On August 15, 2021, the Islamic Emirate of Afghanistan (IEA) (also known as the Taliban) came to power in Afghanistan. The health system continues to be strained by the ongoing economic instability. A long drought has also extended the season of peak malnutrition, and parts of the country have seen an uptick in measles cases. Doctors Without Borders/ Médecins Sans Frontières (MSF) continues to run activities in all five of its projects in Lashkar Gah, Kunduz, Kandahar, Herat, and Khost. There's been an increase in the number of patients across several projects, in part because people are now able to travel more to the few health facilities that are still open. MSF has around 100 international staff and 2,300 Afghan colleagues working in the country. 

MSF Operations in Afghanistan 

Herat

Our intensive therapeutic feeding clinic (ITFC) at Herat Regional Hospital has been very busy this year. The facility was initially set up with 40 beds, but to cope with the increase in malnutrition cases this was increased to 74 beds in October.

Over the course of the year, our teams have seen significantly higher numbers of patients arriving at the feeding center, most likely the combined result of a particularly long and harsh drought, the dire economic situation, and the fact that since the IEA came to power it has become easier for people to move around and reach few functioning health care providers.  

Malnutrition is a seasonal phenomenon in Afghanistan and last year numbers decreased significantly in September, at the end of the seasonal peak. The number of new admissions has started to decrease this year as well, from 65 per week in September to 50 per week in October and then 38 per week in November, but this is happening later and more gradually than before. Significant numbers of patients continue to travel from faraway districts and provinces; in November, Badghis province accounted for 15 percent of ITFC admissions despite being nearly 100 miles away.

On December 8, MSF started supporting the pediatric department of Herat Regional Hospital. The first phase sees our teams working in the emergency room and the intensive care unit. Later we will support the IPD and OPD.

On the outskirts of Herat, MSF continues to provide outpatient care, treatment for non-communicable diseases, and sexual and reproductive health services at the Kahdestan clinic. While we previously admitted patients of all ages, on October 1 MSF restricted its admission criteria to children under five, pregnant and lactating women, and patients with non-communicable diseases who had already started treatment. Other organizations providing health care had returned to Herat so MSF took the decision to focus on treating patients who had fewer options for health care elsewhere. Almost one in two children presented with a respiratory tract infection in November, a trend we expect to continue through the winter. MSF also conducts outreach activities in camps that house roughly 10,000 displaced families.

In November, we triaged around 100 suspected COVID-19 cases per day in MSF’s triage area of the Herat Regional Hospital. Only a small proportion of them were critical or severe COVID-19 patients needing referral to COVID-19 treatment centers (CTC), including the nearby MSF COVID-19 treatment facility.

Key figures (November 1–30, 2021):

• The Kahdestan clinic carried out over 1,700 outpatient consultations, including 625 for antenatal care.
• 150 new admissions to ITC in November, an average of 38 per week.
• 2,800 suspected COVID-19 cases triaged at the Herat Regional Hospital, an average of over 100 per day. We referred an average of four severe or critical patients per day to COVID-19 treatment centers.

Kandahar

Tuberculosis (TB) care is continuing in Kandahar and we have a total of 54 patients enrolled in our DR-TB program. In September, MSF re-started screening patients for TB at Mirwais regional hospital and Sarpoza prison, having put this on hold during the peak of the fighting in Kandahar in August. 

To respond to high levels of severe and acute malnutrition in the area, on December 15, MSF opened an ambulatory therapeutic feeding center (ATFC) in Kandahar, next door to the MSF TB clinic. The first phase of this activity will see us providing outpatient malnutrition treatment for patients aged between six months and five years who have been discharged from the nearby inpatient therapeutic feeding center at Mirwais regional hospital.

Key figures (November 1–30, 2021):

• 54 DR-TB inpatients receiving treatment with the oral Short Course Regimen.
• 20,071 patients screened for TB, leading to diagnosis and starting treatment of 58 DSTB cases in Mirwais Regional Hospital, nine cases of DSTB in PTC and two cases of DSTB in Sarpoza Prison.
• Due to insecurity in 2021, two patients of the DRTB cohort were Lost to Follow Up (zero patients Lost to Follow Up in 2020).

Khost

The MSF Khost maternity hospital continues to work with wider admission criteria, providing care for both complicated and non-complicated deliveries, ensuring that pregnant women from across Khost province have access to medical care despite the struggling health system. We are seeing an increase in patients and deliveries, and MSF helped to deliver 1,800 babies in October and 2,000 in November. Private clinics in the area are seeing significantly fewer patients as the deteriorating economic situation means that people aren’t able to afford to pay for treatment.

The neonatal unit in the Khost maternity hospital has been extremely busy over the last few months. The unit was designed for 28 beds but at times we have had between 30 and 45 babies admitted and in November the bed occupancy rate was 130 percent.

MSF continues to support the eight comprehensive health centers (CHCs) and Khost Provincial Hospital with food, fuel and medical items. These facilities along with others had their funding suspended by the World Bank in August, but staff continued to work and in some cases communities pooled money to pay for fuel, medicine, and other supplies to keep the centers running. Funding for the organization running the CHCs resumed in October but has only been allocated until January. Although the funding allows them to restock supplies and pay staff it takes time for community trust in the facilities to be rebuilt. Once CHCs across Khost are functioning well again and communities return to them, MSF’s Khost maternity hospital will revert to its original admission criteria to focus on complicated cases.

Key figures (November 1–30, 2021):

• Over 2,400 admissions to Khost maternity hospital.
• Over 2,000 deliveries.
• Over 170 babies admitted to our neonatal ward.

Kunduz

The health system in Kunduz continues to be strained, as many staff have not been paid for months and often come to work for only a few hours a day. Medical and logistical supplies continue to be lacking in the public health system, and the main regional referral hospital continues to rely on donations. The MSF trauma center continues to treat people injured in road traffic accidents and those suffering from other trauma injuries. Following an explosion in a mosque on October 8, the trauma center received over 100 major casualties with 20 dead on arrival. MSF admitted 74 patients within two hours of the bombing. All patients except for one have now been discharged. Most of them received treatment for burns. 

Key figures (November 1–30, 2021):

• 921 patients triaged in the trauma center.
• 113 patients treated in the inpatient department.
• 278 surgical procedures.

Lashkar Gah

As the only fully functional public hospital in the province, Boost hospital in Lashkar Gah remains very busy. Other public health facilities both within Lashkar Gah city as well as in nearby rural provinces continue to struggle to deliver services.     

The intensive therapeutic feeding center (ITFC) continued to see a high number of patients in November, but slightly less than October (155 percent bed occupancy rate in November compared to 167 percent in October). One explanation may be that an ITFC run by another organization is now running at full capacity, which gives people more options.

We have seen increased number of measles cases in November, 425 compared to 270 in October. The majority of cases are children under five, and those with severe measles and complications are admitted in the isolation ward.

In November, the maternity staff assisted 1,912 deliveries. This is the third consecutive month that MSF has assisted over 1,900 deliveries in Boost.

Our emergency room continues to be extremely busy. We are supporting the Ministry of Public Health’s Fatima Bayat hospital in Lashkar Gah with medical supplies and medication so that they can treat the less serious cases that we refer to them.

Key figures (November 1–30, 2021):

• 18,353 patients triaged and treated in the Emergency Room, of which over 2,500 were admitted.
• More than 1,900 deliveries assisted.
• 240 children admitted to the ITFC.