By Rick Noack in The Washington Post, June 28, 2023
SHINDAND, Afghanistan — In the U.S.-built district hospital of Shindand in western Afghanistan, the surge in patients took doctors by surprise. As their wards filled up in recent months, they repurposed staff space to make room for more patients and resorted to prescribing single doses of drugs that should be taken in three doses. Some patients with severe conditions have been turned away because of a lack of available beds.
Almost two years after the Taliban came to power, Afghanistan’s rural health sector is rapidly deteriorating as the impact of a prolonged economic crisis starts to hit it with full force. Doctors, nurses and local officials said they face a surge in patients who until recently would have preferred to see private doctors for a small fee but have run out of savings.
A Washington Post visit to four hospitals and medical centers in western and central Afghanistan found alarming signs that the health system itself is now suffering from a lack of cash as foreign donors, distracted by other crises and weary of being seen as supportive of the new Afghan authorities, appear increasingly hesitant about spending more.
United Nations officials say Afghanistan is facing the world’s largest humanitarian crisis. But the Taliban-run government, eager to portray its medical system as a success story, maintains that its clinics are running just fine even as it appeals to the international community to provide more funding and drop sanctions. In an interview last month, Health Ministry spokesman Sharafat Zaman said that “fortunately,” the system is not “in an emergency situation.”
But numbers of patients seeking some services have increased by about 15 to 20 percent across the thousands of UNICEF-funded health facilities and have in some facilities almost doubled, even as the available funding remains roughly the same as before.
The United Nations had recorded only about 10 percent of the funding required to meet its Afghanistan response plan earlier this month when it decided to massively scale down its budget. The World Food Program has already dropped 8 million Afghans from its emergency response programs in recent months.
In Shindand’s hospital, staff predict that those factors, combined with a prolonged regional drought, could double patient numbers over the next few months.
“This is the worst I’ve seen,” said 59-year-old Habibullah Mirzai, the longtime administrator at Shindand hospital.
No peace dividend
Few doctors are holding out hopes that the cash-strapped Taliban government will come to their rescue. And with the U.N.’s humanitarian response effort in Afghanistan one of its most poorly funded, many medical professionals express disappointment with the West that increasingly appears to run just as deep as their frustration with the Taliban-run government.
Just a few miles from what was once the country’s second-biggest air base hosting U.S. and other foreign soldiers, this expanse of wheat fields and mud-brick houses bore the brunt of the war. During the worst fighting, the hospital director hid in a corner of the malnutrition ward as mortar shells exploded outside the gates, he recalled.
Few people here could see any sense in the airstrikes, gunfire and IED explosions that sent patients to the wards on most days. But the foreign presence had ensured a steady inflow of money. Construction of the $5 million Shindand hospital was overseen by the U.S. Army Corps of Engineers.
After the Taliban takeover in August 2021, doctors shared many fears but at least one hope: Peace, they thought, would finally draw private relief organizations that had previously considered Shindand too dangerous.
It’s now clear that the opposite is happening. Development projects that could have provided economic relief are dormant. After the Taliban banned Afghan women from working at nongovernmental organizations and U.N. agencies, some organizations pulled out of the country, while others reduced their presence.
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By restricting women’s rights, “the Taliban abandoned half of our population,” said a senior hospital official in Shindand, who spoke on the condition of anonymity for fear of retaliation. “And now, as a result of that, the world has abandoned all of us,” he said.
The Western military pullout and subsequent decline in funding have been personal for many medical staffers in Shindand. As the Taliban made rapid gains and the West prepared to leave the country in summer 2021, members of the hospital’s staff, like many Afghan health workers, went unpaid for months. Their families struggled to survive, selling their furniture, carpets and motorbikes.
International help eventually returned, including through UNICEF, but lost salaries were never paid. The Organization for Health Promotion and Management, the local group that distributes funding to the hospital, said it recently hired new staff members to address shortages. But foreign donations, the organization said, are insufficient to expand overcrowded facilities.
The funding shortfall leaves Afghanistan increasingly unprepared for an epidemic or major natural disaster, according to humanitarian workers. There are growing concerns over a rise in the number of acute watery diarrhea cases in recent weeks, said Fouzia Shafique, UNICEF’s health lead in Afghanistan.
“This could potentially be a disaster,” she said, but “we are unable to buy all the supplies or deploy as many teams as we want to.”
Irandukht Noorzad, the 30-year-old head of a health center in the central Kalo valley, said her small facility would not be able to absorb substantial cuts in funding. Unemployed urban residents are moving back to this rural area and are putting more pressure on the clinic, and she fears her staff may resign instead of putting up with lower salaries and more work, Noorzad said.
The Afghan Health Ministry did not respond to questions about those concerns. In an earlier interview with The Washington Post, ministry spokesman Zaman blamed the previous U.S.-backed government for having neglected health-care access for decades. The new government, he said, has eased the pressure by launching the construction of 200 new health facilities since taking power.
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Aid groups counter that the Taliban-run government does not deserve much credit. Afghanistan’s health system has only been able to grind on, they say, thanks to international support. UNICEF says it still pays the salaries of tens of thousands of health workers in Afghanistan.
That assistance is facing growing international scrutiny, as some critics view continued cooperation with the government as an acceptance of the Taliban’s ban on female Afghan NGO and U.N. employees.
Female health workers are still exempt from the Taliban ban, and doctors in rural areas said they have encountered few new challenges due to restrictions the Taliban has imposed on women. While the Taliban in many cases restricts women from traveling without a husband or male relative, similar practices were customary in many rural areas even before the Taliban takeover, doctors said.
But some recent interactions with the Taliban have unsettled doctors. A vaccinator in a clinic in western Afghanistan described how officials from the local vice and virtue department, tasked with shaping Afghan life according to the Taliban’s ideology, nearly derailed a recent coronavirus vaccination campaign when they objected to female vaccinators being trained by a male colleague.
The Taliban officials proposed installing a curtain between the male trainer and the trainees, but they eventually relented after the vaccinator asked them about the practical implications: “How do you explain from behind a curtain how to properly inject a vaccine?” he recalled asking them.
The Ministry for the Promotion of Virtue and Prevention of Vice did not respond to a request for comment.
In the long run, the Taliban government’s restrictions on women are likely to have a more pronounced impact than is apparent today. Hospitals are already struggling to find female doctors as the government seeks to further segregate female and male sections, and December’s ban on women studying in universities is likely to aggravate those staff shortages.
The reluctance of foreign donors to fund Afghan projects could have ripple effects, too, said Omar Joya, an Afghan economist at the Bordeaux School of Economics in France.
The Taliban-run government recently applauded a World Bank report that found declining headline inflation, but Joya said high poverty rates and steep losses in income are more telling signs of a trend that is “not very encouraging.” If humanitarian aid decreases, the currency will inevitably depreciate, he said, raising the prices of gas and food.
Villages like Katasang in central Afghanistan could suffer the most. Fifteen years ago, Uzra Hussaini took an offer to serve as a village health worker here, prescribing drugs and referring patients. Even before the Taliban’s return, she was only paid $3.50 a month. Today, she gets half of that.
“I’ve dedicated my life to this,” said Hussaini, 30, whose dream of becoming a doctor was derailed as a teenager by her mother’s illness and her father’s death. She said she is “confused, disappointed and lost” as she worries that the world is turning its back on Afghanistan.
“My fear is that one day everyone will have either fled or died,” she said. https://www.washingtonpost.com/world/2023/06/28/afghanistan-health-doctors-medical-hospitals/
