International Activity Report 2020 > Dasht-e-Barchi: an attack on Hazara mothers
On 12 May 2020, armed men attacked MSF’s maternity wing in Dasht-e-Barchi hospital in Kabul, Afghanistan, killing 24 people, including 16 mothers, an MSF midwife, and two young children.
Fearing that our patients and staff would be targeted again, we made the painful decision to withdraw from the hospital in mid-June. The assailants, whose brutal and despicable attack forced us to close our maternity and neonatology departments, have left women and babies without essential medical care in a country that has some of the worst maternal and neonatal death rates in the world. In 2019 alone, our teams assisted 16,000 births in Dasht-e-Barchi, making it one of our biggest maternal care projects to date.
Our thoughts remain with the victims of this horrific incident, their families, and the health workers in Afghanistan who offer lifesaving care in the face of numerous attacks.
Below are two edited testimonies from staff who were working at Dasht-e-Barchi at the time of the attack.
Aquila, a midwife from Afghanistan
I first worked with MSF in Bamyan province in 2003 and 2004. After MSF temporarily left Afghanistan in 2004, I worked in different places in the health sector.
When MSF opened the Dasht-e-Barchi project in November 2014, I was one of the first to start working there, as a midwife to begin with, then as midwife supervisor in the admission, labour and delivery rooms. After that, I became a midwife trainer – which I remained until the day of the attack.
Dasht-e-Barchi is an area with a large population. Most of the people living here come from other provinces and belong to the poorest layers of society. The vast majority of them are Hazara.
The maternity department offered good services for pregnant women, including labour, delivery and postnatal rooms, a neonatal unit, a blood bank, a laboratory and an operating theatre, as well as health education and family planning. It was one of the few places providing free, high-quality healthcare regardless of ethnicity, religion and nationality, and we looked after patients very well. For this reason, many women chose to come to the hospital to give birth. On average we’d assist 45 to 50 births every day, some of which would be complicated deliveries.
Although I was a midwife trainer, we’d stopped training because of COVID-19. I began helping out in other departments, for example by supervising colleagues assessing patients suspected of having COVID-19. When patients showed symptoms, we took them to an isolation room.
The day of the attack started like any other. I went to work, planning my day along the way. At 9 am, I went to the gate to collect the night report. I realised that there was no registration book and headed to the office to get a new one. Suddenly, I heard gunfire. At first, I thought it might be coming from the street outside; I did not expect a gun to be fired inside the hospital. I met my colleagues on the way, and we all looked at each other questioningly. Just then, the alarm bell rang, and we all headed to a safe room. We closed the door, after making sure most of our colleagues were inside. The sound of gunfire was getting closer and louder. We wondered what was happening. We asked each other why the hospital would be attacked when we were there to bring new life into the world, when most of the employees were female and the patients were pregnant women and newborns.
The sound of gunfire was getting closer and louder. We wondered what was happening. We asked each other why the hospital would be attacked when we were there to bring new life into the world, when most of the employees were female and the patients were pregnant women and newborns.Aquila, a midwife from Afghanistan
The attack started at about 9.50 am and lasted for around four hours. We stayed inside the safe rooms for five hours. Many thoughts came to our minds: ‘I might not see my family or my children again’’; ‘‘This might be the last moment of my life…’’ I was thinking about my patients and colleagues, the poor patients who were in labour and the innocent children who could not defend themselves. Because my work took me to each part of the hospital every day, I could imagine the patients in the delivery room and the labour room – each of them flashed before my eyes. After the shooting ended, we learned that we had lost one of our midwives, Maryam, as well as children, and mothers who had come here hoping for a safe delivery. A number of colleagues, patients and carers had been injured. It made us all very angry. Every time I think about it, I get angry and upset.
MSF’s decision to leave the hospital was even more painful. It was almost as shocking as the attack. I cannot judge this decision, but I know that it will take a heavy toll on the people of Dasht-e-Barchi, because, every day, MSF’s services saved the lives of many mothers who were at risk of dying. MSF's departure from the area not only affected patients, but also the hospital staff, many of whom are still unemployed. For me, my colleagues and the people of Dasht-e-Barchi, this was a black day that will not be forgotten.
Aman Kayhan, assistant project coordinator from Kabul
I live in Dasht-e-Barchi and I’ve worked with MSF since 2017.
Dasht-e-Barchi is in the west of Kabul. It has a population of around one and a half million. People living in this area struggle to access public services, especially healthcare. The hospital that was attacked is the only public facility in this area. Over time, the number of private hospitals has increased, but most people can’t afford them. As long as MSF was in this area, women could seek care for obstetric and gynaecological problems. However, after the attack, MSF decided to leave and life got worse for local people. Dasht-e-Barchi hospital resumed operations without MSF on 25 June 2020, but it doesn’t have enough qualified staff and is unable to meet everyone’s needs. For example, it no longer admits patients with complications. The quality of care is not the same.
The security situation around Dasht-e-Barchi has deteriorated since 2017, as the area has become more exposed to threats from the local branch of the Islamic State group, known as ISK. The group has attacked an educational centre, a religious centre and a wedding hall in the last three years. All that remained was the health centre, and unfortunately, that too has now been targeted.
On 12 May 2020, as usual, we attended the morning meeting to hear the latest information about the situation in the neighbourhood. We thought that things might be tense in Kabul because two key members of ISK had been arrested. The meeting ended, and at about 9.50 am, as we were talking to a government representative in my office, we heard gunshots. I thought it was a gunfight between robbers and the police. A minute later, the hospital alarm rang and we ran to the safe rooms.
The first thing I did was contact the local police and ask them to help. They said the patrol team would be sent out for support, but I told them what was happening was way beyond the capacity of the patrol team.
Every time we heard an explosion, we thought the attackers were blowing up the safe rooms one by one, and that it would soon be our turn. It was 4 pm when the security forces were finally able to rescue us.
Every time we heard an explosion, we thought the attackers were blowing up the safe rooms one by one, and that it would soon be our turn. It was 4 pm when the security forces were finally able to rescue us.Aman Kayhan, assistant project coordinator from Kabul
Even telling the story of those five hours is painful for me. I did not expect to survive. I thought about what would happen to my two children if I was killed. It was very distressing.
In 2020, we mourned patients and colleagues who lost their lives during other direct attacks on health facilities or episodes of inter-communal violence. Others were injured, and our ability to provide medical assistance was compromised several times. Below are some examples of the incidents that marked the year.
In January, armed intruders killed patients in the MSF-supported Al-Thawra hospital in war-torn southwestern Yemen. Staff and patients in the hospital have been subjected to at least 40 incidents of violence since 2018. One month later, a nurse was injured when armed men fired on a clearly marked MSF ambulance in Muyuka, South-West Cameroon. In the same region, a community health worker supported and supervised by MSF was killed in July. Intense intercommunal violence in South Sudan forced us to suspend our activities in Pieri, Jonglei state, in May, after one of our South Sudanese colleagues was killed and two others injured. In June, we also had to suspend our services in the country’s Pibor area, after thousands of people, including MSF staff, fled into the bush to seek safety.
In May, armed soldiers from two sections of the Sudanese security forces in Central Darfur state, Sudan, violently forced their way into a MSF-supported health facility in the town of Rokero. One of our nurses was severely injured during the incident.
Our teams in Kimbi and Baraka, in the Democratic Republic of Congo’s Fizi territory (South Kivu province), took the difficult decision in December to end most of their support to healthcare provision. This followed the withdrawal of most MSF staff from Fizi territory in July, due to several violent incidents against them.
At the end of December, one of our medical colleagues succumbed to his injuries after a shooting incident on a public transport truck in Grimari city in Ouaka prefecture, Central African Republic.
Violence has taken a heavy toll on civilians in many places where we work and each attack on medical facilities or health workers deprives them of much-needed, often lifesaving, care.