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 one hospital 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. In 2019, MSF teams assisted on average over 60 births a day and on their busiest days, 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.
Insecurity and 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 supported the Ministry of Public Health at Ahmad Shah Baba district hospital in eastern Kabul for nearly 10 years, handing the project over in March 2019.
We also had a team at the maternity wing of Dasht-e-Barchi hospital, in Kabul’s west, which provided 24-hour maternal care at the only facility for emergency and complicated deliveries in a neighbourhood of more than one million people.
On 12 May 2020, the maternity wing was attacked by an unknown armed group, seemingly targeting mothers in the wards. During the four-hour attack, 16 mothers – including some who were minutes, or at most hours, away from giving birth – were killed, as were two young boys and an MSF midwife.
We do not know who was behind the attack, or why. On 15 June 2020, we announced that we had made the difficult decision to end services at the maternity wing and withdraw from Dasht-e-Barchi. While we are finding ways to support local initiatives in improving access to healthcare in the area, the attack and our subsequent withdrawal unfortunately deprives women in western Kabul and the surrounding countryside of critically-needed emergency obstetric and newborn care.
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. In December 2019, we introduced a nine-month oral regimen allowing DR-TB patients to change from injectable drugs to pills and reduce their number of consultations at the hospital. The shorter, all-oral 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.
Although nothing can be guaranteed in an active conflict zone, these commitments paved the way for our return to Kunduz in 2017, when we opened an outpatient clinic in the city for people with minor trauma-related wounds and injuries.
A new trauma centre is being built and was due to open at the end of 2020; however, the COVID-19 pandemic has currently put construction on hold. We also run 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.
Emergency and paediatric care in Herat
In 2018, an estimated 150,000 internally displaced people arrived in the city of Herat, in Afghanistan’s northwest, having fled their conflict- and drought-affected villages. To respond to their needs, we opened a clinic on the outskirts of the city in December 2018, and offered medical consultations, treatment for malnutrition, vaccinations, ante- and postnatal care and family planning. Over the course of 2019, MSF teams treated more than 44,000 patients, most of whom were children suffering from acute respiratory infections and watery diarrhoea.
From October 2019, we started running an inpatient therapeutic feeding centre in Herat regional hospital’s paediatric department, treating the malnourished children of displaced families.