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Afghans Worry About Medical Charity Withdrawal from Kabul Hospital

By Roshan Noorzai June 25, 2020

A decision last week by Médecins Sans Frontières (MSF) or Doctors Without Borders to end its operation in Kabul's Dasht-e-Barchi Hospital has been met with concern among Afghans that it could diminish the quality of essential maternal care in the Afghan capital.

MSF announced in a June 15 statement that it would pull out from the hospital, after 25 people, including 16 mothers and two children, were killed in a militant attack on its maternity ward last month.

Calling the MSF decision "unfortunate," Atiqulllah Qaati, the head of the hospital, told VOA that the international medical organization would continue to support local health authorities who will run the ward for about three months, "so that it would stand on its feet."

He said the government was determined to reopen the hospital to the public after MSF's exit. Health officials are trying to recruit doctors and nurses from other hospitals in Kabul to make up for the loss.

"It will not have the same services, but we are determined to provide needed services to the poor and helpless people who come to the hospital from faraway places," Qaati said, adding that the ward under MSF provided "amazing service based on international standards" to Afghan mothers.

"We tried to convince them to reconsider their decision, but it is not a decision by a person or two; it is a decision at the organizational level," he said.

MSF officials say they are "deeply concerned" that their staff and patients could be victims of another terrorist attack after the deadly May 12 incident.

"It happened in this very maternity that we are supposed to give lives to the people," the MSF project coordinator at the hospital, Clement Perrin, told VOA.

"We are not supposed to collect dead bodies on the floor. I think this is the point that we had to take such difficult decisions," Perrin said.

Islamic State or Taliban?

It remains unclear who was behind the attack that stunned Afghanistan. The Taliban has denied any involvement, and the Islamic State (IS) has remained silent despite claiming another attack on the same day against a funeral in eastern Nangarhar province that killed more than 50 people.

The U.S. has blamed the IS, but the Afghan government said its intelligence confirms that both the Taliban's Haqqani Network and the IS were behind the attack.

Dasht-e-Barchi Hospital is a 100-bed facility providing key health care to Kabul's poorest district of the same name, in the Hazara minority community.

The minority has often been targeted by the IS terror group in recent years.

MSF opened the hospital's 55-bed maternity ward in 2014 and offered free-of-charge, 24/7 services for complicated deliveries and neonatal care. The ward helped safely deliver 16,000 infants last year and another 5,401 in the first half of 2020, making it MSF's largest project in the world.

A loss for the poor

One of the infants delivered at the hospital, Mujtaba, survived serious health complications thanks to the rare quality service provided by the hospital, according to the Afghan child's father, Mehdi.

Now 9 months old and healthy, Mujtaba was born with a low birth weight. Mehdi, a day laborer who made only about $60 USD a month, said he and his wife could not afford her three days of delivery hospitalization at a private hospital. The government hospitals, he said, would not let them stay for three nights.

"We would have lost our child if the [Dasht-e-Barchi] hospital was not there," said the 35-year-old father of two. "The services were very good, they were taking good care of the patients, and they charged no money."

The ward's closure, according to him, is seen by the local community as a major loss.

"I do not feel good," he said. "We have poor people who cannot pay for the health services at private hospitals, and the public ones do not provide quality services."

Despite a steady improvement since the early 1990s, Afghanistan remains among the countries with the highest infant mortality rates. The UN children's agency UNICEF estimates that of every 1,000 infants born in 2018 in Afghanistan, 48 died before their first birthday and 62 died before their fifth birthday.

Officials are concerned that continued militant activity against healthcare facilities could further damage the country's war-torn healthcare infrastructure, causing a surge in infant mortality.

The United Nations Assistance Mission in Afghanistan (UNAMA) in a report Sunday said that it was "gravely concerned" by the recent attacks on the health centers and medical workers in Afghanistan.

UNAMA said it has documented 15 incidents, including 12 "deliberate" attacks against health care facilities in Afghanistan, from March 11 to May 23. It said the Taliban were responsible for eight direct attacks and two other "incidental harm" assaults. The government, on the other hand, accounted for three direct attacks and one "incidental harm."

According to MSF, about 70 of its staff and patients have been killed in the Afghan conflict since 2004. In two separate attacks, the organization said, five of its employees were killed in Badghis province in 2004, and 42 people were killed in a U.S. airstrike on its hospital in Kunduz province in October 2015.

MSF has vowed to support "local initiatives" after its withdrawal from the Kabul maternity ward to ensure health services in Dasht-e-Barchi grow. It will continue its medical services in Helmand, Herat, Kandahar, Khost and Kunduz provinces.

Mohib Iqbal, a senior researcher with the Sydney-based Institute for Economics and Peace (IEP), said the government in Kabul is likely not ready to fill in the gap created by the departure of organizations such as MSF and Oxfam.

Oxfam, an international aid organization, announced in May the closure of its operations in Afghanistan and 17 other countries due to funding issues during the coronavirus pandemic.

Iqbal said that recent attacks on health facilities and personnel show a new pattern in the conflict in Afghanistan, warning "it will create serious vacuum in the health care delivery in the country."

Charity health organizations, according to him, could leave areas where it is "absolutely impossible" for the government to provide health services on its own. "But I hope they will stay."

VOA's Afghanistan Service contributed to this story.

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