25 Feb 14 01 Aug 16

Photostory: Long and dangerous roads in Afghanistan

After over a decade of international aid and investment, Afghans still struggle to access critical medical care due to insecurity, distance, cost, or the dysfunction of many health facilities.

There has been some progress, but maternal and infant mortality in Afghanistan remain among the highest in the world, casualties from violence are mounting, and unmet medical and humanitarian needs continue to soar.

Upwards of one-third of Afghanistan’s population lives below the poverty line, and many people therefore have to assume considerable debt to pay doctor’s fees or cover costs for medicines, hospitalisation, laboratory tests and transport. 

Read MSF's latest report: 'Between rhetoric and reality - the ongoing struggle to access healthcare in Afghanistan'

Photostory: Long and dangerous road

Unpaved roads throughout Afghanistan make it difficult to access medical care promptly, especially during the winter months when many roads are unpassable. 

Children wash themselves in muddy puddles in a camp for displaced people on the outskirts of Kabul. Most of the thousands of people living in the camp fled their homes due to heavy fighting. An estimated 630,000 people are internally displaced in Afghanistan, with 124,000 of them leaving them homes in 2013 alone. 

Roads throughout the country are full of traffic, military roadblocks and security checkpoints, all of which delay people’s journey to health facilities, sometimes by hours. Any extra time spent on the roads also exposes them to more violence and increases the cost of the journey. 

Healthcare is free at the Médecins Sans Frontières/Doctors Without Borders (MSF)-supported Boost Hospital in Lashkar Gah. Abdul and his eight-year-old daughter Fatima travelled 80 km from home to seek medical care here. The 250-bed hospital serves a population of roughly one million people living in one of the provinces most affected by conflict in the country.

The conflict not only injures and kills people directly, but also indirectly, by impeding their access to healthcare. Many wait until their condition has deteriorated to the point of endangering their health or lives before risking the journey to reach treatment.


MSF’s Trauma Centre in Kunduz is the only surgical centre of its kind in the north. Staff treats victims of general trauma, as well as those with conflict-related injuries from bomb blasts or gunshots. In 2013, around 17,000 patients were treated and 4,500 surgeries carried out in the hospital. 

The inability to travel at night due to insecurity has severe consequences for injured people and women experiencing complicated labour. Families are forced to hold ‘death-watches’ over their loved ones throughout the night, hoping they will survive until morning when it might be safer to reach a doctor. 

Children come for vaccinations at MSF’s mobile clinic in Speena Posa village, in the eastern outskirts of Kabul. MSF began running mobile clinics to reach out to more isolated areas where people struggle to access quality healthcare. 

People living in remote, insecure areas suffer greatly from the lack of healthcare services. Insecurity hampers most humanitarian organisations from accessing them, leaving the most vulnerable to fend for themselves. In 2014, MSF is focusing on bringing care closer to those in greatest need in remote areas, or trying to bring them to MSF through more effective referral systems.

MSF in Afghanistan

Médecins Sans Frontières/Doctors Without Borders (MSF) runs a specialised trauma centre in Kunduz in the north of the country, as well as a maternity hospital in Khost in the east.

MSF also works alongside the Ministry of Public Health, supporting Ahmad Shah Baba district hospital in eastern Kabul, and Boost provincial hospital in Lashkar Gah, capital of Helmand province.

Over the past year, the number of patients treated by MSF has nearly doubled — a clear indication of the enormous medical needs in Afghanistan.

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Find out more about MSF's work in Afghanistan