Dying to reach health care in Afghanistan

Mazar-i-Sharif Regional Regional Hospital is the only regional referral hospital in the entire province and also supports neighboring provinces. In August 2023, Doctors Without Borders/Médecins Sans Frontières (MSF) started supporting pediatric activities at the hospital in collaboration with the Ministry of Public Health. MSF currently runs the neonatal intensive care unit (NICU), the pediatric intensive care unit (PICU), and the emergency room for children up to the age of 15.

Through our support for Mazar-i-Sharif Regional Hospital, we see that it is facing major gaps in resources that are affecting its ability to continue providing care for patients. Many patients are forced to travel long distances to access medical care either because the nearest facilities are not fully functional, with insufficient staffing and medical supplies to cover the needs of the people. This adds pressure on specialized care provision, which already suffers from systematic inadequacies.

One of our main challenges at Mazar-i-Sharif Regional Hospital is the high number of patients. In the neonatal ward, for example, we started with 65 beds and gradually increased to 100. Despite the increase in capacity, our bed occupancy rate remains above 100 percent. At a certain point, we had a bed occupancy rate of up to 200 percent, meaning every bed had more than one patient. We receive children in very critical condition; and some are dying just as they arrive in the health facility, either because they are brought late, or because of the long distance their parents had to travel to get to the hospital. 

Masoma is a mother of two from the Ali Abad district of Mazar-i-Sharif City, which is one hour away from Mazar-i-Sharif Regional Hospital. Asma, her 20-day-old daughter, was born prematurely at eight and a half months and now receives treatment in the neonatal ward at the hospital. She is stable now but is still underweight. Masoma explained:

"There is a clinic close to our house, but they don't provide all the services. They treat patients with common diseases like diarrhea and colds and provide very basic medicine like paracetamol for the body. Additionally, they provide normal deliveries but not cesarean section. Ali Abad district doesn’t have a specialized health facility with adequate services. If someone falls ill late at night, they won't receive treatment. I experienced pain late at night and went to a nearby private clinic at 3 a.m.

My first baby was born by cesarean section as well. Upon arriving at the clinic, I discovered that the stitches had torn internally, leaving only the skin intact above. The baby's head was visible, necessitating immediate surgery.

The surgery cost me 15,000 Afghani [about US $214]. My husband had to borrow the money because I couldn't reach the regional hospital and had to undergo a cesarean section in a private clinic right away."

Parwen traveled three hours from Chahar Kint district in Balkh province to Mazar-i-Sharif city to deliver her baby and treat her 7-year-old son, Shafiqullah, who has been suffering from fever and body shaking for two months. Shafiqullah was received in the observation room of the pediatric ward at Mazar-i-Sharif Regional Hospital. The family experienced challenges getting Shafiqullah to the hospital because of their financial hardships. Parwen said:

"Chahar Kint district is far from Mazar-i-Sharif city, taking about three hours by car to reach due to the very bad roads. In the beginning, my son had a fever and body shaking for two months. His legs became weak. We didn't take him to the doctor because we live in the mountains and couldn't afford to take him to the hospital. We were also unable to find a car to bring him here. 

We took him to the nearby clinic and they gave him medicines, but his situation did not improve. I was also experiencing labor pains. I went to the maternity ward and they told me to come back four hours later for the delivery. 

The nearest clinic is very far from us. We travel there by donkey, which takes three hours. 

As my delivery time was approaching and I didn't have anyone to support me, I came to my mother's home in Mazar-i-Sharif city and brought my ill son as well for treatment."

Rahima is a resident of the Faiz Abad district in Jawzjan province and traveled three hours to reach Mazar-i-Sharif Regional Hospital. Her 5-month-old son, Ahmad Khalid, has been suffering from malnutrition since birth and now receives treatment in the MSF-supported pediatric intensive care unit at Mazar-i-Sharif Regional Hospital. Rahima is very concerned about her child’s life as his condition is deteriorating day by day. She said:

"We came from Haider Abad, a village in the Faiz Abad district of Jawzjan province. It took us three hours or more to reach this hospital. My son has been sick for a very long time. At first, when he became ill, we took him to Murdyan Aqcha clinic, in another neighboring district of Faiz Abad. Due to his condition, he was admitted there, but he didn’t get better, so we took him to Sheberghan [the capital of Jawzjan Province, west of Mazar] and then to Kabul for treatment. The doctor in Kabul told us that he is malnourished and needs to be admitted to the hospital. 

We decided to bring him back to Murdyan Aqcha clinic, where he received treatment in the malnutrition ward for 45 days. Then he contracted measles, so the doctor at the clinic referred us to Sheberghan Provincial Hospital. His condition was deteriorating, and he was unable to breathe normally, so we decided to bring him to Mazar-i-Sharif Regional Hospital. 

We have been here since yesterday, and the doctor says his condition is not good. He is constantly on oxygen. Without it, I can see his skin color changing to dark.  

He is very sick. It has been five months since we started taking him to different clinics, but he is not showing any signs of improvement."