MSF started working again in Afghanistan in October 2009, after a five-year absence following the brutal killing of five staff in Badghis province in June 2004. MSF’s return was motivated by the general worsening of healthcare provision in the country. In a region where much of the population has been trapped for years in poverty, many people lack access to medical treatment, particularly to secondary healthcare. The situation has been made worse by the intensity of the ongoing conflict, which has led to increasing numbers of people being injured, a rise in the number of people displaced from their homes, and the disruption of medical services in parts of the country. All of these have contributed to a growing health crisis.
Those fortunate enough to have access to healthcare must still choose between public hospitals that function poorly, or expensive private clinics. People in need often have to travel hundreds of miles through dangerous areas in order to reach a clinic or hospital where they can be treated.
MSF is now supporting activities in a district hospital, Ahmed Shah Baba, in east Kabul, and in Boost Hospital, in Helmand’s provincial capital, Lashkargah. It has been crucial to ensure that patients are treated in a safe environment, and a strict ‘no weapons allowed’ policy has been implemented in both hospitals. This is critically important in a country like Afghanistan, where civilians bear the brunt of the fighting between coalition and Afghan government forces and various opposition groups.
In both hospitals, MSF provides free, high quality medicine and equipment, and has health staff working with the hospitals’ existing medical staff to ensure all care provided is of a good standard and free of charge.
Ahmed Shah Baba District Hospital, east Kabul
The population of Kabul has tripled over the last ten years as migration to the city has increased. It includes people displaced from their homes due to political insecurity elsewhere in the country, as well as those returning from refugee camps in Pakistan. But despite the burgeoning population, the health sector in Kabul has largely been neglected by international donors, with priority given to primary healthcare outside the province.
Located in District 12, on the eastern outskirts of Kabul, Ahmed Shah Baba Hospital serves a growing population of 200,000 to 300,000 people. MSF doctors, midwives and nurses – both foreign and Afghan – are working with the hospital’s medical staff to improve the quality of care provided. They have helped to make improvements in patient flow, registration and follow up, and to improve treatment protocols, the emergency room and maternity services. The average number of medical consultations has increased from 6,500 per month to 10,000, and an average of 300 babies are born there each month.
The hospital infrastructure has been upgraded, in particular the maternity wards, emergency room, laboratory and X-ray departments. A central sterilisation system has also been installed.
Surgery and inpatient facilities will be available as soon as the new operating theatre and inpatient department are complete. The recruitment of an additional 40 Afghan medical staff by the Ministry of Health – who will join the existing team of 50 – is currently underway. This expanded team will help to further improve the quality of care.
Boost Hospital, Lashkargah, Helmand province
In November 2009, MSF also started to support Boost Hospital in Lashkargah, the capital of Helmand province. Lashkargah’s one million inhabitants have been among the people most affected by the ongoing conflict.
As one of only two functioning referral hospitals in south Afghanistan – the other supported by ICRC in adjacent Kandahar province – Boost Hospital was seeing 120-160 patients per month. The hospital is now treating 1,200 patients a month overall. MSF’s support to the 145-bed hospital includes the maternity and paediatric departments, the intensive care unit, inpatient services, surgery and the emergency rooms. MSF is also involved in rehabilitating key facilities, putting in place sterilisation and hygiene protocols, and supplying the pharmacy with free, high-quality drugs..
With a current average of 200 deliveries each month, the maternity section now offers family planning, pre- and post-natal care, and an increased capacity for caesarian sections and complicated deliveries. Surgical procedures, including caesarian sections, have doubled since January 2010, with an average of 200 surgeries and 20 caesarians now performed each month.
The paediatric department, which accounts for nearly 40 percent of patients, currently has a bed occupancy rate of 150 percent. More than 1,500 patients have been seen there since January 2010. Plans are underway to expand these facilities.
A recently upgraded emergency room, staffed by a permanent doctor and nurse, now offers a 24-hour stabilisation point for an increasing number of violent trauma and war-wounded patients, who are then referred to other departments for more specialised care. Since the emergency room opened in May 2010, more than 4,000 patients have received treatment.
MSF chooses to rely solely on private donations for its work in Afghanistan, and does not accept funding from any government.
MSF will be extending its support to hospitals and rural health centres in other provinces in Afghanistan later in 2010.