This month Médecins Sans Frontières (otherwise known as “Doctors Without Borders,” or “MSF”) released a report that the health care systems in Afghanistan remain stunted and unable to address the needs of the people. The organization hopes that the news will reverse the waning interest from the international community and bolster support for MSF and other organizations that are challenged to address this need.
Health care in Afghanistan is often touted as an achievement of a recovering state. The government has made a point to open a number of clinics and schools. Encouragingly, the World Health Organization reports that from 1990 to 2010 there was an overall increase in the number of immunizations and a decrease in the under-5 mortality rate. Within this time frame it is shown that the people of Afghanistan are spending more on healthcare and that the availability of improved sanitation facilities has increased as well.
Médecins Sans Frontières is an international organization dedicated to providing medical care to all people in the developing world. Where other organizations balk at entering war-torn or otherwise violent areas, Médecins Sans Frontières is known for sending in doctors under the reasoning that these are the areas that need it most. The organization was founded in 1971 and for the last forty years has been on the front lines of delivering health care to some of the world’s poorest and most neglected regions.
This month Médecins Sans Frontières published a report on a six-month investigation into the challenges faced and triumphs achieved by the Afghanistan health care system. Doctors stationed in hospitals in the provinces of Helmand, Kabul, Khost, and Kunduz conducted cross-sectional surveys, semi-structured focus group discussions, and semi-structured interviews to assess the barriers to adequate and needed health care. Around 800 individuals contributed their feedback to the study.
The report painted a far less rosy picture than one might have suspected based upon all the reports of increased access to better health care. The fact of the matter is that health care in Afghanistan still remains as some of the worst in the world, despite the incremental gains. Depending on the region, patients reported that between 13 and 26 percent either had a family member or close friend die due to a lack of accessible health care. In 2014 alone, it is estimated that the number of people in need of accessible health care will rise from 3.3 to 5.4 million, and this is focusing mainly on easily-diagnosable diseases. It is estimated that as much as 60 percent of the population suffers from mental health disorders or psycho-social problems.
Furthermore, it would seem that many of the clinics that the government has built up over the years are mostly for show and are barely sustained. Many are placed in remote areas that are nearly inaccessible to the public. Others are only open for a few hours a day, despite intending to serve a regional patient group. Even if one manages to get in the door, most do not have sufficient resources available to treat patients.
The report listed fighting and insecurity due to fighting as the greatest barrier to health care for the people of Afghanistan. Between a quarter and a third of MSF patients had suffered from violence in their communities over the past 12 months. The most common causes of this violence were landmines and direct attacks/crossfire. This makes patients extremely hesitant to venture out and travel the long distances to the clinics. In some cases the fighting is so bad that the health care workers are restricted from entering certain zones. This view is probably even worse; of the patients surveyed, the majority of them had faced barriers already in attempting to access the MSF clinics. This may have created a self-selecting sample population which would have emphasized the nation’s more tenacious and/or desperate individuals. It is unknown how many more people are left unaccounted for.
The report from Médecins Sans Frontières on the challenges faced by the health care system in Afghanistan depicts a particularly vulnerable chapter in the country’s development. Addressing this problem will require collaboration between MSF and other organizations, who hope that the world will continue to care about the issues faced by these people and match those feelings with action.
By Sarah Takushi