Landlocked and mountainous, Afghanistan has suffered from such chronic instability and conflict during its modern history that its economy and infrastructure are in ruins.
Many of its 31 million people are refugees, or have been internally displaced.
Médecins Sans Frontières/Doctors Without Borders (MSF) has been working in the country since 1980, providing emergency surgical care, maternal health, responding to natural disasters and treating people cut off from healthcare.
However, we have a troubled history in Afghanistan. In 2004, we withrdrew following the killings of five of our colleagues. We did not return until 2009.
Then, in October 2015, our Kunduz trauma centre - the only facility of its kind in northeast Afghanistan - was destroyed in an attack by the US military. Forty-two people were killed, including 14 of our staff.
Following negotiations regarding the neutrality of medical care with all parties to the conflict, at the end of 2016, we finally obtained commitments that our staff and patients would be respected, and care could be provided to everyone in need, regardless of their ethnicity, political beliefs or allegiances.
Although hard to guarantee in an active conflict zone, we believe these commitments will allow us to evaluate the possibility of resuming trauma care activities in Kunduz in 2017.
Get the latest news from MSF in Afghanistan on Twitter @MSF_Afghanistan
On Saturday, 3 October 2015, 42 people were killed in sustained airstrikes on our hospital in Kunduz, Afghanistan.
Twenty-four patients and 14 staff were killed, along with four caretakers.
As we grieve the loss of our colleagues and patients, we are left with the question: is it still possible to safely provide medical care on the frontline? Between October 2015 and October 2016, there have been a further 77 attacks on medical facilities run and supported by MSF in Syria and Yemen.
Hear from Dr Kathleen Thomas, who was in Kunduz on the night of the attack, on our Everyday Emergency podcast.
MSF’s work in Afghanistan: 2016
In 2016, we focused on improving access to emergency, paediatric and maternal healthcare in Afghanistan, which has one of the highest maternal mortality rates in the world.
The conflict in Afghanistan continued to intensify in 2016, with the number of patients increasing due to growing medical needs.
A quarter of all the births assisted by MSF worldwide are in Afghanistan, and teams helped deliver more than 66,000 babies this year.
AHMAD SHAH BABA HOSPITAL
The capital Kabul has experienced a massive population growth, and the city’s public health services cannot fulfil the medical needs.
At Ahmad Shah Baba district hospital in east Kabul, which serves more than 1.2 million people, we suppor the Ministry of Public Health to deliver outpatient and inpatient care, with a focus on maternal health and emergency services.
The team also provides paediatric care, treatment for malnutrition, family planning, health promotion and vaccinations, and supports the hospital’s laboratory, X-ray services and tuberculosis (TB) treatment programme.
Staff conducted 100,000 consultations and assisted 18,966 deliveries, almost 20 percent more than in 2015.
In 2016, MSF started a new programme for the treatment of chronic non-communicable diseases such as diabetes, hypertension, chronic obstructive pulmonary disease, asthma and epilepsy. Around 600 patients were enrolled.
We collaborate with the Ministry of Public Health to provide around-the-clock care at Dasht-e-Barchi hospital, the only facility for emergency and complicated deliveries in a district with a rapidly increasing population.
We run the labour and delivery rooms, an operating theatre for caesarean sections and other complicated deliveries, a recovery room, a 30-bed maternity unit, a 20-bed neonatology unit and a five-bed ‘kangaroo room’, which provides specialist care for sick babies in their first days of life.
During 2016, our teams assisted 15,627 deliveries, almost 27 percent of which were complicated cases. The team is now aiming to increase referrals for simple deliveries, in order to focus on complicated cases and maintain a high quality of care.
Working at full capacity, the neonatology unit admitted 1,342 babies with complications such as clinical sepsis, hypoglycemia and perinatal asphyxia.
Since 2009, MSF has supported Boost provincial hospital in Lashkar Gah, Helmand province, one of only three referral hospitals in southern Afghanistan.
Over the years, we have significantly increased the number of staff at the hospital and have carried out major construction works.
This year, the team completed the rehabilitation of the entire original hospital building and extended the maternity department. The hospital has grown from 150 to 327 beds, with the number of patients admitted monthly increasing from around 120 in 2009 to an average of 2,750 in 2016. Staff assisted 10,572 deliveries in 2016.
The hospital has a neonatology unit, as well as a 109-bed paediatric department, which includes an inpatient therapeutic feeding centre, where 2,431 children were treated for malnutrition in 2016.
MSF also supports the internal medicine department, intensive care unit and emergency room. MSF teams monitor TB cases and work in the isolation ward for infectious diseases.
In 2012, we opened a maternity hospital in Khost, in eastern Afghanistan, to address the lack of obstetric care in the area.
The hospital helps reduce maternal mortality by offering a safe environment for women to deliver their babies, in the care of predominantly female medical staff, free of charge.
The number of deliveries has increased by 40 percent in two years, from 15,204 in 2014 to 21,335 in 2016.
In December, the number of deliveries reached 1,905, an average of over 60 per day. In 2016, 1,746 newborns were admitted to the neonatology unit, a 15 percent increase compared to the previous year.
This year, MSF began supporting three health centres in outlying districts in Khost province to increase their capacity to assist normal deliveries.
The aim is to reduce the number of simple deliveries at Khost maternity hospital so that the medical team there can focus on assisting complicated births.
Find out more in our International Activity Report