The latest in Afghanistan
After decades of conflict and chronic instability, more than five million people in Afghanistan have been internally displaced, with poor infrastructure and a damaged economy forcing many to rely on humanitarian aid.
Médecins Sans Frontières has been working in Afghanistan since 1980, providing emergency surgical care, responding to conflict and natural disasters, and treating people cut off from healthcare. MSF focuses on emergency, paediatric, and maternal healthcare in Afghanistan, which has one of the highest maternal mortality rates in the world.
By providing free, high quality maternal and neonatal healthcare in hospitals in Kabul, Helmand and Khost provinces, we aim to help reduce death and sickness in mothers and newborns. Training medical staff is an integral and important part of our projects.
Major attacks on our staff and hospitals have occurred in recent years; in October 2015, US airstrikes destroyed our trauma centre in Kunduz, killing 42 people, including 14 MSF staff. An armed group attacked our maternity wing at Dasht-e-Barchi hospital in Kabul in May 2020, with 16 mothers and an MSF midwife among those killed. In the wake of the attack, we made the difficult decision to withdraw from the hospital in Kabul, leaving women in the area without critically-needed emergency obstetric care.
Conflict between the Afghan forces and the Taliban has claimed thousands of lives and displaced millions. Many are unable to safely seek healthcare due to ongoing violence.
Providing care in MSF-run facilities
In response to the second wave of COVID-19 in Herat, our treatment centre has been reopened where hundreds of patients have been treated. MSF is continuing to refer suspected COVID-19 patients to Malika Suraya Hospital.
Supporting health authorities
We are working with the Ministry of Public Health to provide treatment and hospital care for four categories of patients infected with COVID-19 (tuberculosis, surgical, paediatric and maternity patients).
We have resumed weekly health promotion visits to the five MSF-supported community health centres in the districts.
Testing and triage
We are maintaining activities at the COVID-19 triage unit in the Herat Regional Hospital so that close surveillance and monitoring of the health situation can continue.
On 12 May 2020 the MSF maternity ward in Dasht-e-Barchi hospital, Kabul, was attacked. Gunmen killed 24 people, including 16 mothers, two children and an MSF midwife.
Before the attack, MSF had been running the maternity and neonatology departments of the 100-bed Dasht-e-Barchi hospital since 2014. The attack on the hospital rocked MSF to the core, and when no information emerged about the perpetrators or the motive behind it, we made the very difficult decision to withdraw from Dasht-e-Barchi in mid-June. To support the Ministry of Public Health after our departure, we donated medications and medical equipment.
The end of MSF’s activities in Dasht-e-Barchi will likely have devastating consequences for the more than one million people, predominantly Hazara, who live in the area.
Helmand province has been the scene of violent clashes between government and opposition forces for more than a decade. In October, when intense fighting broke out around Lashkar Gah, the main trauma hospital in the city was overwhelmed with casualties within 24 hours, and our team at Boost hospital started to receive an influx of people wounded in the crossfire.
MSF supports several departments in Boost hospital, including the emergency room, which saw around 300 patients a day in 2020, most with trauma injuries, respiratory tract infections or acute watery diarrhoea. Our teams found that, due to a combination of insecurity and COVID-19, many patients delayed seeking care and arrived in a critical condition. From April, we also managed a COVID-19 isolation ward for vulnerable patients such as pregnant women, children, people with tuberculosis (TB) and those who had undergone surgery. All other patients were referred to Malika Suria COVID-19 hospital.
In February, MSF started supporting the outpatient department of Fatima Bayat hospital with training and drug supplies, in order to reduce the number of people with non-urgent medical problems coming to Boost’s emergency room.
The first case of COVID-19 in Afghanistan was confirmed in Herat at the end of February. Kabul and Herat became the epicentres of the outbreak but the true number of people infected with the virus across the country is unknown due to lack of testing.
In Kabul, MSF supported infection prevention and control in the Afghanistan-Japan referral hospital and trained local health staff. These activities ceased after the attack on Dasht-e-Barchi. In early April, we set up a COVID-19 triage system in Herat regional hospital. Then in June, we opened the 32-bed MSF Gazer Ga COVID-19 treatment centre, focusing on oxygen therapy for severely affected patients referred from the regional hospital. The centre closed in September when the number of cases reduced but reopened on 2 December for the second wave.
In all MSF projects in Afghanistan, infection prevention and control measures were reinforced to reduce COVID-19 transmission.
In 2018, MSF opened a clinic for displaced people in the Kadhestan and Shadayee settlements on the outskirts of the city. Our team offers medical consultations, treatment for malnutrition, vaccinations, ante- and postnatal care and family planning, conducting an average of 266 consultations a day. Outreach activities started in December 2020. We also run an inpatient therapeutic feeding centre in the paediatric hospital.
Since 2012, MSF has been running a dedicated 24-hour maternity hospital in Khost, eastern Afghanistan. In 2020, to reduce possible transmission of COVID-19, the admission criteria for the maternity hospital were tightened and women in labour were no longer allowed to be accompanied by a caregiver. This led to a significant drop in the number of women giving birth in the facility and put more pressure on Khost provincial hospital; our deliveries dropped by 38 per cent, while those in the provincial hospital increased beyond their capacity.
To address this negative impact on the population and other health providers, towards the end of the year we loosened the admission criteria and female caregivers were once again allowed to accompany patients. As a result, the number of births in the facility started to increase, rising to 1,000 in December. We also resumed family planning consultations at the hospital, and health promotion activities in the five community health centres we support in the districts.
DR-TB is a major concern in Afghanistan, exacerbated by a lack of knowledge about the disease and poor availability of treatment. MSF has been supporting the national tuberculosis programme in the diagnosis and treatment of DR-TB in Kandahar province since 2016. In December 2019, we introduced a nine-month oral regimen allowing DR-TB patients to change from injectable drugs to pills and reduce their number of consultations at the hospital. The results are promising so far, with no-one defaulting from the short-course treatment. Since insecurity makes it difficult for patients to visit the centre for follow-up, they are provided with a buffer stock of medicine in case they cannot travel.
We also continued to support the health ministry in Mirwais regional hospital and at the provincial TB centre, by providing medical care for drug-sensitive TB patients. In 2020, we supported the Ministry of Public Health to detect TB and manage care for patients in Sarpoza prison.
Activities in Kunduz were hard hit by COVID-19 and they were all suspended in April. However, construction of the new trauma centre resumed in September 2020, with increased infection prevention and control measures to guard against the virus. Stabilisation activities in Chardara for patients with trauma injuries are due to resume in early 2021. The wound care clinic will not reopen.