Kabul/New York, March 4, 2020—People in Afghanistan still struggle to access essential medical care due to violence and widespread poverty, despite decades of international aid and investment in the country, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a report released today.
The report, Reality Check: Afghanistan’s neglected health care crisis, is based on in-depth interviews with MSF patients, their caretakers, and MSF staff in Herat and Helmand provinces. It shows that many Afghans face significant barriers to access medical care, including insecurity, distance, and cost. In addition, many of the country’s health facilities lack the staff and equipment they need. According to MSF, the situation has not improved since the organization issued its last report on the state of medical care in Afghanistan in 2014.
While international attention has recently focused on the potential impact of an agreement between the United States and the Islamic Emirate of Afghanistan (also known as the Taliban) and the anticipated resumption of intra-Afghan peace talks, the country is facing an ongoing humanitarian crisis. Afghans suffer from prolonged conflict, recurring natural disasters, internal displacement, and lack of access to health care.
The effects of active fighting and indiscriminate violence permeate every aspect of daily life, including seeking medical care. Many of MSF’s patients in Boost hospital in Lashkar Gah, Helmand province, have to weigh various factors before deciding to travel to or from the hospital: whether the roads have been mined, whether there are checkpoints along the way, and whether it is safe to travel in the dark or while fighting is ongoing.
“We are scared to leave at night, so we always have to wait until daytime to go to the hospital,” said a patient’s caretaker in the maternity ward of Boost hospital. “With everyone in our family, when they are sick, we wait, even if the person is dying.”
The medical staff working in health facilities managed and supported by MSF regularly see the impact these delays in seeking care—delays that can mean the difference between life and death. During the first six months of 2019, 44 percent of the children who died within 24 hours of being admitted into the pediatric intensive care unit in Boost hospital arrived too late and at a very advanced stage of illness. In Herat regional hospital, 41 percent of people surveyed by MSF stated that a family member, friend, or neighbor had died in the past two years due to lack of access to medical care.
The report shows that poverty also has a significant impact on people’s access to medical care. Up to 89 percent of patients and caretakers surveyed in Herat regional hospital said that they had postponed seeking medical care due to financial pressures. One parent explained that they waited eight days to bring their malnourished baby to the hospital for treatment while they scraped together enough money to hire a car—and they eventually had to borrow the funds from friends and relatives. Another parent said, “We cannot buy food for tonight. How can we pay for medicines and doctors?”
While there has been some progress in health care provision in Afghanistan in recent years, significant gaps remain. There is a clear discrepancy between the official narrative of the Afghan health system’s ability to cope with the needs of the population, and the realities facing our patients.
“Our patients tell us of long, dangerous journeys to bring malnourished babies, pregnant relatives, or injured loved ones to the hospital,” said Julien Raickman, MSF country representative in Afghanistan. ”They describe clinics with insufficient drugs or [without] qualified staff. And they have to contend with mounting debt to pay for treatment.”
As local, national, and international stakeholders look ahead to build a more stable future for Afghanistan, they must acknowledge that the country’s humanitarian situation has not improved and, in some areas, has worsened in recent years. An urgent priority now must be to ensure greater access to free, high-quality health care and respond to the acute medical needs.
MSF has worked in Afghanistan since 1980 and today runs projects in six provinces: Kabul, Khost, Kandahar, Kunduz, Helmand, and Herat. In 2018, MSF teams provided 411,700 outpatient consultations, assisted 74,600 births, and performed 6,890 major surgical interventions. MSF provides medical care free of charge. MSF relies solely on private funding for its work in Afghanistan and does not accept money from any government.