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Afghanistan: war victims struggle to reach treatment

26-08-2011 Feature

The government-run Mirwais hospital in Kandahar, south Afghanistan, receives support from the ICRC to help staff care for patients, from malnourished babies to mine-blast casualties. Because of major problems in reaching the hospital, many arrive in a grave condition.

A painful trip to the hospital

Farmer Abdul Qadir brought his 18-year-old brother, Hasti, to Mirwais hospital following an air strike on his village in Helmand province. Hasti was wounded in the leg during the raid. In the same ward is Kabir Jan, also 18. Kabir's leg was amputated after he stepped on a mine. He was brought to the hospital by his uncle, Agha Badar.

 

Abdul Qadir with his wounded brother Hasti. It took a day to reach the hospital – the road from his village was closed because of mines.
© ICRC / J. Barry

“It was at night and we were attending a wedding ceremony in the village," says Abdul Qadir from his brother Hasti's bedside in the male surgical ward of Mirwais hospital. “We had all just gone inside to sleep when something dropped from the air and there was a huge explosion. My brother was wounded in the leg. Three other people were injured. One of them later died."

“Then there was shooting, and it was impossible to leave the house until the next day,” he adds.“When we could finally go out, it was difficult to get to the local clinic because there were mines on the road to Nawzad.   

“It took a long time to find a taxi that would take us anywhere. The drivers were scared. I asked five or six of them before I could find someone who was willing to take us even some of the way.  

 

Agha Badar brought his nephew Kabir Jan to Mirwais hospital after the young man was injured by a mine blast. Doctors had to amputate his leg.
© ICRC / J. Barry

“We went by a mountain road to Gereshk and on to Maiwand, and finally to Kandahar. We kept having to change taxis because the drivers would only go so far. It took us the whole day to reach this hospital. My brother was unconscious and his leg was very bad.”

Across from Hasti's bed, 18-year-old Kabir Jan is lying back on his pillows. When Abdul Qadir finishes his story, Kabir's uncle, Agha Badar, speaks.

"My nephew was walking in a garden when he stepped on a mine," says Agha Badar. "While he was still conscious he called for help but people were too scared to approach him at first.  

"Eventually, people came forward. They put Kabir in a wheelbarrow and brought him home. After one hour a car came to fetch him and we put him inside."

“Kabir was unconscious on the way to the hospital. He had lost a lot of blood and his face was totally yellow," remembers his uncle. "When we arrived here in Mirwais the doctors told us to bring blood for him quickly, and when the foreign doctors saw him they told us his situation was very bad. If we had delayed one more hour he would have died."

There are no health facilities in the remote area of Maiwand where Agha Badar and his nephew live.  

"Our village is about two hours on foot from the main road, when you are walking fast," remarks Mr Badar. “There is no doctor and no pharmacy. There is a person who has some medicines at home. When you say you need some treatment he says, what do you need? Take what you want."  

“I know of one incident where there was mortar shelling. One person got hurt in the stomach and he died just before getting to hospital. He was a local person called Pacha. I know of another nine people who died on the way to hospital. In another village two people got injured in an explosion. They died on the spot."

From across the ward Abdul Qadir joins in the conversation.  

“The situation has been like this for four months around where we live in Helmand. It used to be better before. But the roads are closed now because of mines. And because of this the prices are going up in the bazaar."

The rise in prices puts an extra burden on village communities who are simple farmers and very poor.

"It cost a lot of money to bring my brother to Kandahar, remarks Abdul Qadir.

He looks at his brother who, despite all that he has been through, manages a smile.

"Will he get better? I don’t know. He has some pain in his leg. The other one was not hurt.”

Mothers between hardship and hope

The stories from the women who bring their sick children to Mirwais all bear the same hallmarks: poverty, little education, and often an unwillingness on the part of their husbands to allow their wives to leave home until it is almost too late.

 

Children in the therapeutic feeding ward of Kandahar’s Mirwais hospital. Some children arrive too late to be saved.
© ICRC / J. Barry

When mothers do bring their sick children to Mirwais, the journey is far from easy. "It took a whole day to get here from my village," said one young woman who did not want to be named. "There were police and soldiers checking the cars."

"Before, there used to be fighting every day in our area," said another women, "But now there is less."  

Even so, life is a constant strain.

"My brother is a driver," the woman continued. "If he is not home by the afternoon, we start getting worried and think he has been killed".

As always in times of conflict, children are among the most vulnerable. The therapeutic feeding ward in Mirwais is full of babies for whom accumulated months of sickness have taken a heavy toll on their young bodies. Swollen limbs, and bloated faces are one of the tell-tale signs of malnutrition. With proper nourishment, and education for the mothers about the benefits of breast-feeding and good hygiene, many children recover. Others, sadly, do not, having arrived at the hospital when they were already beyond hope.  

 

The crowded therapeutic feeding ward at Kandahar’s Mirwais hospital. Mothers wait anxiously for their children to recover.
© ICRC / J. Barry

The mothers sit on the beds with their sick children, sharing friendship and concern in their common cause to bring their babies back to health. "I have been here eight days already," said a mother called Abida. "I will stay here a month. If there is no improvement I will take my baby home."  

But in a month, miracles can happen, as the example of a baby who was born in the hospital recently confirms. One of twins, he weighed only six hundred grammes at birth. His sibling died. The surviving newborn was put in an incubator and slowly gained weight. After a month he weighed 1.6 kilogrammes and was discharged from the hospital. When his parents brought him back to Mirwais for a regular check-up some weeks later, he had gained yet more weight and was doing well.

His was one of the success stories that shine a light on all that the doctors and nurses are doing to try and save young lives scarred by decades of war in Afghanistan.

People are afraid to use the roads

Alia Kuchi, a charge nurse at Mirwais regional hospital in Kandahar was brought up in Kabul, did her nursing training in Quetta, Pakistan, and has lived in Kandahar for the past 20 years with her husband and six children.

 

In Kandahar’s Mirwais hospital, the paediatric ward is overflowing, with up to three infants in a bed.
© ICRC / J. Barry

Alia has worked in a number of different positions at Mirwais hospital over the past 16 years. Currently she is charge nurse on the paediatric ward. Whilst making the rounds one recent morning, she spoke about her work and her concerns for the mothers and children under her care.

“Most of the women who come here are very poor,” she remarks. “They are not educated and go to local doctors before seeking proper medical care. On top of that people are afraid to use the roads, because of fighting, or mines, or bombs.”

“I know of two or three cases where pregnant women who were delayed on their way here lost their babies before they arrived. I feel very sad when that happens.”

 

Alia Kuchi checks infants at the Mirwais hospital. "Almost all the children are suffering from diarrhoea," she says.
© ICRC / J. Barry

The ward is overflowing with sick children, and women wrapped up in voluminous shawls and burkhas. Alia moves between them and says, “Look at this room. There are 14 beds, but each one has three children in it. Fourteen babies very quickly becomes 42”.  

“Almost all the children are suffering from diarrhoea,” she continues as she checks small feverish bodies and adjusts saline drips. “Some are very malnourished. The most severe cases are treated in another ward, where they receive therapeutic feeding."

She finishes her round and rushes off to the next task, always on her feet; her energy and dedication an inspiration to those around her.