Medics overwhelmed as Afghanistan healthcare crumbles

Since fleeing Afghanistan shortly before the Taliban takeover last month, Farhana has been unable to find peace. Nightmares take her back to the moments she jostled among a crowd of thousands to enter the gate of Kabul’s airport.

The 34-year-old gynaecologist was among tens of thousands of Afghans who left the country within days of the Taliban’s return to power 20 years after they were removed in a US-led military invasion.

She is assailed by sorrow and guilt for the patients she has left behind at the public maternity hospital in the western city of Herat, where she was one of eight Afghan female health workers trained by Italy’s Umberto Veronesi Foundation to diagnose breast cancer.

“I am so, so incredibly sorry for them,” Farhana – whose name was changed to protect her identity – told Al Jazeera from Italy.

Patients keep arriving at the now-closed centre only to find it shut, she is told by those who stayed behind. “These people are in need, I hope we can find a way to reopen it in the future,” Farhana said.

‘Close to death’

Health workers, both public and private, who remain in Afghanistan are battling a humanitarian crisis of staggering proportions, with dwindling personnel and resources as the country’s healthcare system nears collapse.

Tankred Stöbe, medical coordinator at Doctors Without Borders (MSF), was on duty at MSF’s inpatient therapeutic feeding centre in Herat when a toddler named Sabratullah was brought in three weeks ago.

“He was close to death,” Stöbe told Al Jazeera. “He couldn’t respond, his eyes were sunken, he couldn’t eat or drink by himself any more.” The 18-months-old boy’s body weight was down to 3.5kg (7.7 pounds) – the weight of a healthy newborn – and Stöbe and his team rushed to inject his feeble body with a nutritious solution.

“To see this little boy on the verge of starvation, in a city where you see food at every corner, is heart-breaking,” Stöbe said. Herat is considered one of Afghanistan’s agricultural and business hubs.

In the wake of Kabul’s fall to the Taliban, the US froze nearly $9bn in assets belonging to Afghanistan’s central bank. Moreover, the country was cut off from international financial institutions, resulting in a liquidity crunch that forced local banks to set a withdrawal limit of 20,000 afghani ($200) per week. But many complain of not being able to access even this sum.

One in three Afghans is estimated to be acutely food insecure due to high food prices and increasing poverty, among other factors, with the situation likely to get worse, aid agencies say.

While needs are soaring, nearly 2,000 donor-funded health facilities have closed or are partially operational after international donors halted aid money due to concerns over funding a Taliban government.

The suspension in aid money has crippled the Sehatmandi Project, a multi-donor health programme administered by the World Bank and implemented by the Afghan Ministry of Public Health that constitutes the backbone of Afghanistan’s health system.

Out of a total of 2,309 facilities, 393 remain fully operational.

A spokesperson for the World Bank told Al Jazeera the organisation is “deeply concerned about the situation in Afghanistan” but that “historically, alignment of the international community on recognising governments has been a prerequisite of World Bank assistance.”

The Taliban government has yet to be recognised by any country.

The few remaining health organisations are confronted with the near-impossible task of filling the void.

At MSF’s feeding centre in Herat, 60 beds are now occupied by more than 100 children below the age of five who are suffering from malnutrition. Nearby, the organisation’s emergency clinic receives more than 1,000 people a day but is able to treat a maximum of 400.

Stöbe’s team quickly sifts out life-threatening cases, working longer and longer hours to respond to the emergency. “If we shut our door, you can count the number of more deaths,” he said.

Yet, these efforts can never cover the needs on the ground. “We are doctors without borders, but not doctors without limits,” Stöbe added.

Sabratullah, the 18-month-old boy his team fought to bring back to life, has since died.

No cash to deliver medical supplies

Necephor Mghendi from the International Federation of Red Cross and Red Crescent Societies (IFRC), said: “The biggest challenge we are now facing in Afghanistan is access to money.”

While remote areas are more accessible than they have been in years, the banking crisis is making it arduous to secure hard currency to pay contractors to deliver medical supplies.

“I have staff members who have been queueing in the past weeks and have not even been able to get $200,” Mghendi, IFRC’s head of delegation for Afghanistan, told Al Jazeera.

According to data provided by the World Health Organization (WHO), about two-thirds of the 2,309 facilities in the Sehatmandi project have reported stock-outs of essential medicines.

At a High-level Ministerial Meeting on the Humanitarian Situation in Afghanistan convened by the UN on September 13, the international community pledged more than $1bn to address humanitarian needs in the country.

However, it remains impossible to provide humanitarian assistance without engaging with the Taliban.

In the eastern province of Nangarhar, a mobile clinic operated by the Afghan Red Crescent with support from IFRC depends on fresh supplies to be able to continue providing medical assistance.

Malalai Amin, a 34-year-old midwife, told Al Jazeera the mobile clinic is one of the few remaining facilities delivering primary healthcare since essential public services have been suspended.

“The number of patients we see has tripled,” Amin said. “The burden placed on us is too much.”

Despite the personal toll, she has vowed to continue working. “Serving and protecting the health of the people of Afghanistan is our duty, both in the previous government and in the current one,” she said.

Among other services, the mobile clinic delivers inoculation against polio, a preventable disease still spreading across the country. However, it cannot deliver COVID-19 vaccines, which require refrigeration.

According to the WHO, all aspects of the COVID-19 response have been disrupted following the cuts to the Sehatmandi project and 2.1 million doses of vaccine are at risk of expiring. Only 5 percent of the population has received full COVID inoculation.

Meanwhile, neighbouring Iran is in the throes of a fifth wave of the pandemic, which has proven to be by far the deadliest. Healthcare providers in Afghanistan have expressed concerns that a similar wave may be forthcoming.

The time to act is now

The humanitarian crisis is the result of multiple interwoven crises, according to observers, with the current aid cuts compounding an already dire situation.

Several studies indicate an increase in frequency, scale, duration and impact of droughts in the country, which reduced the population’s access to food and clean water.

In 2018, more than two-thirds of Afghanistan was hit by severe drought. The western provinces of Badghis, Herat and Farah witnessed significant population movement as people sought livelihoods in the larger, more prosperous Herat, increasing pressure on the province.

In Badghis, one of the most underdeveloped and farming-reliant provinces in the country, satellite imagery shows the drop in vegetation moisture, with dark blue indicating more moisture and red less.

The wheat season in May-July 2021 was also upended by drier-than-average conditions associated with La Niña, a complex weather pattern resulting from variations in ocean temperature.

According to the UN’s Food and Agriculture Organisation (FAO), a new drought is likely to hit the country for a second consecutive season next year.

“In the old days, you’d have four or five years to recover,” Richard Trenchard, FAO’s representative in Afghanistan, told Al Jazeera. “Now, with the increase in frequency, we are seeing that it’s really hard for farmers and livestock owners to respond.”

Farmers who have had their harvest cut by a third – or in some cases by half – are less likely to have set aside a portion of the crop to sow next year. Buying seeds amid the ongoing cash crisis, however, is not an option for many of them.

FAO has warned that urgent liquidity is needed to help farmers buy seeds before the onset of winter. “There’s plenty of good quality seeds available in the country, the worry is that they are going to sit in warehouses rather than being put into the field,” Trenchard said.

The health implications of not sowing now are alarming, according to the FAO representative, in a country where approximately 80 percent of livelihoods depend directly or indirectly on farming and malnutrition is rampant.

FAO estimates the cost of growing about 1.2 tonnes of wheat to feed a family for a year is approximately 150$. With no harvest, families are more likely to face food insecurity and displacement, which will come at a greater human and financial cost.

“What we need now is a massive humanitarian uplift,” Trenchard said. “The challenge now [is finding the] cash needed to offset a far deeper and far more expensive crisis next year.”

Additional reporting by Mohsin Khan Momand in Kabul.