No Weapons, No Fees - MSF in Afghanistan

MSF started working again in Afghanistan in October 2009 after a five-year absence following the brutal killings of five colleagues in Badghis province in June 2004. The return of the organization was motivated by what was seen as an overall worsening in healthcare provision. In Afghanistan, the population has been trapped for years in conditions of poverty and a general lack of access to medical treatment, particularly to secondary health care. The intensity of the ongoing conflict has led to many wounded and displaced and to a disruption of services, adding to the health crisis faced in parts of the country. Even those fortunate enough to have access to healthcare must still choose between public hospitals that do not function well or expensive private clinics. In addition, due to growing insecurity, people in need often have to travel hundreds of miles through extremely dangerous areas in order to reach a health structure. MSF is now supporting activities in a district hospital, Ahmed Shah Baba, located in east Kabul and Boost Hospital, in Helmand’s provincial capital, Lashkargah. It was crucial for MSF to secure agreements with all parties involved in order to ensure the hospital is a safe environment for patients. A strict no weapons allowed policy has been implemented in both structures. This is critically important in a country like Afghanistan, where civilians are most affected by the fighting between coalition and Afghan government forces, and various opposition groups. In both hospitals, MSF provides free, high quality medicine and medical materials, and has health staff working together with the existing hospital medical staff to ensure all medical care provided is of good standard and free of charge.

Ahmed Shah Baba District Hospital, east Kabul

The tripling of the population of Kabul over the last ten years reflects a recent migratory trend towards urban areas, and includes displaced persons fleeing insecure regions in Afghanistan and returnees from refugee camps in Pakistan. Despite the growth in population numbers, the health sector in Kabul has largely been neglected by the international donors, with priority given to primary health care outside the province. Located in District 12, on the outskirts of eastern Kabul, Ahmed Shah Baba hospital serves a growing population of 200,000 to 300,000 inhabitants. MSF expatriate and national doctors, midwives and nurses work together with the hospital’s medical staff to improve the quality of care that is being provided in this facility. This has been helped by upgrading internal processes like patient flow, registration and follow up, as well as improving treatment protocols, emergency room, and maternity services. The monthly average of medical consultations has increased from 6,500 to 10,000 and there are 300 deliveries each month. The existing hospital infrastructure has also been rehabilitated, with improvements made to the maternity section, emergency room, laboratory and x-ray departments as well as the installation of a well functioning central sterilization system. Surgery and inpatient facilities will soon be available, when the new operating theatre and inpatient department are complete. The recruitment of an additional 40 national medical staff by the Ministry of Health – who will join the existing team of 50 - is currently underway. This expanded team will help to further improve quality of care.

Boost Hospital, Lashkargah, Helmand province

In November, 2009, MSF also started to support Boost provincial hospital in Lashkargah, the capital of Helmand province. Lashkargah’s more or less one million inhabitants have been among the people most affected by the ongoing conflict. As one of only two functioning referral hospitals in south Afghanistan – the other supported by ICRC in adjacent Kandahar province – Boost Hospital was seeing 120 to 160 patients per month. The hospital is now treating 1200 patients a month overall. MSF’s support to the 145-bed hospital includes the maternity, pediatrics, surgery, Intensive Care Unit, inpatient services and emergency rooms. MSF is also involved in the rehabilitation of key facilities, putting in place sterilization and hygiene protocols, and supplying the pharmacy with free, high quality drugs. With a current average of 200 deliveries each month, the maternity section now offers pre- and post-natal care, family planning as well as an increased capacity for caesarian sections and complicated deliveries. Surgical procedures, including caesarian sections, have doubled since January 2010, with an average of 200 surgeries and 20 caesarians now performed each month. The pediatric wing, which accounts for nearly 40% of patients, currently has a bed occupancy rate of 150%. More than 1500 patients have been seen in the pediatrics department since January 2010. To better accommodate patients, plans are underway to expand these facilities. A recently upgraded emergency room, staffed by a permanent doctor and nurse now offers a 24-hour stabilization point for an increasing number of violent trauma and war-wounded patients, which are then referred to other departments for more specialized care. Since the emergency room opened in May 2010, more than 4000 patients have received treatment.

MSF will be extending its support to hospitals and rural health centres in other provinces in Afghanistan towards the end of 2010. MSF chooses to rely solely on private donations for its work in Afghanistan, and does not accept funding from any government.