Afghanistan's Health-Care System In 'Free Fall' As Punishing Winter Looms

A punishing winter looms for many Afghans who are already dealing with the effects of a devastating humanitarian crisis and an economic crunch brought on by the Taliban takeover, the withdrawal of foreign forces, and suspension of international funding.

The state health-care system, propped up by foreign aid for two decades, was hurting even before the Taliban seized power in mid-August, with many health-care workers going unpaid for months. Now the system is trying to stave off total collapse.

"The situation is dire,” Khan, a resident of the eastern province of Kunar, told RFE/RL's Radio Azadi. “We are on the eve of winter and disease is spreading."

Like many both at home and abroad, Khan called on foreign countries and aid groups not to abandon the country.

The main problem affecting Afghanistan’s health-care sector is the loss of financial aid, according to Patricia Gossman, associate director for Human Rights Watch's Asia Division.

A doctor checks on a patient as others sit in a crowded room at Indira Gandhi Children's Hospital in Kabul on October 5.

"There is no money to pay health-care workers. There is no money to buy medicines," said Gossman, who added that the system was "already weak" under the previous government. "With former donors blocking aid -- not humanitarian aid, but actual cash to pay salaries -- the health-care situation is in a free fall like the rest of the economy."

Hundreds of health facilities have been shuttered in Afghanistan since the Taliban toppled the internationally recognized government in Kabul.

Abdul Bari Omari, the Taliban's caretaker deputy director of public health, told RFE/RL in October that nearly 90 percent of the sector was dependent on foreign aid, which led to the closure of 2,300 health centers when that aid was cut off.

Urgent appeals for more funds by NGOs and the United Nations have resulted in pledges of more than $1 billion, and outside states and aid groups have delivered much-needed medical supplies. But there is no clear path for the distribution of the funds and supplies, and billions of dollars held by Afghanistan's previous government remain frozen in the United States.

Many have turned to outside organizations that continue to provide health services in Afghanistan, such as the United Nations Children's Fund (UNICEF), which has worked in the country for 70 years, and Doctors Without Borders (MSF).

Representatives of both organizations say they saw the departure of some staff and an uptick in patients following the Taliban takeover, and cite malnutrition as a deadly concern.

Christophe Garnier, a MSF project coordinator, said the organization’s therapeutic feeding centers in the western city of Herat and the southern city of Lashkar Gah were operating at twice their capacity and maternity units were helping more than 55 women a month deliver babies in the eastern city of Khost and more than 60 per day in Lashkar Gah.

"There are several factors that explain why we are seeing so many patients but perhaps the biggest problem is that other health facilities aren't functioning, so people have few other places to seek health care," Garnier said in e-mailed comments from Afghanistan. "Now the situation has slightly stabilized, many organizations have returned, but the health system is still struggling."

An Afghan doctor checks a COVID-19 patient at the Afghan-Japan Hospital in Kabul in January.

Garnier singled out financial measures taken against the Taliban's acting government, including the freezing of nearly $9 billion in Afghan assets held in the United States, as having "paralyzed the country's banking system and pushed the country toward economic and institutional collapse."

Sam Mort, chief of communication, advocacy, and civic engagement for UNICEF Afghanistan, said that the organization is urgently scaling up its humanitarian response to the crisis in Afghanistan. Mort said in e-mailed comments from Afghanistan that most of UNICEF's team is physically back at work in the country, including women, and that new staffers are being hired.

Mort said that the organization was well equipped to deal with the challenges experienced in Afghanistan in recent months and was able to distribute supplies to Afghans displaced by fighting, water to areas heavily hit by drought, therapeutic food to combat malnutrition, and mobile health teams to provide health services.

But the challenges remain immense and complex, Mort said.

"More than 600,000 people are displaced; there is drought; winter is approaching; there are outbreaks of measles and acute watery diarrhea, food and fuel prices are rising, and around 20 million people will face acute food insecurity this month," Mort said.

"And when food insecurity spikes, so too does severe acute malnutrition," which he said could lead to the deaths of 1 million children under the age of 5.

Following a visit to Kabul in mid-October, UNICEF deputy executive director Omar Abdi, expressed shock at the conditions he saw.

Abdi based some of his observations on his visit to the capital's 360-bed Indira Gandhi Children's Hospital, which is dealing with staff shortages after many medical workers fled the country or took other work due to a lack of payment.

"I visited the children's hospital and was shocked to see how packed it was with malnourished children, some of them babies," Abdi said.

A woman holds one of her two babies undergoing treatment at the malnutrition ward at Indira Gandhi Children's Hospital in Kabul on October 5.

Abdi noted that even before the Taliban takeover at least 10 million children in Afghanistan were in need of humanitarian assistance, and listed polio and measles as sources of concern in addition to acute malnutrition.

RFE/RL has documented many complaints from citizens about the state of public health care, including at Indira Gandhi Hospital.

Shirin Gul said her granddaughter recently died after the hospital was unprepared to treat her heart condition.

"There were no services or supplies at the hospital," Gul said, adding that she had to go elsewhere just to obtain medicine.

Meanwhile, officials at the state-run Afghan-Japan Hospital in Kabul -- the only active hospital for the treatment of COVID-19 patients in Afghanistan -- told RFE/RL that employees had not been paid in three months.

As fears mount of a fourth wave of coronavirus infections, chief physician Tariq Ahmad Akbari said that the facility was short of funds to buy medicine, oxygen, and even food for patients.

Akbari said the hospital was sending requests for financial assistance to authorities and institutions both within and outside the country, and that if the pleas are not answered the hospital might be forced to close.

UNICEF'S Mort said that finding a way to pay health workers stands among the biggest challenges in Afghanistan because such professionals could be forced to look for other work to support themselves.

"To ensure delivery of essential medical aid, we urgently need the health system operational, health workers paid, and facilities open and well stocked," Mort said.

MSF's Garnier said that during a recent visit to a displaced persons camp near Herat, community leaders expressed concerns about the upcoming winter.

"This community has no work, no income, no land, no home, and no food," Garnier said. "They are very worried about what will happen in the winter, when they already don't know what they will eat today."