Decades of conflict and instability have left Afghanistan’s economy and infrastructure in ruins and many people dependent on humanitarian aid. Against this backdrop, an estimated 4,300 women die yearly due to complications during pregnancy or childbirth. And one in 13 babies die in their first year.
For decades, Afghan women were denied education, which has led to a shortage of female medical staff to look after women in labour. Yet many families will only seek care from a female medical provider. That’s partly why up to two-thirds of births take place at home without assistance. Another reason is that, outside big cities, most women don't have adequate access to essential obstetric care, or can't afford it.
We work in three hospitals in Kabul and one in Helmand province, in collaboration with the Ministry of Public Health. Our services range from maternal and paediatric care to vaccinations and treatment for malnutrition.
We also run a maternity hospital in rural Khost province, in eastern Afghanistan, where our work is strongly focused on complicated deliveries.
We place an emphasis on training local, female staff through our projects in Afghanistan. Almost all the midwives are Afghan women, some of whom have become highly experienced in managing complicated deliveries since we opened our maternity hospital in Khost in 2012.
Khost, Afghanistan's biggest maternity hospital and MSF's busiest
The inpatient department at our hospital in Khost includes a 68-bed maternity unit and a 22-bed newborn unit. We also run two operating theatres and offer comprehensive emergency obstetric care, vaccinations for newborn babies, family planning, health promotion and a women’s health clinic.
When we first opened in 2012, we had 15 deliveries a day. That quickly climbed to 30, then 50. By 2018, the team was receiving an average of 2,000 women a day and on their busiest days assisted as many as 100 births.
MSF is also one of the largest employers of women in Khost: we employ around 430 people, as cleaners, nurses, midwives, nannies and doctors. The majority are women, many who had never had jobs before.
In the peripheral districts of the province, we're helping health centres to increase their capacities. They are now open 24/7 and assist simple deliveries without having to unnecessarily refer them to our maternity hospital. That makes it easier for mothers to give birth close to their homes and enables our facility to focus its resources on those that involve higher risks for mothers and babies.
Growing medical needs in the capital
Kabul, the capital of Afghanistan, has experienced massive population growth over the last decade, and the city’s public health services cannot meet the medical needs. People continue to come into the city from other parts of the country, fleeing insecurity or searching for economic opportunities.
We have supported supported the Ministry of Public Health at Ahmad Shah Baba district hospital in eastern Kabul since 2009. We also have a team at Dasht-e-Barchi hospital, providing 24-hour maternal care at the only facility for emergency and complicated deliveries in a neighbourhood of more than one million people.
At the end of 2017, we started to support another hospital in the area with staff, training and essential drugs in order to increase the facility’s capacity to provide maternity services.
The burden of tuberculosis (TB) is increasing in Afghanistan. The World Health Organization estimates that 61,000 people are infected annually, causing around 12,000 deaths every year.
In 2016, we began supporting the diagnosis and treatment of drug-resistant tuberculosis (DR-TB) in Kandahar province, and opened a laboratory and facilities to host patients during their treatment in Kandahar city.
In 2017, the first patients in our DR-TB programme in Kandahar successfully completed their treatment and were discharged. By the end of the year, 41 DR-TB patients had been diagnosed and 13 had been put on an innovative regimen that reduces the treatment from at least 20 months to only nine. The shorter treatment produces fewer side effects and improves the patients’ quality of life.
We also provide support to Mirwais regional hospital, and organise training for other facilities in Kandahar to improve the detection of TB, including drug-sensitive cases.
Attack on our trauma centre in Kunduz
On 3 October 2015, our trauma centre in Kunduz was destroyed in airstrike attacks by the US military. Forty-two people were killed, including 14 of our staff. The hospital had opened in 2011 to give much needed quality medical and surgical care to victims of violent and non-violent trauma.
After the airstrikes, we engaged in a period of internal reflection and intense discussions at the highest levels with all parties to the conflict. This attack on a medical facility left thousands of people without lifesaving care and made an indelible mark on MSF in Afghanistan and around the world.
At stake was not only MSF’s work in Kunduz, but the ability to provide trauma care on the frontline in conflicts all over the world.
At the end of 2016, we finally obtained commitments that our staff, patients and hospitals would not be attacked, and care could be provided to everyone in need, regardless of their ethnicity, political beliefs or allegiances.
Although nothing can be guaranteed in an active conflict zone, these commitments paved the way for our return to Kunduz in 2017.
We now run an outpatient clinic in Kunduz for people with minor trauma-related wounds and injuries, and a small stabilisation clinic in Chardara district outside the city.
The need for lifesaving trauma care is extremely high in Kunduz, where little quality medical care is available. The security situation remains volatile and medical needs will continue to increase.