Un Doctors In Afghanistan: A Delicate Presence

Afghanistan has been in a state of conflict for decades, resulting in immense medical needs, particularly among women and children. The country has faced challenges such as drought, famine, and political upheaval, which have led to a fragile and overburdened public health system. Despite these difficulties, organisations like Doctors Without Borders/Médecins Sans Frontières (MSF) have been working tirelessly to provide essential medical care to Afghans. MSF operates several projects in Afghanistan, including running hospitals, trauma centres, and outpatient clinics. They also provide support to local health centres and hospitals by donating medicines, funding additional staff, and offering specialised healthcare services.

The UN has also played a role in Afghanistan, particularly in condemning attacks on healthcare workers and facilities during the COVID-19 pandemic. According to a report by the UN Assistance Mission in the country, there were 15 attacks on healthcare facilities in Afghanistan during the first two months of the pandemic. These attacks, perpetrated by both the Taliban and Afghan national security forces, have been condemned by the UN as deliberate acts of violence that undermine healthcare operations and constitute war crimes.

While the security situation in Afghanistan improved in 2022, making it easier for people to access healthcare facilities, many Afghans still face significant challenges in obtaining the care they need. Economic hardships and restrictions on women's freedom of movement, access to education, and work create barriers to accessing healthcare.

The UN condemns attacks on healthcare workers in Afghanistan

The United Nations has condemned attacks on healthcare workers in Afghanistan, expressing grave concern over deliberate assaults on healthcare personnel and facilities, especially during the COVID-19 pandemic. According to a report by the UN Assistance Mission in the country, 15 attacks on healthcare facilities were recorded in Afghanistan during the first two months of the pandemic. The report revealed that 12 of these attacks were deliberate, while the rest involved incidental harm. Eight targeted attacks were attributed to the Taliban, who were also suspected of causing incidental harm in two other incidents.

The UN Secretary-General's Special Representative for Afghanistan, Deborah Lyons, emphasised the lack of excuse for such actions and stressed the priority of safeguarding the civilian population's safety and well-being. The UN mission reminded all parties that deliberate violence against healthcare facilities and personnel is prohibited under international humanitarian law and constitutes war crimes.

The context of the COVID-19 pandemic further exacerbates the reprehensibility of these attacks, as noted by Fiona Frazer, UNAMA Chief of Human Rights. The pandemic has already stretched health resources thin, and targeted assaults on healthcare workers and facilities only serve to compromise the ability to provide critical care to the civilian population.

The UN has called for adherence to the Secretary-General's appeal for a global ceasefire during the pandemic, recognising that the highest priority at this time is ensuring uninterrupted healthcare services.

This condemnation from the UN comes amidst a backdrop of ongoing conflict and political upheaval in Afghanistan, which has resulted in immense medical needs, particularly among women and children. The volatile security situation and economic challenges have made it increasingly difficult for Afghans to access healthcare.

The UN's stance aligns with the broader international outcry following incidents such as the 2015 US airstrike on a Doctors Without Borders hospital in Kunduz, which resulted in the deaths of patients, caretakers, and staff members.

Doctors Without Borders provides medical care in Afghanistan

Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing medical care in Afghanistan since the 1980s, working in areas under the control of various political and armed factions. The organisation relies solely on private funding for its work in the country and does not accept money from any government.

MSF runs a range of projects in Afghanistan, responding to the immense medical needs caused by decades of conflict and political upheaval, particularly among women and children. The organisation provides free medical care and supports hospitals and health centres across the country, offering services such as surgery, internal medicine, maternity and paediatric care, and treatment for tuberculosis and acute watery diarrhoea.

In 2022, MSF ran seven projects in seven provinces, maintaining a strong focus on providing specialised healthcare. They supported hospitals such as the 340-bed Boost Hospital in Lashkar Gah, Helmand Province, and the Ahmad Shah Baba Hospital in Kabul. They also responded to emergencies, such as the 5.9-magnitude earthquake in Paktika and Khost provinces, setting up outpatient and inpatient clinics for those affected.

MSF's work in Afghanistan is challenging due to the country's instability, displacement of people, and acute health needs. The organisation has faced security risks, such as the bomb attack on their maternity hospital in Khost in 2012. Despite these challenges, MSF remains committed to providing essential medical care to the Afghan people.

The impact of conflict on medical care in Afghanistan

Afghanistan has been in the throes of conflict for over four decades, which has severely impacted its health system. The conflict has disrupted the provision of services in areas such as health, education, and agriculture. The decades of conflict have resulted in a disarrayed health system, with high maternal and child mortality rates and low coverage of reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH&N) interventions.

The security situation in Afghanistan poses a challenge to the delivery of healthcare services. Violence and attacks on healthcare facilities and workers have been reported, with 15 attacks recorded during the first two months of the COVID-19 pandemic. The conflict has also disrupted the supply of medicines and medical equipment, with healthcare facilities facing shortages due to insufficient budget allocation and delivery challenges.

The conflict has further exacerbated existing societal and cultural norms that hinder women's access to healthcare. Traditional and religious healers are still preferred by some communities over modern medicine. Additionally, the Taliban's restrictions on women's education and employment have limited the number of female healthcare workers, further impacting the delivery of healthcare services.

The impact of the conflict on medical care in Afghanistan has also been felt in terms of infrastructure. Poor road networks, lack of transportation, and difficult terrain have made it challenging for people, especially those in rural areas, to access healthcare facilities. The conflict has also resulted in damage and destruction to healthcare facilities, further limiting the availability of medical services.

Overall, the conflict in Afghanistan has had a detrimental effect on the country's medical care system, with shortages of health workers, limited access to facilities, inadequate infrastructure, and disruptions in the supply chain. These factors have combined to create a challenging environment for the delivery of healthcare services, particularly in rural and conflict-affected areas.

The role of the international community in providing humanitarian aid to Afghanistan

Afghanistan is facing one of the world's worst humanitarian crises, with over 90% of the population living below the poverty line and millions suffering from food insecurity and a lack of access to safe water and healthcare. The situation has been exacerbated by decades of conflict, natural disasters, economic instability, and political upheaval.

The international community has played a crucial role in providing humanitarian aid to Afghanistan to address these pressing issues. Here are some key examples:

United States

The United States has provided significant humanitarian assistance to Afghanistan, committing over $720 million since August 2021. This funding is channelled through independent humanitarian organizations such as the United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM), and United Nations Children's Fund (UNICEF). The US also continues to call on other members of the international community to honour their pledges made during the High-Level Pledging Event on Supporting the Humanitarian Response in Afghanistan.

European Union

The European Union (EU) has been funding humanitarian operations in Afghanistan since 1994, providing close to €1.7 billion in aid. In 2023 alone, the EU allocated €156.5 million in humanitarian aid. The EU's priority is to provide life-saving assistance, ensure access to basic services, and build the resilience of the Afghan population. To facilitate the delivery of aid, the EU has transported over 1,340 tonnes of relief items through humanitarian air bridge flights to Kabul.

International Rescue Committee (IRC)

The IRC has been providing vital support to Afghans affected by violent conflict, natural disasters, and economic collapse. They offer humanitarian relief and recovery assistance to Afghans both within the country and abroad. In 2023, the IRC served nearly 2 million clients with health services, over 250,000 with economic recovery aid, and almost 200,000 through educational programs. They also provide family support programming and implement education programs for children under 12 in several provinces.

Doctors Without Borders (MSF)

MSF runs a range of projects in Afghanistan, addressing the immense medical needs caused by conflict and political upheaval, especially among women and children. They support hospitals and health centres across the country, offering services such as maternal and pediatric healthcare, surgery, and treatment for malnutrition. MSF also responds to emergencies, such as outbreaks of acute watery diarrhoea and earthquakes.

Other International Organizations

Other international organizations, such as the World Food Programme and the International Committee of the Red Cross, are also actively involved in providing humanitarian aid to Afghanistan. These organizations work to address food insecurity, support healthcare services, and assist vulnerable populations.

The challenges faced by women in accessing healthcare in Afghanistan

Afghanistan has experienced chronic conflict and war for over 40 years, which has had a detrimental impact on women's rights and healthcare. Ranked 157 out of 162 countries in the 2019 Gender Inequality Index, Afghanistan has a long way to go in terms of improving women's access to healthcare. Here are some of the key challenges faced by women in Afghanistan:

• Inadequate Healthcare Infrastructure: Afghanistan has a shortage of medical professionals, with only 4.6 doctors, nurses, and midwives per 10,000 people, far below the World Health Organization's threshold of 23 healthcare professionals per 10,000 people. This lack of medical staff often results in long delays in receiving treatment, especially in rural areas.
• Limited Access to Basic Healthcare: Women and girls often struggle to access basic healthcare services, including contraception, prenatal and postnatal care, and safe birthing services. The cost of transportation and medications creates a financial barrier, preventing many women from receiving timely care.
• Security Concerns and Conflict: Insecurity and fighting due to the ongoing war create significant obstacles for women seeking healthcare. Health facilities and workers are often caught in the crossfire or even targeted, making it challenging to provide consistent services.
• Cultural and Social Barriers: Afghanistan's conservative society and low literacy rate among women restrict their mobility and opportunities. Women often face pressure from their families to give birth at home and are discouraged from seeking prenatal and postnatal care. Additionally, cultural norms dictate that women can only be treated by female healthcare providers, further limiting their access to care.
• Lack of Information and Education: Many women lack access to basic information about their health and family planning. Comprehensive sexuality education is not included in the national curriculum, and social stigma surrounding discussions of sexuality contributes to this knowledge gap.
• Inequality and Gender Discrimination: Afghanistan's deep-rooted gender inequality affects decision-making within families, with men often having more power than women. This dynamic influences women's ability to make their own healthcare choices and access necessary services.
• Poverty and Economic Instability: Poverty rates in Afghanistan are alarmingly high, and the country's economic instability further exacerbates the challenge of accessing healthcare. Many women cannot afford transportation costs or the medications and supplies required for treatment.
• Impact of the Taliban Rule: The Taliban's restrictions on women's movement and education have further hindered their access to healthcare. Women are often required to have a male guardian accompany them to seek medical care, and there is a shortage of female healthcare providers due to restrictions on women's education and employment.
• Funding and Donor Support: Afghanistan's healthcare system relies heavily on international donor support, which has been declining. The withdrawal of foreign troops and the pause in donor funding have put the gains made in maternal health and other areas at risk.

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