Between Rhetoric and Reality: The Ongoing Struggle to Access Health Care in Afghanistan

KABUL/NEW YORK, FEBRUARY 25, 2014—After more than a decade of international aid and investment, access to basic and emergency medical care remains severely limited in Afghanistan, while needs are growing due to ongoing armed conflict, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said in a report released on February 25.

While health care is often held up as an achievement of international state-building efforts in Afghanistan, the situation is far from being a simple success story.

Although progress has been made in health care provision since 2002, the report, Between Rhetoric and Reality: The Ongoing Struggle to Access Health Care in Afghanistan, reveals the serious and often deadly risks that people are forced to take to seek basic and emergency care.

The research—conducted over six months in 2013 with more than 800 patients in the hospitals where MSF works in Helmand, Kabul, Khost and Kunduz provinces—makes it clear that the upbeat rhetoric about the gains in health care risks overlooking the suffering of Afghans who struggle without access to adequate medical assistance.

"One in every five of the patients we interviewed had a family member or close friend who died within the last year due to a lack of access to medical care," said Christopher Stokes, MSF General Director. "For those who reached our hospitals, 40 percent faced fighting, landmines, checkpoints or harassment on their journey."

Read Between Rhetoric and Reality: The Ongoing Struggle to Access Health Care in Afghanistan

The patients' testimonies expose a wide gap between health care services that exist on paper and those that actually function. The majority of patients interviewed by MSF had to bypass their closest public health facility during a recent illness, traveling greater distances—at significant cost and risk—to seek care.

"People spoke of clinics lacking medicines, qualified staff, and electricity, and of facing mounting debt to pay for treatment," said Stokes. "Others told us about being forced to watch over sick or injured relatives throughout the night, hoping they would survive until morning when it might be safe enough to make it to a hospital."

Throughout the past 12 years, decisions made by belligerent governments on where and how to provide assistance in Afghanistan have too often been based on considerations other than medical needs, such as stabilization, counterinsurgency strategies or "winning hearts and minds." One result is that there are still major gaps in meeting the urgent needs created by the ongoing conflict. International donors, aid providers and Afghan authorities must urgently address serious shortcomings in health care provision, and put aside any consideration other than people’s needs.

The disruption of medical services disproportionately affects those living in militarily contested areas. However, insecurity and limited access to those communities by health authorities and humanitarian agencies, including MSF, impedes a sustained or adequate response.

In order to reach the most vulnerable people, humanitarian agencies will have to prioritize negotiating their access with all sides in the armed conflict, MSF said. At the same time, all parties to the conflict need to do much more to ensure that impartial health care can be provided to all those who are sick and wounded.

"As international interest in Afghanistan wanes, MSF sees a conflict that still rages in many parts of the country alongside a failure to meet rising medical and humanitarian needs," Stokes said. “While the international community seeks refuge in rhetoric, the Afghan people have to deal with the harsh reality.”

MSF works in Ahmad Shah Baba Hospital in eastern Kabul and Boost Hospital in Lashkar Gah, Helmand province. The organization also runs a surgical trauma center in Kunduz, providing lifesaving surgical care to people in northern Afghanistan, as well as a maternity hospital in Khost in the east of the country. In all locations, MSF provides medical care free of charge. MSF relies only on private funding for its work in Afghanistan and does not accept money from any government.