MSF focuses on improving access to emergency, paediatric and maternal healthcare in Afghanistan, which has one of the highest maternal mortality rates in the world.
After a US military airstrike destroyed its trauma centre in Kunduz, killing 42 people, in October 2015, MSF engaged in negotiations regarding the neutrality of medical care with all parties to the conflict. At the end of 2016, MSF finally obtained commitments that its staff and patients would be respected, and care could be provided to everyone in need, regardless of their ethnicity, political beliefs or allegiances. Although hard to guarantee in an active conflict zone, MSF believes these commitments will allow it to evaluate the possibility of resuming trauma care activities in Kunduz in 2017.
The conflict in Afghanistan continued to intensify in 2016. MSF’s other projects in the country remained operational, with the number of patients increasing due to growing medical needs.. A quarter of all the births assisted by MSF worldwide are in Afghanistan, and teams helped deliver more than 66,000 babies this year.
Ahmad Shah Baba hospital, Kabul
The capital Kabul has experienced a massive population growth, and the city’s public health services cannot fulfil the medical needs. At Ahmad Shah Baba district hospital in eastern Kabul, which serves more than 1.2 million people, MSF supports the Ministry of Public Health to deliver outpatient and inpatient care, with a focus on maternal health and emergency services. The team also provides paediatric care, treatment for malnutrition, family planning, health promotion and vaccinations, and supports the hospital’s laboratory, X-ray services and tuberculosis (TB) treatment programme.
MSF has increased the capacity of the hospital from 46 to 62 beds and this year started to rehabilitate the buildings. Staff conducted 100,000 consultations and assisted 18,966 deliveries, almost 20 per cent more than in 2015.
In 2016, MSF started a new programme for the treatment of chronic non-communicable diseases such as diabetes, hypertension, chronic obstructive pulmonary disease, asthma and epilepsy. Around 600 patients were enrolled.
Maternal care at Dasht-e-Barchi hospital, Kabul
MSF collaborates with the Ministry of Public Health to provide around-the-clock care at Dasht-e-Barchi hospital, the only facility for emergency and complicated deliveries in a district with a rapidly increasing population. MSF runs the labour and delivery rooms, an operating theatre for caesarean sections and other complicated deliveries, a recovery room, a 30-bed maternity unit, a 20-bed neonatology unit and a five-bed ‘kangaroo room’, which provides specialist care for sick babies in their first days of life. In addition, MSF offers vaccinations and runs the laboratory, blood bank and sterilisation unit.
During 2016, teams assisted 15,627 deliveries, almost 27 per cent of which were complicated cases. The team is now aiming to increase referrals for simple deliveries, in order to focus on complicated cases and maintain a high quality of care.
Working at full capacity, the neonatology unit admitted 1,342 babies with complications such as clinical sepsis, hypoglycemia and perinatal asphyxia.
Khost maternity hospital
In 2012, MSF opened a maternity hospital in Khost, in eastern Afghanistan, to address the lack of obstetric care in the area. The hospital helps reduce maternal mortality by offering a safe environment for women to deliver their babies, in the care of predominantly female medical staff, free of charge.
The number of deliveries has increased by 40 per cent in two years, from 15,204 in 2014 to 21,335 in 2016. In December, the number of deliveries reached 1,905, an average of over 60 per day. In 2016, 1,746 newborns were admitted to the neonatology unit, a 15 per cent increase compared to the previous year.
This year, MSF began supporting three health centres in outlying districts in Khost province to increase their capacity to assist normal deliveries. The aim is to reduce the number of simple deliveries at Khost maternity hospital so that the medical team there can focus on assisting complicated births.
Boost Hospital, Lashkar Gah
Since 2009, MSF has supported Boost provincial hospital in Lashkar Gah, Helmand province, one of only three referral hospitals in southern Afghanistan. Over the years, MSF has significantly increased the number of staff at the hospital and carried out major construction works. This year, the team completed the rehabilitation of the entire original hospital building and extended the maternity department. The hospital has grown from 150 to 327 beds, with the number of patients admitted monthly increasing from around 120 in 2009 to an average of 2,750 in 2016. Staff assisted 10,572 deliveries in 2016.
The hospital has a neonatology unit, as well as a 109-bed paediatric department, which includes an inpatient therapeutic feeding centre, where 2,431 children were treated for malnutrition in 2016.
MSF also supports the internal medicine department, intensive care unit and emergency room. MSF teams monitor TB cases and work in the isolation ward for infectious diseases.
Intense fighting in 2016 in Helmand province hampered access to the hospital for many patients. Still, 20 per cent of them came from outside the city, exposing themselves to significant risks due to active fighting and dangerous roads.
Kandahar TB activities
In 2016, MSF started supporting the diagnosis and treatment of drug-resistant TB (DR-TB) in Kandahar province, and opened a laboratory and facilities to host patients during their treatment in Kandahar city. MSF also provided additional staff at Mirwais hospital, and organised training for other facilities to improve case detection. During the last quarter of 2016, 13 patients were diagnosed with multidrug-resistant TB.