“Still No Weapons, No Fees” : MSF in Afghanistan – One Year On
November 26, 2010
MSF started working again in Afghanistan in October 2009, after a five-year absence following the assasination of five colleagues in Badghis province in June 2004. MSF’s return was motivated by an overall worsening in healthcare provision as the country became once again engulfed by war. The Afghan population has been trapped for years in conditions of poverty and a general lack of access to medical treatment, particularly to secondary health care. In addition, due to growing insecurity and ongoing conflict, people in need often have to travel hundreds of miles through extremely dangerous areas, sometimes outside of Afghanistan, in order to reach a health structure.
MSF now has medical activities in Boost Hospital, in Helmand’s provincial capital, Lashkargah and a district hospital, Ahmed Shah Baba, located in east Kabul. In both hospitals, MSF provides medicine and medical materials, and has expatriate and national health staff working together with the existing hospital staff to ensure all medical care provided is of good quality and free of charge.
To ensure these hospitals are safe places for patients to be treated, it was crucial for MSF to secure agreements with all parties involved to ensure the hospital is a safe environment for patients. A strict ‘no weapons allowed’ policy has been implemented in both structures. Many patients testify to feeling safer in these facilities as a result.
Ahmed Shah Baba District Hospital, east Kabul:
Ahmed Shah Baba – or Arzan Qimat (Dari for ‘cheap land’) as it used to be known - is a sprawling urban settlement of between 200,000 to 300,000 people on the outskirts of east Kabul. Kabul’s overall population has increased dramatically in the last ten years – from around 1 million to anywhere between 3 to 5 million today.
This is both related to insecurity, as well as people coming to the capital for economic reasons. Ahmed Shah Baba is where many displaced returnees from the Afghan refugee camps in Pakistan and Iran as well as economic migrants have settled in recent years. So while Kabul remains a relatively stable, urban setting, MSF decided that Ahmed Shah Baba represented a vulnerable group largely neglected by international donors who tend to focus instead on regions outside the capital.
A lot has changed over the last year in the hospital. MSF expatriate and national doctors, midwives and nurses – who live close by – are working together with the hospital’s medical staff to improve quality of care. To start, the existing building was rehabilitated, and improvements made to the maternity section, emergency room, laboratory and X-ray departments.
More recently, an operating theatre and small inpatient department was completed, with the very first surgery done at end of October. This means that basic but lifesaving surgical procedures, like ceasarians, can now be done locally, instead of being referred to central Kabul hospitals an hour away.
In October 2010, 15,000 medical consultations took place - compared to 5,500 in October 2009 – with around 1200 of these seen in emergency. The newly opened dressing room administered approximately 300 dressings. In maternity, there were 330 deliveries, with 600 pre-birth check ups and 300 family planning sessions. A brand new outpatient department will shortly be complete, with the leftover space being used to expand the inpatient department.
Boost Hospital, Lashkargah, Helmand province:
In November 2009, MSF also started to work in Boost provincial hospital in Lashkargah, the capital of Helmand province. The region’s more or less one million inhabitants have been among the people most affected by the ongoing conflict.
As one of only two functioning referral hospitals in south Afghanistan – the other supported by ICRC in adjacent Kandahar province – Boost Hospital was seeing 120-160 patients per month. The hospital now treats an average of 1200 patients a month overall. MSF’s work in the 145-bed hospital includes the maternity, pediatrics, surgery, Intensive Care Unit, inpatient services, isolation unit and emergency room. MSF is also involved in the rehabilitation of key facilities, putting in place sterilization and hygiene protocols, and providing inpatients and their families with two meals a day.
In October 2010, the maternity section had around 240 deliveries, which is helped by an increased capacity for caesarian sections and complicated deliveries. The maternity section now also offers pre-natal (ANC) and post-natal care (PNC) and family planning consultations, services which were virtually non-existent in November 2009. In October, there were over 200 ANC, 30 PNC and nearly 100 family planning consultations.
Surgical procedures, including caesarian sections have doubled since January 2010. In October 2010, there were 130 surgeries and 20 caesarians performed. (put something about decrease of war wounded cases with return of Emergency, but still had 45 war wounded referrals, and increasing)
The pediatric wing, which accounts for between 25-30% of patients, until recently had a bed occupancy rate of 150%. This meant additional beds and occupants lining drafty corridors with little privacy. In September 2010, a 16-bed extension to the pediatric ward was completed, bringing the pediatric ward – which contains a general pediatric unit, Therapeutic Feeding Centre (TFC) and a new Intensive Care Unit (ICU) – up to 30 beds. In October 2010, 250 pediatric cases were treated, 40 of which were newborns.
An upgraded emergency room, staffed by a permanent doctor and nurse now offers a 24-hour stabilization point for an increasing number of violent trauma and war-wounded patients, which are then referred to other departments for more specialized care. Since the emergency room opened in May 2010, around 20,000 patients – 10% of which are considered critical cases - have received treatment. In October alone, 4251 cases were seen.
MSF chooses to rely solely on private donations for its work in Afghanistan, and does not accept funding from any government. In 2011, MSF will extend its work to other conflict affected provinces.