been lost to follow-up. However, insecurity remains a key challenge in the area, as fighting makes access difficult. Patients are provided with a buffer stock of medication in case they are delayed visiting the DR-TB center in Kandahar for their follow-up consultations.
To respond to high levels of severe and acute malnutrition in the area, on December 15, 2021, MSF opened an ambulatory therapeutic feeding center (ATFC) in Kandahar, next door to the MSF TB clinic. The first phase of this activity will see us providing outpatient malnutrition treatment for patients aged between six months and five years who have been discharged from the nearby inpatient therapeutic feeding center at Mirwais regional hospital.
In the Spin Boldak district, MSF recently launched a temporary emergency response as well. From September 9, 2021 to October 7, MSF provided 1,388 outpatient consultations including to 438 children under five (mainly for diarrhea, respiratory infections, and malnutrition) and provided drinking water to hundreds of families living in an informal settlement for internally displaced people.
MSF also provides support to Mirwais Regional Hospital, the Provincial TB Center, and the Sarpoza Prison to diagnose drug-sensitive, which can be treated with first-line medications.
How MSF is fighting COVID-19 in Afghanistan
Our priority in Afghanistan is to continue our regular medical activities while ensuring the safety of patients and staff. Where possible we has integrated COVID-19 activities into existing projects, for example by creating a separate unit in Khost for COVID-positive pregnant women and newborns or treating COVID-19 patients with comorbidities at our projects in Helmand and Kandahar.
In Herat, MSF has been supporting the pandemic response by triaging COVID-19 cases in Herat Regional Hospital since April 2020, and has opened a COVID-19 treatment center in Gazer Gah. This facility bolsters the region’s inpatient bed capacity for those in need of oxygen and has so far been opened three times in response to waves of infection, caring for patients with severe COVID-19 symptoms from June to September 2020, December 2020 to February 2021, and most recently from June 9, 2021 through the end of the year. With Afghanistan in the grips of a third wave of COVID-19, MSF is continuing to look at ways to support the Ministry of Health’s response.