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{{ subitems[item.mlid].linktitle }}Landlocked and mountainous, Afghanistan has suffered from such chronic instability and conflict during its modern history that its economy and infrastructure are in ruins.
Many of its 31 million people are refugees, or have been internally displaced.
Médecins Sans Frontières/Doctors Without Borders (MSF) has been working in the country since 1980, providing emergency surgical care, maternal health, responding to natural disasters and treating people cut off from healthcare.
However, we have a troubled history in Afghanistan. In 2004, we withrdrew following the killings of five of our colleagues. We did not return until 2009.
Then, in October 2015, our Kunduz trauma centre - the only facility of its kind in northeast Afghanistan - was destroyed in an attack by the US military. Forty-two people were killed, including 14 of our staff.
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Kunduz attack
On Saturday, 3 October 2015, 42 people were killed in sustained airstrikes on our hospital in Kunduz, Afghanistan.
Twenty-four patients and 14 staff were killed, along with four caretakers.
As we grieve the loss of our colleagues and patients, we are left with the question: is it still possible to safely provide medical care on the frontline? Between October 2015 and October 2016, there have been a further 77 attacks on medical facilities run and supported by MSF in Syria and Yemen
"There have been no impartial investigations carried out by an independent international body into any of the seven aerial attacks on hospitals that have occurred over the past year. This is because there is zero political will among governments to have their military conduct examined from the outside."
The United States' government has admitted to carrying out the bombing of our hospital.
It was the destruction of the Kunduz Trauma Centre, and the devastating assault on health facilities in Syria and Yemen that led to UN Security Council Resolution 2286 being passed in May 2016.
The resolution strongly condemned attacks on medical facilities and demanded that all parties to armed conflict comply fully with their obligations under international law.
Hear from Dr Kathleen Thomas, who was in Kunduz on the night of the attack, on our Everyday Emergency podcast.
MSF’s work in Afghanistan: 2015
On 3 October 2015, the Médecins Sans Frontières/Doctors Without Borders (MSF) Trauma Centre in Kunduz, Afghanistan, was destroyed in an aerial attack, during which 42 people were killed, including 14 MSF staff, 24 patients and four patient caretakers.
MSF opened the hospital in Kunduz in August 2011, in order to provide free, high-quality surgical care to victims of general trauma, such as traffic accidents, as well as patients with conflict-related injuries. It was the only facility of its kind in the whole northeastern region of Afghanistan.
Independently run by MSF, the 84-bed hospital had an emergency room, an intensive care unit, three operating theatres, outpatient and inpatient departments (with separate surgical wards for male and female patients), a physiotherapy department, a laboratory, an X-ray room and a pharmacy.
Other services included mental healthcare and health promotion. The hospital offered services not only to the residents of Kunduz province but also to patients from neighbouring provinces such as Badakhshan, Takhar, Baghlan, Balkh and Samangan. The hospital’s capacity reached 92 beds by September 2015, just before it was bombed.
Between January and August, more than 2,400 patients were admitted to the centre, most of whom (88 percent) had been injured in road or domestic accidents.
Twelve percent presented with injuries caused by explosions, gunshots or bombings. Over the same period, MSF staff carried out 18,088 outpatient consultations and 4,667 surgical interventions, including orthopaedic surgery involving internal fixation techniques to repair bones.
Kabul
Ahmad Shah Baba hospital
At Ahmad Shah Baba hospital in eastern Kabul, MSF’s support has concentrated on upgrading the facility so it can cater effectively to the needs of the growing population in the area, and capacity has increased to 58 beds. A range of free, high-quality medical services is offered, with a particular focus on emergency and maternal care. Working with the Ministry of Health, MSF ensures treatment for malnutrition, paediatric care, family planning services, health promotion activities and vaccinations.
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As the population is growing, and because MSF offers the highest-quality obstetric care in the district, the maternity department is one of the busiest in the hospital. On average, 1,400 deliveries were assisted each month and 16,654 antenatal consultations conducted over the course of the year.
MSF continued running mobile clinics in the most remote of eastern Kabul’s suburbs to increase access to free, high-quality preventive and curative healthcare for children under the age of five, and referred severely ill patients to Ahmad Shah Baba hospital. In 2015, more than 5,370 pregnant women were vaccinated, and 6,721 children under five were screened for malnutrition.
Dasht-e-Barchi hospital
MSF continued to run a maternity department in Dasht-e-Barchi hospital dedicated to complicated deliveries, and emergency neonatal and obstetric services. Today, Dasht-e-Barchi hospital and three small satellite health centres are the only options for public healthcare in the district.
Opened in November 2014, the maternity department is open around the clock, and offers free medical care. During its first year, 10,727 deliveries were assisted, 558 caesarean sections were performed and 1,303 babies were admitted to the neonatal unit with complications such as hypoglycaemia.
By the end of the year, up to 300 women were being admitted to the maternity ward each week and 40 babies were being delivered per day.
Helmand
Lashkar Gah
Much of the area surrounding Lashkargah was the scene of active fighting in 2015, although MSF’s Boost hospital continued to function in the provincial capital as normal. For the past six years, MSF has been supporting Boost hospital, one of only three referral hospitals in southern Afghanistan. A new 54-bed maternity ward, a 24-bed neonatal intensive care unit and a 10-bed paediatric intensive care unit were also built. By the end of the year, 12,721 babies had been delivered in the hospital.
MSF supports the hospital with surgery, internal medicine, emergency services and intensive care. In mid-2015, the team also began supporting the diagnosis and follow-up of TB patients, addressing a major yet under-reported public health concern in Afghanistan, and 181 patients started first-line treatment. At the end of the year, an MSF surgical burns specialist provided training to improve treatment for the high number of burns patients seen at the hospital.
Malnutrition continues to be one of the main causes of child mortality in the region, and the hospital’s intensive therapeutic feeding centre treated 2,281 children this year, many of whom were suffering from severe malnutrition.
Khost
Maternity hospital
Afghanistan is considered one of the most dangerous places in the world to give birth, due to the high number of women who die during pregnancy or labour.
In 2015, approximately one out of every three babies born in Khost province was delivered in MSF’s maternity hospital and in December deliveries reached a record high of approximately 58 a day and 1,733 in one month. In addition to the maternity ward, there are two operating theatres, a neonatal unit and a dedicated women’s health clinic. MSF also offers vaccinations for newborns, family planning and health promotion activities.
In order to focus on caring for women with complicated deliveries, who are most at risk of dying, and to manage the large number of patients, MSF is working to improve the referral system to the Ministry of Health’s hospital. When the MSF maternity hospital reaches maximum capacity, patients showing no signs of complications are referred to the provincial hospital.
Find out more in our 2015 International Activity Report