The Afghan health system is on the verge of collapse

When US troops arrived in Afghanistan in 2001, they found a land of dusty roads. With less than 80 kilometers of paved roads - with an area somewhat larger than France - many Afghans and, above all, many Afghans died on those roads or in hospitals that they had arrived too late. They, often bled to birth. In 2002, maternal mortality was 1,600 deaths for every 100,000 live births, according to Unicef. In 2020, that macabre toll was 638 deaths, the UN estimates. This insufficient improvement runs the risk of being reversed with the arrival to power of the Taliban on August 15.

Just nine days after its takeover, the World Bank, the first donor to the Afghan health system, froze the funds for the country.

Its other two main sources of funding, the European Union and the United States Agency for International Development (USAID), did the same.

Only the World Bank had planned to grant 784 million dollars (658 million euros) for that purpose in 2021. Without that money, with the borders closed in a country that depends almost entirely on imports of medical supplies and medicines, and with many fled, the Afghan health system could be heading "to disaster", explains by phone from Kabul, Filipe Ribeiro, representative of Doctors Without Borders (MSF) in Afghanistan.

More information

• The women of Afghanistan, always at the crossroads

• The UN warns that Afghanistan is facing a "humanitarian catastrophe"

They have not been the only institutions that have announced the freezing of international aid funds which, in 2020, constituted 42.9% of the country's GDP.

The Taliban will not even have access to the central bank's foreign exchange reserves, stored in the United States Federal Reserve, which currently does not allow them access to that money, which is around 9.4 billion dollars (7.9 billion euros).

That figure would be enough to cover Afghanistan's imports, including medical supplies and food, for 18 months, according to an analysis in

Foreign Policy

magazine

.

The possible collapse of a health care built on foreign aid that the West now intends to use to pressure the Taliban is even more likely considering "their weakness", explains the MSF representative. Ribeiro is critical of the way in which these international funds have been used. "The priority of this investment was not the patients or guaranteeing the population's access" to health services, he assures.

In a 2020 report, the medical organization contradicted the Afghanistan success story of institutions like the World Health Organization (WHO). The NGO argued that "by implementing health-related programs (...) the humanitarian situation in Afghanistan has not improved, and in some areas it has worsened in recent years." The report, which is based on MSF's work in two Afghan provinces, Herat and Helmand, cites, for example, the data of the reduction in maternal mortality, whose global improvement in these 20 years hides a stagnation in the last decade. And, again, one of the reasons is the difficulty in reaching health centers and accessing care that, despite the flow of millions of international aid, Afghans finance in part out of their own pockets. In fact, the document specifies, number 77,4% of health spending comes from the family budget in a country where 80% of the population lives below the United Nations absolute poverty line. These problems "are not going to get better now," laments Ribeiro.

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External dependency

NGOs play a crucial role in the Afghan health system. Its reconstruction, which began in 2003, was based on a public-private partnership in which basic health services - the so-called Basic Health Package - were outsourced to companies and NGOs. The contracts were then awarded to whoever presented the lowest budget, something that has had an impact on the quality of care, criticizes MSF. The consequence is that Afghan health also depends on the permanence of these organizations in the country. Ribeiro confirms that all MSF centers in the country "continue to work." However, his is a particular case, because Doctors Without Borders works with its own funds and does not depend on either the Afghan government or international aid.

From the Kabul Surgical Center for War Victims, which is managed by the Italian NGO Emergency, its program manager, anesthetist Gina Portella, stresses by phone that they are not considering leaving either. Like the MSF representative, he assures that the Taliban have guaranteed them that they will be able to continue doing their job. The doctor warns after the risk of shortages of medicines and medical supplies due to lack of funds and the closure of borders. At the end of August, the WHO already warned that medical supplies would run out "in a few days."

The most vulnerable groups, such as women and children, "if they are not the ones who will pay a higher price, they will be the first to pay it," laments the doctor. For MSF's Ribeiro, the dilemma between putting pressure on the Taliban by freezing aid and the collapse of the public health system "cannot be resolved by leaving Afghans to their fate." And he underlines another aspect: the Taliban have guaranteed to his organization that their workers will not have problems. This is a question far from trivial, not only for the right of Afghan women to work; Not only because many families live off a woman's salary, but also because, in large parts of Afghanistan, cultural practices prohibit a man from examining a woman, even during childbirth. The shortage of sanitary remains,According to various international studies, one of the barriers that prevents the reduction of maternal mortality.

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