Unpaved roads throughout Afghanistan make it difficult to access medical care promptly, especially during the winter months when many roads are unpassable.

Children wash themselves in muddy puddles in a camp for displaced people on the outskirts of Kabul. Most of the thousands of people living in the camp fled their homes due to heavy fighting. An estimated 630,000 people are internally displaced in Afghanistan, with 124,000 of them leaving them homes in 2013 alone.

A woman sits in the camp with her week-old child, who was born in this very same mud home. The mother says she has been bleeding continually since the birth and still cannot stand. Without skilled medical help, women who deliver at home are at greater risk of illness or death if they face complications.

Roads throughout the country are full of traffic, military roadblocks and security checkpoints, all of which delay people’s journey to health facilities, sometimes by hours. Any extra time spent on the roads also exposes them to more violence and increases the cost of the journey.

More than one-third of Afghanistan’s population lives below the poverty line, and many people therefore have to assume considerable debt to pay doctor’s fees or cover costs for medicines, hospitalisation, laboratory tests and transport.

People gather outside a local clinic and pharmacy in Kunduz, northern Afghanistan. The private healthcare sector is widespread, but the costs push it out of reach for many people, and the quality of the treatment and medicines provided can be questionable.

Healthcare is free at the MSF-supported Boost Hospital in Lashkar Gah. Abdul and his 8-year-old daughter Fatima travelled 80 km from home to seek medical care here. The 250-bed hospital serves a population of roughly one million people living in one of the provinces most affected by conflict in the country.

The conflict not only injures and kills people directly, but also indirectly, by impeding their access to healthcare. Many wait until their condition has deteriorated to the point of endangering their health or lives before risking the journey to reach treatment.

At MSF’s Trauma Centre in Kunduz, staff revive a patient who suffered a head injury from a motorcycle accident. Beyond medical needs related to the conflict, the everyday emergencies such as traffic accidents, heart attacks and respiratory infections also fill MSF’s emergency rooms.

MSF’s Trauma Centre in Kunduz is the only surgical centre of its kind in the north. Staff treats victims of general trauma, as well as those with conflict-related injuries from bomb blasts or gunshots. In 2013, around 17,000 patients were treated and 4,500 surgeries carried out in the hospital.

Chamangul, 12, has the body of a boy half his age, but his head is abnormally large. His mother brought him to an MSF mobile clinic on the outskirts of Kabul after she was turned away from hospitals in the city. The MSF doctors say he has an aggressive form of sarcoma that has rotted most of his head, as well as one ear and eye. His mother has already lost two children to the same illness, but the doctors say that while they may have been able to help the child had they seen him earlier, now they can only ease his pain.

Muhammad, 40, a farmer, was shot in the leg. By the time he reached Kunduz Trauma Centre, he’d already been wearing a very tight tourniquet for four hours. After trying to save his leg, the doctors decided they had to amputate him above the knee. He is now doing physiotherapy after the surgery.

Najibullah, a father of 11, waits for a check-up at the Kunduz Trauma Centre. His left leg was amputated after he was shot in the leg when a firefight broke out near the construction site where he worked. Police closed the road and his relatives had to keep him at home until the fighting stopped the next morning. When he finally reached the centre, he was in critical condition.

The inability to travel at night due to insecurity has severe consequences for injured people and women experiencing complicated labour. Families are forced to hold ‘death-watches’ over their loved ones throughout the night, hoping they will survive until morning when it might be safer to reach a doctor.

Many pregnant women and their babies do not survive the wait; they either die during the night, during the journey to a medical facility, or shortly after they arrive. Afghanistan is one of the most dangerous places in the world for women to give birth. The need for quality obstetric care is immense. Across MSF’s maternity wards in 2013 – in Kabul, Khost and Helmand – medical staff safely delivered more than 33,500 babies.

Children come for vaccinations at MSF’s mobile clinic in Speena Posa village, in the eastern outskirts of Kabul. MSF began running mobile clinics to reach out to more isolated areas where people struggle to access quality healthcare.

People living in remote, insecure areas suffer greatly from the lack of healthcare services. Insecurity hampers most humanitarian organisations from accessing them, leaving the most vulnerable to fend for themselves. In 2014, MSF is focusing on bringing care closer to those in greatest need in remote areas, or trying to bring them to MSF through more effective referral systems.