In the last two years, since the abandonment of the country by international forces and the establishment of the Taliban government in Afghanistan, EMERGENCY has carried out 249,722 visits and over 41,000 admissions in hospitals in Kabul, Lashkar-gah, Anabah; more than 700,000 consultations in its 42 First Aid Posts and Basic Health Centres. The number of “victims of war” is decreasing but the number of those who are unable to get treatment for economic reasons is increasing.
This is what the association found in the country where, at the beginning of 2023, the United Nations Office for Humanitarian Affairs had estimated that there would be 28.3 million Afghans in need of humanitarian aid. Now that number has nearly reached 29 million; 77% are women and children.
On August 15, 2021, Afghanistan witnessed the rise to power of the Taliban; EMERGENCY with its 3 hospitals, a maternity center and 42 first aid posts and primary health centers has continued to work to assist the wounded, and has remained in Afghanistan over the past two years bearing witness to the serious situation in the country between the consequences of more than twenty years of war, the economic crisis, the increase in poverty and the scarcity of essential services.
“Immediately after August 2021 we started talking about the tragic economic crisis facing the country – recalls Stefano Sozza, director of the EMERGENCY program in Afghanistan -. The population is no longer able to access essential goods and services, including health care. We testify to this directly in our centers where compared to 2022 we have seen the type of incoming patients change. Fewer ‘war’ wounded but many Afghans who – if they didn’t come to us to receive free treatment and medicines – would have their lives in danger.”
In March 2023 EMERGENCY together with CRIMEDIM published the report “Access to treatment in Afghanistan: the voice of Afghans in 10 provinces”, which takes a picture of the health situation in the country after the change of government in August 2021. The research was carried out in 20 of its structures in the 10 provinces in which it operates, through the administration of questionnaires and interviews to over 1,800 people including patients and healthcare staff of EMERGENCY and public hospitals.
Among the data that emerged from the research: one out of two Afghans cannot buy the medicines necessary for treatment and 1 out of 5 has lost a relative or friend who was unable to access the treatment he/she needed; 5 out of 10 had to save on food and clothing in order to pay for health services and 9 out of 10 borrowed money. There are no ambulances in case of an emergency. The structures are inadequate, lacking in specialized personnel, machinery, electricity and water, especially in rural areas. The health system is not adequate to respond to the needs of the population because structurally more resources than those available would be needed.
Women represent one of the most vulnerable groups, particularly in the management of pregnancy. The lack of safe and efficient means of transport, the absence of clinics offering obstetric care for expectant mothers in rural areas and the decrease in purchasing power make the possibility of accessing timely and effective care for Afghan women even more precarious.
In a country that depended on international aid for 75% of its public spending, the United Nations Office for Humanitarian Affairs has estimated that 17.6 million Afghans will have serious or extreme health needs.
“Already after August 2021, and throughout 2022, we have seen the health needs of Afghans change – says Sozza -. The admission criteria of the centers for victims of war (particularly in the hospital of Lashkar-gah) have also been opened up to civilian trauma. To date we see a clear improvement in the security conditions of the country and especially of the capital. In our hospital in Kabul in 2022 we handled patient flows, often massive, 29 times due to episodes such as explosions and attacks, for a total of over 380 patients. In 2023, however, [we had] only two, and from March 2023 to today, none”.
In the last year, the decisions taken by the government regarding the sphere of women’s rights have aroused great attention and apprehension.
On 20 December 2022, the Afghan Minister of Higher Education announced a ban on women attending university, while on 24 December, the Ministry of Economy announced a ban on Afghan women working with non-governmental organizations, both national and international.
“In a country already torn apart by a very serious economic and humanitarian crisis, denying girls education means depriving Afghanistan of future resources that could strengthen the economy, public health and stability – continues Sozza -. Similarly, prohibiting employment in NGOs reduces the possibility for vulnerable sections of the population to be reached and to have their needs and rights recognised. Healthcare personnel are not included in the provision provided for by law and our colleagues continue to work with us, but we still believe it is essential that the authorities reconsider these decisions to allow women to continue to contribute to the development of their country”.
EMERGENCY has 377 Afghan women in its staff; in particular, the Maternity and Neonatology Center in Anabah, in the Panjshir Valley, is completely managed by women: [there are] 187 [women] among obstetricians, gynecologists, paediatricians, nurses and non-healthcare workers.
In these two years EMERGENCY has not stopped working on the training of local staff, including women, with specialization courses in its own structures; at the moment residency programs are active in surgery, anesthesia and resuscitation, gynecology and paediatrics, thanks to which new specialists can be trained.
“There is a risk that next year Afghanistan will no longer be considered a priority emergency and, consequently, funds for the country would also decrease, so we do not expect the situation to improve; on the contrary we risk forgetting even more what the Secretary General of the United Nations has defined as ‘the most serious humanitarian crisis in the world’ – concludes Sozza. Today more than ever it is important not to forget this country and its population: we cannot know what will happen in the future, but leaving Afghans alone and isolating Afghanistan will certainly not help rebuild what has been destroyed in 20 years of war ”.
EMERGENCY has been present in Afghanistan since 1999 with two surgical centers in Kabul and Lashkar-gah, a surgical and pediatric center and a maternity center in Anabah, in the Panjshir Valley, and a network of 42 first aid posts. In 2023, EMERGENCY hospitals admitted over 10,000 people and carried out over 50,000 visits. In its Maternity Center, in 2023, it delivered over 3,000 babies.