No guns, no fees in Ahmed Shah Baba hospital, Kabul, Afghanistan

After a five year absence, MSF returns to Afghanistan

Medecins Sans Frontieres (MSF) started working again in Afghanistan in 2009. The organisation’s return to the country – after five years – was motivated by the increasing number of signals that the overall situation for Afghans was getting worse rather than better. The country is becoming more insecure, and access to health services is problematic for large number of Afghans.

MSF is now working in Ahmed Shah Baba hospital on the eastern side of Kabul, which will be developed into a district hospital that will provide a wide range of medical services, including emergency care. The hospital is located in an area that sees a rapid population expansion as people seek relative safety from the conflict and hope for work, as is the case for Kabul as a whole.

Soon, MSF will also boost the ailing hospital in Lashkargah, the capital of Helmand province in the very heart of the conflict. In the absence of staff and medicines, few people use it, despite the fact that it is one of only two remaining referral hospitals in the south of Afghanistan.

MSF left Afghanistan in June, 2004 after the brutal killing of five of its staff in Badghis province. At that time, many had hopes that Afghanistan was on its way to recovery thanks to a major international investment in development aid. Today, that hope has been crushed. The need for emergency medical assistance has once again become acute.

For its work in Afghanistan, MSF does not accept funding from any government. Instead, the organisation relies solely on donations from the public.

By 11:30 a.m., most patients in Ahmed Shah Baba district hospital, in eastern Kabul, have been seen. They tend to arrive early in the morning, queue up for consultations and treatment, and are back home before the hottest part of the day begins.

Just before the staff take their lunch break, there is only one patient left in the emergency room, and two pregnant women in the maternity ward. Only the vaccination room and its waiting area are still bustling with women in bright blue burkas and their young children. The register shows that the staff have already vaccinated 150 children today.

Ahmed Shah Baba is a sprawling neighbourhood and it is growing fast. In 2004, when MSF stopped working here, its population was around 80,000; today nobody knows, but even the most conservative commentators estimate that the figure has doubled or tripled. People come from Jalalabad, and from further away, across the border, refugees are returning from Pakistan. Most hope to find work in Kabul, especially with all the foreign aid pouring into Afghanistan, but many are disappointed and jobless rates are high.

The emergency room reveals the associated problems. The doctor on duty explains that they see many people with injuries. A fair number are the result of road accidents. Ahmed Shah Baba lies between the two very busy roads that connect Kabul and Jalalabad. But an equally large number of injuries, mainly knife wounds but also the occasional bullet, stem from fighting.

“{They fight} over land, for instance," said the doctor. "Or sometimes because people simply cannot deal with being without work.”

The clinic is becoming a district hospital and MSF has come in to make it function as an emergency hospital. Until today, many of the patients need to be transported to other health centres, at least one hour away, for emergency care. MSF will boost the current facilities, add an operating theatre as well as an in-patient department where people stay overnight under medical observation, and generally work on improving the quality of the care given and drugs administered.

The support is only just starting. Yesterday, for the first time in five years, an MSF doctor diagnosed and treated a patient. The woman had come to the emergency ward with burns all over her face, arms and legs, after a gas cooker exploded in her kitchen. Maria was the only female doctor around and so the only one who could check under the woman’s burka. She found further severe burns across the woman’s chest and dressed them.

Today, an MSF nurse, Leen, was called in to assist with a delivery. She says the baby, a healthy girl, came out quickly and without any problem.

“We are absolutely not planning to jump in and take over. It is amazing to see how the clinic has continued functioning without support,” says MSF project coordinator, Sylvie Kaczmarczyk, referring to the withdrawal of an NGO three months ago that had taken over management of the hospital after MSF’s previous involvement had ended.

“We are starting with repairs to some of the building and construction of new areas so that, in the future, the hospital will also have all the facilities needed for a range of emergency medical care and can function fully as a district hospital.”

A “no weapons allowed” policy has been introduced, but this morning a policeman was in the emergency ward carrying his gun and had to be informed of the policy. Nine guards are receiving their first instruction today, including on how to convince every visitor to leave their weapons behind at the entrance. “That rule applies to policemen and military, but equally to members of ISAF,” explains Kaczmarczyk to the guards, referring to the international security force in Afghanistan.

Another priority is to make sure that nobody is paying for consultations or treatment. The hospital director, Dr Sattar proudly points at a new sign at the entrance of the delivery ward. “No one is allowed to give presents or pay money to the staff of the policlinic,” it reads. “If someone sees this happen, please call the director of the Ahmed Shah Baba on the following number:….”

It is important that MSF is back in Afghanistan, said Kaczmarczyk. “At first glance, this is just a good MSF project – rapid urbanisation with services that cannot keep up, distance from the city where you find more health facilities, difficulties for the population to access medical care - but that does not necessarily make it specific for Afghanistan. What is crucial is that MSF use the presence to get a clearer view of what is happening in the country. From the bit that we know today, we can only conclude that things are getting worse. Insecurity increases, health care is faltering, and, as always, it’s the ordinary people who pay the price.”

The support to Ahmed Shah Baba marks the return of MSF to Afghanistan after five years of absence, following the murder of five colleagues in 2004.

Within weeks, MSF will also start boosting the hospital in Lashkargah, the capital of Helmand province which is at the heart of the fighting between ISAF forces and the Afghan army on the one hand and the armed opposition on the other.

MSF is not accepting funding from any government for its work in Afghanistan, but chooses to rely solely on private donations.