The BMJ appeal 2021-22: “Doctors must raise their voices to advocate for those in Afghanistan”BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o78 (Published 14 January 2022) Cite this as: BMJ 2022;376:o78
For an organisation funded entirely by private donations, the scale of Médecins Sans Frontières’s humanitarian operation in Afghanistan at the start of 2022 is significant.
It has five major healthcare projects in some of the country’s largest cities: Helmand, Herat, Kandahar, Khost, and Kunduz. These projects deliver both emergency and everyday healthcare—including surgery, maternity services, and emergency treatment for malnutrition—to hundreds of thousands of vulnerable Afghan people.
This involves the paid employment of 2300 Afghan staff, along with 100 international staff, at a time of the near complete unravelling of the country’s economy and healthcare system. MSF also purchases and imports the drugs and medical technology required by these services in planes that it charters itself.
So far, so normal for MSF, which has been carrying out similar interventions since it was set up in France in 1971. It currently employs 45 000 staff in 70 countries, some of whom are facing the most serious medical emergencies on the planet.
Afghanistan today faces an abnormally bleak reality. Its foreign reserves ($9bn) have been frozen following the formation of the country’s new government under the Taliban in August 2021. At the same time, billions of dollars of international funding, which had made up four fifths of the previous government’s budget, was abruptly cut.
Humanitarian agencies now predict “the world’s worst humanitarian catastrophe,”1 with 22.8 million people facing food insecurity. One million children, half of all children under the age of 5, will be severely malnourished within weeks, according to Unicef.2
In response, MSF has plans to increase its operations in Afghanistan. Some are temporary, short term interventions. In September 2021 in Spin Boldak, on the border with Pakistan, the organisation ran a mobile clinic for people living in informal settlements to help provide clean water. In October, it opened a 20 bed treatment centre at Ahmad Shah Baba hospital in Kabul, with oral rehydration points in key areas of the city to tackle the outbreak of acute watery diarrhoea.
On 15 December 2021, it opened an ambulatory therapeutic feeding centre in Kandahar, responding to high levels of severe and acute malnutrition in the area. Here it provides outpatient malnutrition treatment for patients aged between six months and five years, following their discharge from the nearby inpatient therapeutic feeding centre at Mirwais regional hospital.
MSF continues to support eight comprehensive health centres in Khost, along with the Provincial Hospital, with food, fuel, and medical supplies. It is also supporting the Ministry of Public Health’s Fatima Bayat Hospital in Lashkar Gah with medical supplies and drugs.
Practitioners stress the power of doctors’ advocacy internationally. “Yes, we desperately need donations to support our work, but just as important is bearing witness to what is happening here,” says Filippe Ribeiro, MSF’s representative in Afghanistan.
The organisation’s longstanding practice of “témoignage”—bearing witness and speaking out about the plight of those they treat—has never been in conflict with its impartiality. “MSF cannot compensate for the economic situation, the loss of international aid, and the freezing of the country’s assets,” Ribeiro tells The BMJ. “Our work here is more than a drop in the ocean, but it’s not much more.”
MSF is demonstrating what can be done, he says. “Our daily work shows that it is possible to bring funds and medicines into the country and provide care for Afghan people without government interference,” he says. “Our Afghan workforce, including women, continue their work unimpeded.”
The organisation’s staff in Afghanistan speak bluntly about their experience. “Here in Afghanistan, healthcare is politicised,” Mohammed Abdullah, an MSF regional supervisor, tells The BMJ. “Decisions by the international community deprive Afghan people of their livelihoods and their healthcare. That is what we see every day in front us, with our clinics ever more crowded with desperate patients.”
MSF is not alone in making the point that economic choices by the outside world are the main driver of the crisis in Afghanistan. Western media also question the justification for economic measures as a response to the Taliban’s taking over of government. As one “foreign official” told the Financial Times, “It’s mind boggling to say that we’ll sacrifice 15 million women in order to defend women’s rights.”3
Abdullah says MSF in Afghanistan needs funding more than ever before. “We also ask UK doctors to raise their voices to advocate on behalf of us all in Afghanistan and make the case for restarting vital aid to the country.”
“MSF’s work shows that Afghanistan can be supported at this critical time,” Ribeiro adds. “But it can’t do this work all on its own.”
How to donate
Please give generously to The BMJ’s appeal for 2021-22. Donations can be made at msf.org.uk/bmj.
The 2021-22 appeal is being supported by the Green Room Charitable Trust. Up to £50 000 in funding has been made available to match donations received before 31 January 2022. This means that your support will go even further.
The Afghan Crisis Appeal will fund MSF’s work in Afghanistan, as well as supporting its work in neighbouring countries.
Commissioned; not externally peer reviewed.
Competing interests: None declared.