Afghanistan: A health-care system on life support
To prevent the collapse of the secondary-health-care system, the International Committee of the Red Cross (ICRC) launched the Hospital Resilience Project (HRP), supporting 33 hospitals with a total capacity of 7,057 beds and reaching about 26 million people. The support includes paying the salaries of nearly 10,500 health workers (of whom around one-third are women) and buying medical supplies to limit the disruption of treatment of patients. It also includes cash assistance to buy fuel to run ambulances, ensure power continuity, provide food for patients and carry out necessary maintenance work.
"If the ICRC had not started supporting our hospital it would have closed by now and a large number of people would have been denied access to health care," says Dr Hafiza Omarkhail, medical director at Malalai Maternity Hospital, one of the busiest maternity hospitals in Kabul. "We had been facing many challenges because we didn't have money to buy the necessary medicines or pay salaries. Some doctors even decided to leave the hospital because of the lack of salaries, putting further strain on the already overstretched staff. Fortunately, in December 2021, the ICRC started paying the salaries and running costs of the hospital. Now, we are again able to provide quality service to mothers and children," adds Dr Omarkhail.
"We were doctors, midwives, specialists and guards at the same time"
Sharifa, a midwife in another maternity hospital in Kabul, remembers how things were in October 2021. "We used to have 100 medical staff on duty. By the end of 2021, however, we only had two midwives and one doctor left. We didn't even have cleaners. The doctor and midwives cleaned the patients, the beds and chairs. We did everything; we were the receptionists, doctors, midwives, specialists and also the guards," she says.
Because of the shortage of staff, medicines and equipment all patients could not be admitted. "This incapacity caused other tensions, with families of the patients wanting to beat us for refusing treatment," adds Sharifa.
The situation has been grim for patients too. Noorulhaq, who was hospitalized in October 2021, shares, "I was riding a bicycle when a car hit me and broke my leg. The doctors treated me very well, but the hospital's pharmacy did not have the prescribed medicines. I had to borrow money and buy the medicines from outside. Even my blood tests and other laboratory tests could not be done at the hospital so I had to go to external laboratories, which was expensive and difficult."
HRP: Preventing the collapse of health care
Access to health care remains a major concern for communities across Afghanistan. To access specialized care, patients often travel several hours, sometimes along dangerous roads in areas that are still heavily contaminated by landmines and explosive remnants of war. Ensuring the availability of qualitative and specialized health-care services in Afghanistan is critical and the HRP is a vital project that has enabled life-saving medical response.
"It is heartbreaking to see a patient in extreme pain and be forced to wait for their caregivers to buy the needed painkillers from outside the hospital because we do not have them," says Dr Amanullah, a doctor in the emergency ward of one of the biggest hospitals in Kabul where most patients suffering from injuries related to explosions are referred.
Gulaghai, 45, from Jaghouri district of Ghazni province, is one of the patients who directly benefited from the restored medical capacities through ICRC's support. "I had complications during childbirth, so the doctors decided to do a caesarean. Unfortunately, it led to more complications because of medical malpractice and the doctors had to perform two more surgeries. Eventually, my husband brought me to Malalai Maternity Hospital in Kabul, a seven-hour trip from our district. The hospital provided me medicines, did my laboratory examinations and also performed my surgery free of charge. I am now fully recovered and ready to go home," she says.
"Providing health care is a humanitarian duty"
Dr Malalai Rahim Faizi, director of Malalai Maternity Hospital, says that though it is one of the big hospitals in the country, they had been meeting OPD patients in a corrugated iron prefabricated shelter with very limited equipment. "With the ICRC's support, we have been able to shift this section to a separate building with a proper OPD ward, gynaecological ward, ultrasound room and a minor surgery room. Our operation theatre also has the necessary equipment and materials now and we are able to perform 40 to 50 C-section surgeries every day," she says.
Dr Faizi shares that the ICRC support has helped them provide nutritious food and medical care to patients who could not afford even a cup of soup. "We are experiencing a crisis in Afghanistan. International aid is vital to deal with such a critical situation. Our request to the international community is that the health sector should not be politicized. Patients need to be treated. Providing health care is a purely humanitarian duty," she says.
The ICRC started the Hospital Resilience Project (HRP) in November 2021 in Afghanistan. The project supports 33 regional, provincial and teaching hospitals across the country and will ensure the continuity of services provided by these hospitals. This support helps to pay the salaries of nearly 10,500 health workers, cover the running costs of the facilities and buy medicines and medical supplies. It also ensures that about 26 million people living in those areas have access to health care. The ICRC will continue to support the hospitals as long as is needed.