More than a decade has passed since the United States lead a military invasion into Afghanistan. During that time, Afghanistan has seen huge changes in politics, infrastructure and basic public services. Now, in 2014, only 50,000 troops remain and the majority of international military personnel is expected to withdraw by the end of this year. Although intervening nations such as the United States, Italy and Britain can point to many successes, Afghanistan still has plenty challenges to overcome: and according to a new report from Doctors Without Borders (Médecins Sans Frontières, or MSF), health care may just prove to be the most daunting.
Doctors Without Borders has been working in Afghanistan since long before the American invasion; offering free medical services and supplies, and assisting in the construction of hospitals. Since the war, the work of MSF (and other relief agencies) has grown: the conflict has caused a huge spike in injury, disease and death. What’s more, the medical needs of Afghanistan are now decreasing with time. In fact, 2013 was reportedly the second most dangerous years for Afghan civilians since 2001.
In their report, MSF explain that although many politicians refer to Afghanistan as a military success, in reality, the conflict is still wreaking havoc upon the health of the nation. MSF reports that in 2013, more than one quarter of Afghani civilians either experienced violence or heard news of it happening to a family member or friend – and that violence was often fatal. As well as dying because of an injury, many of those fatalities were due to an inability to access a proper health care facility.
There are a few reasons why the average Afghani may find it difficult to get medical treatment. To begin, there is the barrier of cost: a huge amount of the populace lives on less than US$1 per day, and yet treatment at a hospital can easily cost more than US$100. The price of transportation may also affect an individual’s ability to seek health services, especially when experiencing an illness such as pneumonia that at first might seem innocuous or easy to treat, but later could prove life threatening.
Of course, ongoing fighting can also prevent a patient from getting to the doctor. In surveys, MSF found that 18 percent of people who were sick or injured but abstained from going to a medical facility made that decision based on fear of armed conflict in the area between their home and the nearest clinic. Many Afghani patients who did make it to the hospital on the days of these particular surveys reported to researchers that although they were currently seeking treatment, violence or fear of violence had prevented them from seeking treatment during the past year.
Doctors Without Borders indicates in this report that leaders outside of Afghanistan err when they expound “overly optimistic rhetoric” about health care within the country. Medical personnel with MSF estimate that of all the injuries and fatalities seen in 2013, 87 percent were the result of an ongoing armed conflict – demonstrating that although the war may feel final for those countries currently withdrawing troops, the struggle for peace and stability isn’t over.
Besides violence, the Afghani populace must also contend with the health risks of poverty, food insecurity and disease. Children are particularly vulnerable: statistics show that one out of every 10 children in Afghanistan dies before the age of five as a result of preventable disease such as pneumonia, diarrhea or malnutrition. Illnesses such as measles and pneumonia are easily preventable by immunization, but without enough money or the ability to reach a health clinic safely, many children are unvaccinated and therefore vulnerable to these fatal conditions.
Children may also be falling ill due to poor facilities, at home as well as in school. In 2009, UNICEF reported that 2 million students in Afghanistan did not have access to clean drinking water, and that 75 percent of state schools were lacking proper sanitation services. Unclean water brings with it a huge risk of bacterial infection and disease such as hepatitis A. Without water and soap for washing hands, the risk of spreading diarrhoeal diseases increases greatly. The UNICEF report also noted that because bathrooms for older girls are often insufficient or non-existent, many girls stop coming to school altogether – leading to long term losses in women’s education and self-sustainability.
The 2009 UNICEF report is just one of many such publications documenting the poor state of health within Afghanistan. Where the recent MSF report differs from previous communications is in its firm assertion that more blame should be placed upon international aid agencies. MSF points out the error in United States military controlled aid programs such as the Commander’s Emergency Response Program that directed funds into areas held by international troops, rather than the parts of Afghanistan most in need. What’s more, by putting aid in the hands of the military in the first place, an impression has been created that access to health care and other services hinges upon compromise or surrender – making many Afghani’s suspicious of international aid and less likely to seek out health services.
Doctor Without Borders also chastises governmental and non-governmental aid groups for presenting misleading statistics, such as the claim that access to health care in Afghanistan has experienced a huge growth since 2001. It is oft-quoted that in 2001 just 9 percent of Afghanis has health care, and that in 2012, 85 percent can access medical services. However, according to MSF, these figures are inadequately inclusive of the southern region, where many Afghani citizens live in rural conditions and cannot easily get health care.
In its conclusion, the MSF report explains why dropping overly-positive rhetoric is so important to fixing Afghanistan’s health care system. Rather than setting up clinics in safer urban centers (where progress and good results are likely to be achieved), aid organizations must try harder to bring clinics and personnel to rural areas; areas in which security is low, but need is very, very high. Agencies should also try harder to maintain neutrality amongst administrators and staff, so that civilians are not brought into the military conflict even more than they already have been. Finally, MSF warns against propaganda that portrays the situation in Afghanistan as simple – it is a multifaceted problem and one which will take a range of long-term solutions if basic and advanced health care security is to be achieved.