'No Weapons, No Fees' - MSF in Afghanistan
MSF started working in Afghanistan in 1981, but left in 2004 when five staff were killed in Badghis province. MSF returned to the country in October 2009, due to the growing conflict and overall worsening in healthcare provision. In Afghanistan, people have been trapped for decades in conditions of poverty and a general lack of access to medical treatment, particularly to secondary health care. The majority of Afghans must often choose between public hospitals that do not function well or expensive private clinics. In addition, due to insecurity, people in need often have to travel hundreds of miles through extremely dangerous areas in order to reach a health structure.
MSF works alongside hospital staff in Ahmad Shah Baba, a district hospital located in east Kabul and Boost Hospital, in Helmand’s provincial capital, Lashkar Gah. MSF also runs a surgical hospital in Kunduz, and has just opened a maternity hospital in Khost. Wherever MSF works, agreements are secured with all parties involved to ensure that health facilities are safe places for patients and staff, with a strict ‘no weapons’ policy implemented throughout.
In Ahmad Shah Baba and Boost hospitals, MSF provides medicine, medical material as well as a wide range of technical support. Our health staff work together with existing hospital medical staff to ensure that all medical care provided is of good quality and free of charge. In the Qunduz hospital, which is fully run by MSF, MSF provides life-saving surgical treatment, physical rehabilitation and all medicines free of charge.
During 2012, MSF will also work to make it easier for patients at our hospitals to give feedback on the care they receive. This will include putting in place a medical standards and ethics committee, as well as a system for better informing patients and handling complaints.
MSF currently has around 70 international staff and around 600 national staff in Afghanistan, with staff numbers set to increase substantially during 2012.
Ahmad Shah Baba District Hospital, east Kabul:
The tripling of the population of Kabul over the last ten years reflects a migratory trend towards urban areas, and includes displaced persons fleeing conflict in more insecure regions in Afghanistan and returnees from refugee camps in Pakistan.
Located in District 12, on the outskirts of eastern Kabul, Ahmad Shah Baba district has a growing population of 200,000 to 300,000 inhabitants. MSF’s aim in the Ahmad Shah Baba hospital has been to improve the quality and availability of free medical care, with a particular focus on emergency and maternity services. Key to this has been increasing the range of medical services available - like emergency surgery- this reduces and improves the referral process, so that fewer patients need to be transported to other hospitals for further treatment.
In 2010, an operating theatre and small inpatient department were put in place. Around 40 surgeries, including 10 caesarean sections, now take place each month. Improvements have also been made to the maternity and emergency departments. In 2011, there were on average 550 deliveries per month, compared to an average of 300 per month in 2010. In the emergency room, which has been supplemented by a wound dressing room, between 1,500 and 2,000 cases are now seen monthly (of which 10 per cent are critical cases needing serious medical attention).
To better accommodate the large number of women and children patients, a new female and paediatric outpatient department (OPD) was built in 2011. The OPD now sees an average of 9,000 patients per month, compared to just 5,500 in October 2009. At the same time, the old space has been used to increase the capacity of the hospital’s inpatient department, which now contains 30 beds and has separate wards for men, women and children.
Boost Hospital, Lashkar Gah, Helmand province:
MSF started supporting activities in Boost provincial hospital in Lashkar Gah, the capital of Helmand province, one of the most conflict-affected provinces in the country, in November 2009. As one of only two functioning referral hospitals in south Afghanistan – the other supported by ICRC in adjacent Kandahar province – Boost serves Helmand’s roughly one million inhabitants which are among those most affected by the ongoing conflict.
When MSF first started working in the 150-bed hospital, around 120-160 patients were being admitted each month. By the start of 2012, the hospital was equipped with 180 beds and admitted an average of 1,500 patients monthly, with this figure looking set to increase.
MSF support to the hospital has centred primarily around improving the provision of medical care in the various hospital departments, including maternity, paediatrics, internal medicine, surgery, Intensive Care Unit, and the emergency room. The maternity section now offers pre- and post-natal care, family planning and an increased capacity for caesarean sections and complicated deliveries. Nearly 450 deliveries occur every month. Surgical procedures, including caesarean sections, have doubled since 2009, with a current average of 150 surgeries and 30 caesareans each month.
MSF opened a new outpatient service in March 2011. The large numbers of consultations – over 6,000 patients per month - suggest that news of Boost’s renewed services is spreading. The emergency department is seeing 2,200 patients a month of which around 75 per cent are critical cases needing serious attention, compared with only 10 per cent in 2010. Nearly 30 per cent of emergency cases come from outside of Lashkar Gah, sometimes covering distances of up to 150 km, which suggests a lack of healthcare services in the outlying districts.
Maintaining standards of hygiene to reduce the risk of infection continues to be a priority for Boost; a 70-person sanitation team now works around the clock to keep the hospital clean, while sterilisation and hygiene protocols continue to be developed.
Despite an extension in 2010, the paediatric ward is again overflowing with around 300 patients a month for only 30 beds. To address this, an extension to the hospital was completed in May 2011, meaning more beds for paediatric patients. A new, separate therapeutic feeding centre (TFC) was opened in December 2011, to free more room for the paediatric ward, and to have a specialised unit to address malnutrition, which is one of the most frequent cause of mortality among children in Helmand. An extension of the physiotherapy room is also planned for 2012, as well as a 24-hour radiology service . The number of community health promoters will triple in 2012, in order to strengthen education on health aimed at the Boost hospital patients.
In August 2011, MSF opened a surgical hospital in Kunduz province in northern Afghanistan. Violence has continued in the north of the country in recent years, and the hospital is the only one of its kind in the region, providing high-quality, free surgical care to victims of general trauma like traffic accidents, as well as those with conflict-related injuries from bomb blasts or gunshots.
The hospital, fully run by MSF, has one emergency room, two operating theatres, an intensive care unit, as well as x-ray and laboratory facilities. There are separate surgical wards for male and female patients. MSF also provides physical rehabilitation and follow-up after surgery by a full-time physiotherapist. The hospital currently has 58 beds, which will expand to 70 beds during 2012.
Since opening, the Kunduz hospital has seen an average of 350 patients every month. Most patients come from Kunduz province, but with information about the hospital becoming more widely available, many patients travel from surrounding province like Takhar, Baghlan and Balkh, and even Herat in the far west of the country.
In March 2012, MSF opened a 56 bed maternal hospital in Khost province. This province has seen intense levels of fighting since 2001. Most women, especially in rural areas, must resort to giving birth without skilled assistance and in unhealthy conditions, which puts their own lives and those of their children at significant risk. The newly opened hospital will be able to help hundreds of women every month make safe deliveries and care for their newborn children by offering specialised medical care.
This facility is the first specialised maternity center of its kind in the region. It has a delivery room that offers obstetric care for normal and complicated deliveries and an operating theatre for emergency obstetric surgery. Ill pregnant women will be hospitalised in the wards, to which women will also be admitted after giving birth or undergoing surgery. Furthermore, there is a neo-natal ward for newborns requiring specialised care.
MSF relies solely on private charitable donations for its work in Afghanistan, and does not accept funding from any government or institutional donor. All healthcare and medicines are provided free of charge, and MSF does not allow any weapons inside its hospitals.