Fieldset
Afghanistan: “Treating patients is our responsibility. There’s a lot of work on our shoulders”

After months of fighting on the outskirts of Herat in Afghanistan, the Islamic Emirate of Afghanistan, also known as the Taliban, took control of the city on August 12. MSF is running a malnutrition unit, a clinic for displaced people, and a COVID-19 treatment centre in Herat. An MSF medic working in the city describes how the team have kept services running and the new challenges that they and other health services in the area are facing today...

Top image shows the malnutrition unit in Herat regional hospital. This photograph was taken in December 2020. It shows the general activities of medics on the unit and does not depict the specific people described in this post.

When the fighting approached Herat there was quite a lot of fear, people were worried. So was I, not knowing what would happen in the future. When the real fighting started inside the city many people were scared so stayed at home, but the situation changed dramatically in about three hours and the Islamic Emirate of Afghanistan took full control of the city.

I find it inspiring that during the fighting there were people running towards the hospital to help...

During the fighting a lot of injured people were brought to Herat regional hospital. When the local community heard about casualties or bombs they would get on their bicycles and come to the hospital and say they wanted to donate blood. So many people donated that the hospital announced that they had enough supplies and would call people if they needed more. I find it inspiring that during the fighting there were people running towards the hospital to help. It’s a very good spirit.

More than ever

The morning after the Taliban took control I went to our malnutrition unit to help support the staff. When I reached the hospital there weren’t many people there yet; no one was sure what the situation was in the city or if we were still open. First we gave all our patients their medications and then we contacted our staff to let them know the city was open and it was safe for them to come to work. After a couple of hours we had our full team together and carried on treating patients.

We now have around 80 children admitted, and the numbers are increasing day by day...

Some of my colleagues told me that when they left home to come to work in the morning some of their neighbours were worried for them and asked “what are you doing? You have to stay at home.” They explained that our job is to help people, and this is the time they need help because the other health facilities are closed. Many staff came in with this attitude and it was good to see.

Before the fighting we had 95 malnourished children admitted in the malnutrition unit. We only have 42 beds, and although we added another 18 by putting up tents to act as temporary wards, we were still well over capacity. During the fighting the number decreased to around 60, but the numbers are increasing again. We now have around 80 children admitted, and the numbers are increasing day by day.

150 patients in a day

We also run a clinic near camps where many displaced people have settled, including from other provinces like Badghis and Farah. The first Sunday after the takeover a lot of patients came to our clinic as a lot of other organisations suspended their operations, either for security reasons or because they’re not able to pay salaries. MSF has found a way to pay all its staff and that has made people calm and more full of hope.

People have hope but still little idea about what the future will bring...

We started working with two doctors first, then three and now four. We run a triage system, so we’d see the people who needed medical attention most urgently first. There were a lot of people coming to the clinic, on one day one of our doctors examined over 150 patients.

It’s an uncertain time so people are working very hard, people are tired but we hope it will calm down. People have hope but still little idea about what the future will bring.

Uncertainty and poverty

Now the main worry is that the other health facilities, for example those that receive funding from the World Bank, won’t be able to carry on their work in Herat, as the World Bank has stopped its funding. There’s no clear picture about what will happen. Some staff working for other organisations haven’t received salaries for months: this has happened before but at those times people had hope that they would be paid eventually. Now with so much uncertainty people tell me they have no hope, many are looking for another job.

Some staff working for other [healthcare] organisations haven’t received salaries for months...

There was one malnourished child in our centre who was from an extremely poor family. We treated the child and provided food for the mother while they stayed at the hospital. The father stayed outside. We asked them how they'd been able to travel to hospital as the father told us that before he didn’t even have 10 Afghanis (0.10 USD). They had sold their sheep and cows and used that money to get to the hospital. Others have to borrow money from their relatives.

Treating patients, building trust

People are very happy when we’re able to cure their children. There was a two-and-a-half-year-old patient who came to us from Badghis, about 250 km away. First the baby was admitted in the dermatology department at Herat regional hospital (HRH) with a skin condition. After six days the skin condition was still very bad, but it was clear they were also malnourished, so they were sent to the MSF malnutrition unit. We saw the child would need a skin graft from the hospital's surgery department, but first we treated the malnutrition.

All the time the baby was with us his father was knocking on the door, asking how the child was doing and questioning how they could still be sick after one and a half months. We spoke with him and said "let us treat the patient". We convinced him to trust our treatment, procedures, the environment and close follow-up of the patient.

He saw that there was a big improvement for his baby ... they were super happy

For two weeks he went back to look after his remaining children in Badghis with his wife staying in the malnutrition unit with the baby. When he came back, he saw that there was a big improvement for his baby and he had a discussion with his wife and they were super happy. After another ten days we could discharge him.

At least one time each month since the father calls us to say hi and say Salam to everybody, and that he was inspired by the treatment we gave. When the fighting started in Herat, he was the one calling us asking if we were fine and he did the same after the city was taken over.

The last option

Treating patients is our responsibility, that’s how I think about it. Right now MSF is the only international organisation working in Herat as the others stopped their activities. Before we could refer people to other health providers but now it feels like when people come to us we are their last option.

Compared to the time before, there is more responsibility, more challenges. There is a lot of work on our shoulders.

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