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Afghanistan: Violence spreads around the country after US withdrawal

12 Aug 2021

Conflict has been steadily increasing in Afghanistan throughout 2021, with the region becoming increasingly insecure since announcements in April of US and NATO forces withdrawing their troops. With these troops gone, Afghan forces and the Islamic Emirate of Afghanistan—also known as the Taliban—are fighting for territory in clashes that continue to claim thousands of lives while crippling public infrastructure. 

MSF staff continue to treat patients in Afghanistan, adapting to the increasingly fragile situation and performing lifesaving surgery on victims of the violence.

A medic in MSF's Kunduz Emergency Trauma Unit treats a patient who has suffered a complicated fracture due to a bomb blast. © Stig Walravens/MSF 

The increase in violence in Afghanistan is restricting access to medical care and increasing the number of people killed and wounded by bullets and explosions. It is also causing widespread displacement, with as many as 938,000 people newly displaced from their homes by conflict over the past three months, and approximately five million people have been internally displaced in total.

In the areas where MSF works—Lashkar Gah, Kandahar, Kunduz, and Herat—the consequences of this violence are being felt acutely. 

“The situation in the country has deteriorated to a point that in some cities, like Lashkar Gah and Kunduz, the medical facilities are on the frontlines,” says Laura Bourjolly, MSF Afghanistan Humanitarian Affairs Manager. 

“MSF staff continue to treat patients in all of our projects, under dire circumstances, and we have adapted our medical activities to respond to the acute needs.”

On 9 August a rocket exploded in the compound very close to the emergency room—fortunately there were no casualties.

Treating victims of shelling, rocket attacks and airstrikes

In Lashkar Gah, where MSF supports Boost hospital, intense fighting has surrounded the city for the past week. Healthcare staff have remained in the hospital to treat patients despite the shelling, mortar and rocket attacks, and airstrikes. On 9 August a rocket exploded in the compound very close to the emergency room—fortunately there were no casualties. 

MSF teams have treated 652 patients with war wounds since the beginning of May. The noise of war makes it very difficult to sleep, but  staff have managed to keep all departments of the hospital open. In the past week MSF teams in Boost have treated dozens of war wounded patients, performing 20 surgeries in just one day. Many people have now fled the city and in the last few days we’ve seen a significant reduction in the number of patients coming to the hospital for care.

Fighting also surged recently in and around Kunduz, and at the end of last week the city fell to the Taliban. When the violence intensified in July, the MSF office space was transformed into a trauma unit with the team providing care to people injured by explosions, bullets, and shrapnel, treating both adults and children. We are contining this trauma care and have started to transfer outpatient services to the new Kunduz Trauma Centre, which has been under construction since 2018. We are also continuing to support the district advanced post in Chahar Dara, a stabilization unit in a district outside Kunduz city.

Samiullah (12) suffered a gunshot wound to the head on 4 May. His family travelled for two and a half hours, crossing gardens and a river to avoid fighting, before reaching Boost hospital. © Tom Casey/MSF

It’s too dangerous for people to go to the hospital

In areas with heavy fighting it is often too dangerous for people to leave their homes for medical treatment, causing people to delay seeking care until they are very sick. We see that the number of patients in our emergency rooms, COVID-19 treatment centre, or outpatient clinics decreases as the violence increases, due to this insecurity. 

Medical emergencies, births and chronic conditions do not stop during times of war.  For patients with ongoing medical concerns, the insecurity makes it extremely difficult to access the regular care they need. In Kandahar, where MSF runs a project for patients with drug-resistant tuberculosis, MSF patients are now undertaking consultations remotely, and being provided with additional stocks of medication to avoid having to cross frontlines. 

In areas with heavy fighting it is often too dangerous for people to leave their homes for medical treatment, causing people to delay seeking care until they are very sick.

In Lashkar Gah, the number of pregnant women seeking care increased when the situation was calmer. 

“We only had one pregnant woman in the hospital,” explains Sarah Leahy, MSF Helmand Project Coordinator, “but the next day, after the fighting died down for a bit, ten pregnant women managed to reach us, so we know the needs are out there. 

“We’re really worried that women are having to give birth at home with no medical help available if they have complications.”

“We’re really worried that women are having to give birth at home with no medical help available if they have complications.”

Sarah Leahy
MSF Helmand Project Coordinator

Hundreds of thousands displaced

The clashes between the warring parties have forced hundreds of thousands of people from their homes. Some have sought safety in urban areas and are living in informal settlements with little access to basics such as food, shelter and medical care. 

In July in Kunduz, MSF opened a small clinic providing outpatient consultations for displaced women and children in Sar Dawra and began providing safe drinking water to internally displaced people. The clinic has been providing treatment for around 300 patients per day, and in early August MSF handed over the activities to another organisation to allow teams to focus on trauma care. 

In Haji camp, an informal settlement in Kandahar where 500 displaced people are currently living, we have set up a temporary clinic providing medical care to children under five. We have also been repairing water access points and improving access to toilets and showers. Since the end of July more than 170 children had been treated in this clinic, the majority for respiratory illnesses, diarrhoea and anaemia. 

The conflict remains very dynamic with violence flaring in different areas of the country, and MSF is adapting its projects as much as possible to address the changing needs. But medical staff around Afghanistan are faced with fighting taking place in the streets around medical facilities, and with little rest or respite; constantly worried about the families they have left at home. 

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As violence increases around the country, MSF is calling on all parties to the conflict to ensure that health facilities, patients and staff are not attacked or threatened and that patients can safely access medical care.