Afghanistan: Massacre in a maternity ward

By Zahra Koochizad, MSF midwife supervisor

As midwives in Afghanistan, we bring new life into this country under conditions more difficult than in most. Despite some improvements over the past years, Afghanistan has one of the highest maternal and newborn mortality rates in the world. One of the biggest challenges that every midwife and pregnant woman in Afghanistan faces is insecurity. I’ve painfully experienced this firsthand.

I am the midwife supervisor in the MSF-run maternity wing of Dasht-e-Barchi hospital in Kabul. The attack there occurred on May 12. I remember that day: we had very nice weather, the air was fresh, and I felt a sense of peace when entering the hospital. Once I arrived, I saw my colleagues working; they all looked motivated and eager to start a new day of providing services to pregnant women in need. On a daily basis, we are used to tragedy in our communities, but nothing could have prepared us for the horror to come.

In Afghanistan, a maternity ward is one of the few spaces where women are the leaders. The terrorists entered an area where no men are ever allowed to go. They stormed the maternity wing armed with guns, killing pregnant women, new mothers, and newborns. Their leader must be very proud—celebrating victory over an army of one-day-old babies and women wearing only their hospital robes.

A hospital is supposed to be a protected space. It says this under international humanitarian law. And yet the assault on my maternity wing is not an exceptional case — attacks on health care happen frequently here. What is different about this attack than all the others?

As midwives in Afghanistan, we are the silent leaders of our country. We are at the bedside of pregnant women giving birth to the country’s future—and we need to be protected. Midwives like our beloved Maryam, who was killed in the most incomprehensible way as she assisted soon-to-be mothers giving birth.

On the day of the four-hour assault on Dasht-e-Barchi maternity ward, the terrorists not only attacked pregnant women and newborns, but also the decades of work to reduce maternal and newborn mortality in Afghanistan. Because of this attack, the western area of Kabul—with more than one million residents, and women coming from faraway provinces—no longer has access to any comprehensive obstetric and newborn care.

Each month, the MSF-run maternity wing provided quality services to more than 1,200 mothers who delivered their babies there. Most patients who came to Dasht-e-Barchi belong to the Hazara community, a historically marginalized and still poor ethnic minority. They don’t have the means to pay for their treatment in other places.

Giving birth, in my opinion, is one of the most glorious and most critical moments in a woman’s life. My passion to see new life coming into the world and my strong desire to serve my own people made me choose to become a midwife. I am hurt, my life has changed, but I am still committed to continue my work.

By Rasha Khoury, OB-GYN and MSF board member

I was nursing my four-week-old daughter in the dark, in the early hours of the morning, when I learned of the attack on MSF’s hospital in Dasht-e-Barchi on May 12. My heart felt extinguished. These were my colleagues and friends.

I was instantly transported back to life within those hospital walls. Inside the bustling delivery room, I could hear the prayers and cries of women in labor, giving birth, meeting their babies, calling out to family, sipping juice, exhausted, smiling, relieved, crying. I could smell the blood, sweat, and tears.

Since 2016 I have spent more than a year working for MSF in Afghanistan on multiple assignments as an obstetrician gynecologist. This has meant spending thousands of hours in the labor and birth wards, working alongside Afghan col- leagues, mostly midwives and nurses. Together, we accompanied women through what often felt like, and sometimes were, death-defying experiences—all the while centering on dignity and strength.

Before Afghanistan, I had never been part of a team that so beautifully cared for the most vulnerable women in one of the most dangerous places in the world to give birth. Where pregnancy can be a death sentence. I watched our midwife staff, many of whom were young mothers themselves, work with steadfastness, empathy, and solidarity to safely deliver quality care in spite of the precarious conditions just outside the hospital gates. Many traveled to the hospital every day at great risk to themselves and their families. The hospital was a safe haven, as it should be for both patients and staff. And despite the incessant violence outside, they brought joy to their transformational work. I remember thinking at the time that when I went through my own labor and birth, I would like to come back and be cared for by these midwives.

MSF projects in Afghanistan aim to reduce maternal and neonatal morbidity and mortality with free, high-quality care to all people—regardless of ethnic group, religion, or political status. The Dasht-e-Barchi hospital has been a landmark in western Kabul since 2014, providing safe obstetric and newborn care to over 1,200 women a month.

The attack took the lives of women in labor, women who had just given birth—women and newborns no different than myself and my daughter. MSF midwife Maryam accompanied these women until their and her last breath, living out the meaning of midwife: “with woman.” Her last words were, “I cannot leave her alone.”

The impact of these murders reverberates still. Losing a mother increases the risk of infant mortality. Attacks on health facilities spread terror and often lead to people avoiding or delaying care for fear of violence in the very places they should be safe. The loss of free and affordable health services increases the risk of more death, disease, and suffering. Women and children in Afghanistan cannot afford these losses. Humanity cannot afford this violence. Civilians and health workers are #NotATarget.

>> Read more from Alert Summer 2020: Nurses and midwives on the frontlines.