Political instability and covid-19 are straining Afghanistan’s already fragile health system, and organisations such as MSF cannot shoulder people’s healthcare needs alone, writes Tankred Stöbe

One of my MSF colleagues described the healthcare system in Afghanistan today as going from catastrophic to apocalyptic. If this sounds too pessimistic, we should not forget that healthcare in this war stricken country has been on life support for decades. It has been underfunded, under-resourced, and understaffed, and has failed to meet the critical needs of the population. It’s also hugely reliant on foreign donors. 

During the worst of the fighting and since the Taliban took control of the country on 15 August, MSF has maintained its operational presence and continued to receive and treat patients in all five of our project locations: in Herat, Kandahar, Khost, Kunduz, and Lashkar Gah. Now that the situation is calmer, we’re able to take stock of the changes that have occurred and how they’re affecting people’s health and access to care. A few months ago, our hospitals in Lashkar Gah and Kunduz were right on the conflict’s frontlines and we treated a lot of patients who’d been wounded by fighting. Now, with increased security, people can reach hospitals more easily and so we are treating a wider range of health conditions. In Lashkar Gah we’ve been seeing up to around 750 patients a day in our emergency room: sick children, people injured by road traffic accidents, and other conditions. Many times over recent weeks, our 300 bed hospital has been full. 

In Herat, where I worked as medical coordinator, many of the province’s other healthcare facilities are closed or poorly functioning, leaving us with a huge number of patients to see as people have few other options. In our clinic on the outskirts of the city where around 70 000 internally displaced Afghans live in three camps, we treat 400 patients a day. We’ve cared for around 57 000 people since the beginning of 2021—almost 50% more than in the same period last year.

The impact of food insecurity on children’s health is of particular concern, as it can mean children have weakened immune systems and are less resistant to endemic diseases such as measles. Our 40 bed feeding centre in Herat, which had already been expanded to 60 beds in order to cope with the seasonal influx, now has up to 100 malnourished children, putting it well over its bed capacity. This places enormous pressure on patients and resources, and staff have to work overtime to care for everyone. We are seeing a 40% increase in patients in the centre when compared to 2020.

The covid-19 pandemic has further added to the country’s health burden. The third wave hit Afghanistan harder than previous ones, with too few vaccines, hospital beds, oxygen supplies, and ventilation devices available to prevent unnecessary deaths. We run a triage centre at the regional hospital in Herat where we’ve seen 56 000 patients with suspected covid since its opening in April 2020: around 10% of these cases typically need hospital treatment. Now our covid treatment centre in Gazer Gah Hospital, Herat sees about 100 patients a day with covid-19. We admit the severe cases to our 75 bed covid centre, where we offer treatment that includes medication, oxygen, and mask ventilation.

Basic medical services are unequally distributed across the country and rare in rural areas where an estimated 75% per cent of the population live. Afghans have persistently struggled to overcome healthcare obstacles related to distance and the cost of transport and medical care, and this will only get worse as the socioeconomic situation in Afghanistan continues to unravel. As people lose their jobs and businesses are forced to close, food prices will carry on rising even as purchasing power declines. The shortage of female doctors, nurses, and midwives in Afghanistan is also particularly problematic for women’s access to healthcare. MSF has witnessed and communicated these worrying trends in Afghans’ access to healthcare a number of times, with reports in 2014, 2020, and 2021. 

Today, Afghanistan needs to improve and expand public healthcare facilities countrywide (including in hard to reach rural areas); train additional healthcare workers, including female doctors, nurses, and midwives, to improve women’s access to healthcare; and ensure the requisite supplies in drugs, equipment, and materials in public healthcare facilities, free of charge to patients. MSF started working in Afghanistan in 1980 and now has an allocated $47 million budget for the country in 2021. We rely solely on private donations and do not accept funding from governments. However, others are not so lucky and the recent suspensions of financing for Afghanistan will heavily impact those healthcare providers who count on donor resources to continue their projects. An added challenge is the number of professionals, such as medical personnel, who left the country in August, further increasing staff shortages.  

But there may be glimmers of hope for Afghanistan. In a health meeting with all senior medical representatives in Herat in mid-September, chaired by non-medical Taliban members, probably the best news delivered was that, with the end of fighting, resources that were previously needed to keep the war going can now be given to healthcare. Sadly, even if this is true, it will not cover the urgent needs of Afghanistan’s people. And organisations such as MSF cannot shoulder the country’s healthcare alone. 

Tankred Stöbe, medical coordinator, MSF-Afghanistan.

Competing interests: none declared.