Intended for healthcare professionals

Opinion

Afghanistan is in crisis—urgent health and humanitarian aid must be facilitated

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3160 (Published 30 December 2021) Cite this as: BMJ 2021;375:n3160
  1. Gaetan Drossart, MSF operational coordinator
  1. MSF, Afghanistan

MSF's work in Afghanistan has always been challenging, says Gaetan Drossart, but now teams are struggling to provide care in a country that is on the brink of collapse

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It’s always been a challenge to deliver healthcare in Afghanistan. I have spent most of the past decade working with our Afghan teams, during which time MSF has spoken out repeatedly about the many problems preventing the people of Afghanistan from receiving adequate medical care. Decades of conflict and the lack of availability of funds, services, supplies, and staff had left many people reliant on humanitarian aid, particularly in rural areas. However, what we’re seeing today is unprecedented.

Now the whole country is on the brink of collapse. If there is no clear, tangible action to improve the situation quickly, it will be a disaster. The scale of the problem is huge; government ministries don’t have the means to coordinate or implement policy, unemployment and inflation is high, and families have lost savings and spending power.

If the banks fail, people will lose everything. It is complicated to get money into the country, and it is difficult to travel in or out. The ripple effect of pre-existing sanctions and the financial measures against the new government is being felt deeply nationwide, and it is wintertime. Afghanistan is isolated and facing near total economic and institutional collapse. The United Nations Development Programme predicts that if things don’t change soon, 97% of the population could be living under the poverty line by mid-2022.1 It’s like a domino effect: once one thing starts to fall, everything falls.

As a result of all these compounding problems, the health and humanitarian response in Afghanistan has been greatly reduced. Some 70-80% of the healthcare system in Afghanistan was funded by foreign donors and the World Bank.2 Suddenly, in August, that money stopped coming. The government is unable to pay people’s salaries. Most of the Ministry of Health staff are now working unpaid. The country also has a shortage of everything required to run a hospital, from medications and medical supplies to food and fuel.

The way MSF works and is privately funded has ensured that we’ve been able to continue supporting the people of Afghanistan in our five project locations: Herat, Kandahar, Khost, Kunduz, and Lashkar Gah. We’re able to get supplies and people into the country but the cost of running our operations is increasing dramatically due to all these new obstacles. When everything is so uncertain for our Afghan staff and for the general population, we have grave concerns for the future. We don’t know what tomorrow will be like.

The people of Afghanistan were already facing multiple health risks. Afghanistan has had worrying health indicators, particularly for women and children, for many years. MSF regularly sees malnourished children in Afghanistan, but the situation is worse this year. In Lashkar Gah and Herat, our intensive therapeutic feeding centres have been over capacity for months. In Helmand, during the month of November, we were treating an average of 54 malnourished children a day. This widespread malnutrition is weakening people’s immune systems. In Khost, we delivered over 2000 babies in November, but now those mothers and babies are more vulnerable than ever. In Helmand there used to be more than 80 health centres—now almost every facility is non-functional. Amid the chaos, immunisations will be forgotten, there may be all kinds of disease outbreaks, the number of measles cases in Helmand is increasing, and a fourth wave of covid-19 is inevitable.

The way MSF has negotiated access over the years has built up a level of trust with local communities. We’re still in Afghanistan and working on scaling up our response due to our independence and neutrality and the incredible commitment of all our staff. For example, in Herat we have started to work in the inpatient department of the regional hospital, and in Kandahar we are opening an ambulatory therapeutic feeding centre. We’ve seen huge increases in patient numbers in every project and in all departments. We’re under a lot of pressure.

The fact that money for Afghanistan is frozen and that funding has been severely cut is causing great ripple effects of harm. The Afghan people are not receiving the aid and services that they desperately need. We urgently need concrete measures from the main stakeholders to support and facilitate the delivery of humanitarian aid and to increase our capacity to respond to these enormous healthcare challenges. We needed action yesterday—we are running out of time.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not peer reviewed.

References

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