On 3 October 2015, the MSF Trauma Centre in Kunduz, Afghanistan, was destroyed in an aerial attack that killed 42 people, including 14 MSF staff, 24 patients and four patient caretakers.
At the time of this report going to print, MSF had not yet made a decision regarding restarting medical activities in Kunduz and was in the process of analysing and understanding the circumstances of the attack. MSF is seeking explicit agreement from all parties to the conflict, including the Afghan authorities and the US military, that there will be no military interference or use of force against MSF medical facilities, personnel, patients or ambulances. Equally, that MSF staff can safely provide medical care based solely on medical needs, without discrimination, and regardless of patients’ religious, political or military affiliations.
MSF opened the hospital in Kunduz in August 2011, in order to provide free, high-quality surgical care to victims of general trauma, such as traffic accidents, as well as patients with conflict-related injuries. It was the only facility of its kind in the whole northeastern region of Afghanistan. Independently run by MSF, the 84-bed hospital had an emergency room, an intensive care unit, three operating theatres, outpatient and inpatient departments (with separate surgical wards for male and female patients), a physiotherapy department, a laboratory, an X-ray room and a pharmacy. Other services included mental healthcare and health promotion. The hospital offered services not only to the residents of Kunduz province but also to patients from neighbouring provinces such as Badakhshan, Takhar, Baghlan, Balkh and Samangan. The hospital’s capacity reached 92 beds by September 2015, just before it was bombed.
Between January and August, more than 2,400 patients were admitted to the centre, most of whom (88 per cent) had been injured in road or domestic accidents. Twelve per cent presented with injuries caused by explosions, gunshots or bombings. Over the same period, MSF staff carried out 18,088 outpatient consultations and 4,667 surgical interventions, including orthopaedic surgery involving internal fixation techniques to repair bones.
Following heavy fighting in Kunduz province in May and June, there were huge influxes of wounded people. In the three weeks after the announcement of the start of the annual ‘fighting season’, medical staff treated 204 war-wounded patients, 51 of whom were women and children. In June, MSF opened a district advanced post (DAP), a stabilisation clinic in Chahardara – 15 kilometres from Kunduz city – because people living in the area were struggling to access the trauma centre due to fighting, road blocks and checkpoints. Nurses there tended to the wounded and then arranged for them to be transferred to Kunduz trauma centre for advanced care. With the hospital closed, nurses are now only able to provide much-needed basic care in Chahardara.
On 1 July, three months before the aerial attack, heavily armed men from the Afghan Special Forces entered the MSF hospital compound, physically assaulted and threatened MSF staff, and proceeded to arrest three patients. After an hour, the men released the patients and left the hospital. MSF condemned this incident as an unacceptable breach of international humanitarian law, which protects medical services from attacks.
Ahmad Shah Baba hospital, Kabul
At Ahmad Shah Baba hospital in eastern Kabul, MSF’s support has concentrated on upgrading the facility so it can cater effectively to the needs of the growing population in the area, and capacity has increased to 58 beds. A range of free, high-quality medical services is offered, with a particular focus on emergency and maternal care. Working with the Ministry of Health, MSF ensures treatment for malnutrition, paediatric care, family planning services, health promotion activities and vaccinations. MSF also supports the hospital’s laboratory and X-ray department and the Ministry of Health’s tuberculosis (TB) treatment programme. In partnership with the International Psychosocial Organisation, MSF provides mental health and psychosocial counselling services.
As the population is growing, and because MSF offers the highest-quality obstetric care in the district, the maternity department is one of the busiest in the hospital. On average, 1,400 deliveries were assisted each month and 16,654 antenatal consultations conducted over the course of the year.
MSF continued running mobile clinics in the most remote of eastern Kabul’s suburbs to increase access to free, high-quality preventive and curative healthcare for children under the age of five, and referred severely ill patients to Ahmad Shah Baba hospital. In 2015, more than 5,370 pregnant women were vaccinated, and 6,721 children under five were screened for malnutrition.
Dasht-e-Barchi hospital, Kabul
MSF continued to run a maternity department in Dasht-e-Barchi hospital dedicated to complicated deliveries, and emergency neonatal and obstetric services. The population of Dasht-e-Barchi is estimated to have grown tenfold over the past decade, and the limited public healthcare services in the area are failing to keep pace with the demographic boom. Today, Dasht-e-Barchi hospital and three small satellite health centres are the only options for public healthcare in the district.
Opened in November 2014, the maternity department is open around the clock, and offers free medical care. During its first year, 10,727 deliveries were assisted, 558 caesarean sections were performed and 1,303 babies were admitted to the neonatal unit with complications such as hypoglycaemia. By the end of the year, up to 300 women were being admitted to the maternity ward each week and 40 babies were being delivered per day.
Khost maternity hospital
Afghanistan is considered one of the most dangerous places in the world to give birth, due to the high number of women who die during pregnancy or labour. The specialised maternity hospital in Khost aims to reduce maternal deaths in the province by providing free, high-quality maternal and neonatal care. In rural areas and away from the big cities, the majority of women do not have adequate access to essential obstetric care, which, in places like Khost, is further restricted by the limited availability of female midwives and doctors.
In 2015, approximately one out of every three babies born in Khost province was delivered in MSF’s maternity hospital; in December, deliveries reached a record high of approximately 58 a day and 1,733 in one month. In addition to the maternity ward, there are two operating theatres, a neonatal unit and a dedicated women’s health clinic. MSF also offers vaccinations for newborns, family planning and health promotion activities.
In order to focus on caring for women with complicated deliveries, who are most at risk of dying, and to manage the large number of patients, MSF is working to improve the referral system to the Ministry of Health’s hospital. When the MSF maternity hospital reaches maximum capacity, patients showing no signs of complications are referred to the provincial hospital.
Boost hospital, Lashkargah, Helmand province
Much of the area surrounding Lashkargah was the scene of active fighting in 2015, although MSF’s Boost hospital continued to function in the provincial capital as normal. For the past six years, MSF has been supporting Boost hospital, one of only three referral hospitals in southern Afghanistan. In 2015, MSF began extensive rehabilitation of the hospital building. Modern central heating was installed, and the interior was painted and refurbished to provide better infection control. A new 54-bed maternity ward, a 24-bed neonatal intensive care unit and a 10-bed paediatric intensive care unit were also built. By the end of the year, 12,721 babies had been delivered in the hospital.
MSF supports the hospital with surgery, internal medicine, emergency services and intensive care. In mid-2015, the team also began supporting the diagnosis and follow-up of TB patients, addressing a major yet under-reported public health concern in Afghanistan, and 181 patients started first-line treatment. At the end of the year, an MSF surgical burns specialist provided training to improve treatment for the high number of burns patients seen at the hospital.
Malnutrition continues to be one of the main causes of child mortality in the region, and the hospital’s intensive therapeutic feeding centre treated 2,281 children this year, many of whom were suffering from severe malnutrition.