Latest The Magazine — 14 March 2014

The ongoing struggle to access healthcare in Afghanistan, February, 2014.

The international NGO Médecins sans Frontières (MSF) has just come out with its 2014 report on Afghanistan as the country enters its final phase leading up to presidential and provincial elections followed by the pullout of the bulk of international troops. While the war in Afghanistan has lumbered on for over three and a half decades, the report looks specifically at the current situation since the US-led invasion in October, 2001. MSF’s Emmanuel Tronc will be discussing this report at the launch of the 4th edition of The Essential Field Guide to Afghanistan in Geneva on 27 March, 2014 at the Graduate Institute’s Maison de la Paix. FOR MORE DETAILS ON LAUNCH PANEL: Afghanistan Beyond 2014: Have we learned nothing from history?

Of concern, too, is that the international community is already turning its attention elsewhere with existing interest focusing primarily on military drawdown, security transition and pre-electoral wrangling. “Conspicuously lacking, is a focus on the daily reality of Afghans, trapped in an escalating conflict,” the report maintains. “Indeed, 2013 was reportedly the second most violent year for civilians since 2001.”

MSF points out that as coalition forces withdraw, their leaders seek to define the legacy of the international intervention in Afghanistan. “Alluring narratives of success – crafted to suit political and military agendas – abound,” it says. “When it comes to healthcare provision, much investment and progress has undoubtedly been made since 2002. However, official accounts of Afghanistan’s health system habitually emphasise achievements, yet neglect unmet medical humanitarian needs.”

According to MSF, the overly optimistic rhetoric about healthcare success often diverges significantly from the reality of what the organization’s teams perceive on the ground. At the same time, MSF admits that a dearth of reliable statistics exists. This makes it difficult to gain a comprehensive view of the true extent of needs. To build a clearer picture of people’s ability to access healthcare, MSF conducted research in the four hospitals where its medical teams work: Helmand, Kabul, Khost and Kunduz provinces. This was done over a six-month period with survey interviews carried out with more than 800 patients and their caretakers to help better understand the extent of the barriers people face when trying to obtain medical care.


Key finding include:


Impact of ongoing violence and insecurity


– Within the previous 12 months, one in four people (29%) had either experienced violence themselves, or had a family member or friend who had experienced violence.


– One in four people (23%) had a family member or friend who had died as a result of violence within the preceding year.

– The vast majority (87%) of the violence and deaths were caused by the continuing armed conflict. The remaining deaths and violence were the result of criminality or personal or communal feuds.

Such results are grim, MSF maintains. The statistics and personal accounts highlight the devastating impact of the ongoing war on Afghan communities. In a country with some of the highest mortality rates in the world, the conflict is causing widespread disruption to health services, particularly in remote areas. The stories recounted in the report reveal the war’s toll on civilians: an entire family blown up by a landmine as they travelled home from hospital with a new baby; villages caught between the attacks and the demands of multiple rival armed groups; people forced to hold night-long ‘death watches’ over sick or injured loved ones as fighting rages outside, in the hope of safely reaching medical care the next day.

The 2014 MSF Afghanistan report can be download here.


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