Afghan Diary: Health system on the verge of collapse - patients "mostly go home sick"

Created: 12/22/2021, 10:10 AM

Medical care in Afghanistan is devastating.

The international correspondent Natalie Amiri reports of great need - and people who see a doctor for the first time in 20 years.

Kandahar / Kabul - I am amazed at the information I am getting at the hospital in Kandahar. Dr. Alkozai doesn't talk about medical shortages in the first place, no, he tells me he's happy. About the fact that it has finally stopped, the fighting, the war that the hospital was in the middle of. The young doctor is surrounded by people who want something from him. Sick people, their relatives, in the middle of it all a Taliban fighter with a rifle around his neck, an image to which everyone here seems to have gotten used to.

Dr.

Alkozai is maybe 40 years old.

He takes me into a room and locks it from the inside so that nobody can disturb us.

Before answering my questions, he sighs deeply and says that he has not had a salary in more than six months.

He's doing this on a voluntary basis.

Then he explains to me why he is also happy: “In war nobody cares about the other.

We here in the hospital were right on the front line, on one side the Taliban and on the other the Afghan police units.

Then the Taliban came to the hospital, I was very afraid that they would kill us.

But that didn't happen, they behaved decently, they were even nice. "

Medical care in Afghanistan: patients seeing a doctor for the first time in 20 years

We are at the Mirwais Hospital in Kandahar. The hospital has always been overcrowded. Especially at the time when the war was raging in the southern province. Many who were admitted here blamed the American drone attacks and bombs for their misery - more than the Taliban fighters and their suicide attacks, the doctor tells me. Now the Americans are gone. The war ended. One might assume that there is less to do now. But exactly the opposite is the case. Even more patients have become.

Because all the Taliban families who could not come into the city for 20 years, hid in the provinces in the mountains, they are coming now. The dividing line between the Taliban, their families and the Afghan civilian population no longer exists. The Taliban are everywhere now. They are standing at the entrance of the hospital with their AK-47s. I also see handcuffs stretched across her chest that says Made in USA. The Taliban fighters are right next to a poster that shows a machine gun, crossed out, and above it it says: No Weapons. Probably this is still a relic from the time before August 15, before the Taliban came to power, which you never see without weapons.

Dr. Alkozai groans under the enormous crowd. “I have so many patients who haven't seen a single doctor in twenty years, they never made it to town and the hospital. Many roads were closed, many villages cut off from the infrastructure because there was war. Now the streets are clear. Right now, five percent of my patients are urban people, or maybe ten percent. 80 to 90 percent of my patients come from the formerly inaccessible Taliban areas. They come with diseases that they didn't know had a name, a diagnosis and a cure. ”In early 2020, more than 300 patients a day came to Mirwais Hospital every day, the International Red Cross calculates on its website. Dr. Alkozai now has several thousand patients a day.

Medicine is too expensive for most.

And so thousands come to a hospital for the first time in their lives.

But neither the patients nor the state have the money for the treatment.

And so they usually go home sick.  

Natalie Amiri, Afghan Diary

He tells me about Fahim, who was hospitalized three days after the fall of the Ghani government.

He comes from Zari, a district about 50 to 70 kilometers from the city.

He was out of town for 25 years.

The doctor asked his age, he was 25 years old.

So he had never set foot in the city before his eyes in his life.

He is not the only one, there are very many like him who are coming to Kandahar for the first time.

A change of power in Afghanistan has exacerbated poverty - the country is dependent on international aid

We go back to the consultation room.

A new patient is already lying there, he is very old.

His family came along, the men.

All of them have long beards, they seem a little unsettled.

You can tell from them that it is an unfamiliar environment for them.

Perhaps unaccustomed to being taken care of.

That you don't want to harm them.

You are no longer the enemy, at least for some.

Then the doctor tells me that he can often only give medical advice to the people who come to him.

Medicine is too expensive for most.

And so thousands come to a hospital for the first time in their lives.

But neither the patients nor the state have the money for the treatment.

And so they usually go home sick.

In part 6 of her Afghan Diary, the international correspondent Natalie Amiri deals with medical care in Afghanistan after the Taliban came to power.

© N. Amiri / N.Bruckmann / M.

Litzka / afp

Since the Taliban came to power, the country's economic situation has worsened.

The change in power has triggered a 20 percent decline in the Afghan currency, the Afghani, since August.

At the beginning of November, the now ruling radical Islamic Taliban * forbade paying with any other currency besides the Afghani.

They declared: "The economic situation and the national interest of the country require that all Afghans use the Afghani in every transaction."

It goes on to say that anyone who does not adhere to them will be punished.

$ 9.5 billion has been frozen by the US, the International Monetary Fund and the World Bank since the Taliban came to power.

Afghanistan has no money and is dependent on international aid.

Salaries have not been paid for months.

The health system in Afghanistan, which was largely built up by the international community, is on the verge of collapse.

Catastrophic medical care: Health system at its limit even before the Taliban

The medical situation is dire across the country.

The main problem is that the entire healthcare system in Afghanistan was sick and fragile even before the Taliban came to power.

It depended on the international community's drip.

That means that all salaries and hospitals were funded from abroad.

A solution was never thought of for day X, the day on which aid from abroad will stop.

There was no intra-Afghan approach to how these hospitals could be financed.

How to ensure that the hospitals continue to exist.

more on the subject

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Afghan Diary: In the stronghold of Talibanism - "They destroyed the policemen's gravestones themselves"

General practitioner Dr.

Wardak has lived in Germany since 1992 and has repeatedly raised this problem both in the Afghan Ministry of Health and in the Ministry of Higher Education, where he has worked for medical faculties.

“Nobody thought about it and everyone cooked their own soup,” he tells me when I contact him in Germany.

“Today's situation was to be expected.

It was clear that one day there would be no billions. "

Many doctors have not received any salaries for months, medical equipment, bandages and medicine are missing.

The first clinics have already closed.

I am speaking to an employee of the Ministry of Health in Kabul.

He tells me how discouraged everyone is.

They no longer have any ambitions, they know they no longer have a guarantee for their job, and many have not received a salary for a long time.

Ministry of Women in Afghanistan abolished: "It has become almost impossible for women victims of violence to get help"

“And suddenly we have superiors,” the employee, who wants to remain anonymous for security reasons, tells me, “who are illiterate, with no training or work experience. Let alone knowledge of the health sector. And just because they belong to the Taliban, they now have a post in which they have the say. ”All programs that investigated domestic violence, investigated it and offered help for women, by the Ministry of Women in cooperation with the Ministry of Health, have been discontinued.

The Ministry of Women no longer exists. In the Ministry of Health, the Taliban are no longer interested in these cases, the employee said. He is convinced that the cases of domestic violence against women have increased because the men know that nobody is investigating the cases and therefore the perpetrators. "From now on, it has become almost impossible for women victims of violence to get help."

I visit a day clinic in the Dewanbegi district in the west of Kabul. Dr. Wardak set up the clinic with friends and acquaintances in 2016. We meet with an employee of the clinic at a major intersection in Kabul. We wouldn't find the clinic on our own, he tells us on the phone. He's right. We drive with him through narrow, narrow streets. The people here look very poor, and the shops are very sparse. It's dusty, our car is throwing up even more dust. It is also cold, at the end of November it was minus temperatures in Kabul. The people are poorly dressed. The women here all wear a burqa, under the burqa they lower their faces when I appear with my camera. Only the doctor who greets us doesn't. She wears a headscarf, lightly tied around her head. As before the 15thAugust, many women in Kabul wore the headscarf.

Famine in Afghanistan: Taliban seizure of power and droughts have aggravated economic situation

The clinic cooperates with two German associations.

“Kinderhilfe Afghanistan eV” and “humedica e.

V ".

They are also running a nutrition program that they initiated three years ago.

It is a program to combat malnutrition.

In the clinic, women and children have the opportunity to be examined for malnutrition free of charge.

If this is found, they are given access to a nutrition program.

Also for free.

The Red Cross warned in November that more than half of the Afghan population is now believed to be suffering from a lack of food.

Not only the Taliban are to blame for this situation, severe droughts have hit 80 percent of the country in recent years and largely paralyzed food production.

Many have lost their source of income as a result.

And prices have shot up.

The price of wheat alone has risen by 28 percent within a year.

More and more children are abandoned by their families in villages, and countless they wander around.

And there are more and more, so the German World Hunger Aid.

According to aid organizations in Afghanistan, one million children are at risk of starvation.

Natalie Amiri, Afghan Diary

More and more people come to the day clinic for a check-up, hoping that this free program for the undernourished will give them more physical strength, at least a little.

Children up to six years of age, when the risk of malnutrition is greatest, and women between 16 and 45 years of age are allowed to register.

During this time there is a possibility of pregnancy.

“On average, the women who come to us have six children,” Dr.

Wardak and laughs, not pleased, rather frustrated.

The clinic also offers a family planning program.

"So that they at least have their children two years apart so that the women can regenerate," says Dr.

Wardak.

Children in Afghanistan: One million faces starvation - the majority of the people live in poverty

There are so many children in Afghanistan. No matter where I was with the camera, it came instantly from everywhere, and I was constantly surrounded by dozens of children. When I was in the countryside in Kandahar Province, I asked a woman who lived in an apartment with five other families, each of whom had at least four children. "If so many people are poor here, why do you have so many children, cost children, you cannot look after them?" The older woman looked at me and said: "Stupidity". And her son, who was sitting next to her with his baby in his arms, his fifth child, said: "No, that is God's will."

More and more children are abandoned by their families in villages, and countless they wander around. And there are more and more, so the German World Hunger Aid. According to aid organizations in Afghanistan *, one million children are at risk of starvation. According to the UN, 18.8 million go hungry every day. 97 percent of the Afghan population will live in poverty by the end of the year, according to the UN. 97 percent of 38 million people.

Dr.

Freshta is the head of the clinic, she tells me that her problems start on the way to the clinic.

They gather, three or four women, in one place, and then together make their way past the Taliban checkpoints.

If they were alone, the Taliban would ask for someone to accompany them, a male one.

The Taliban have neither allowed nor forbidden her to work as a doctor.

"I don't think about that either, I work for the people here in this country as long as I can."

Medical supplies are dwindling, salaries are no longer paid: Great need in Afghanistan

Dr. Freshta confirms to me that, just like in the clinic in Kandahar, people cannot pay for medical care: “Many women who previously had an income have lost their jobs. Lots of the men too. Or they are not paid a salary. The patients who come to us at the clinic have to buy the medicine that we prescribe for them from the pharmacy themselves. Most of them don't pick up the medication. A woman came yesterday, she was so weak and in miserable condition, I asked her why she came so late, she said she had no money to pay for the car to the clinic. "

“Our stocks of medicine that come from abroad are shrinking.

Nothing follows.

I don't know how to proceed.

We don't have our own pharmaceutical production in Afghanistan, we are 100 percent dependent on other countries, ”reports Dr.

Freshta.

Many thousands of projects and aid cooperation with Afghanistan have been stopped since the Taliban came to power.

A project that the Dewanbegi day clinic set up with GIZ will also not be continued.

From January 1, 2022, this project will be put on hold, Dr.

Wardak with.

How to provide aid without supporting the Taliban?

Even then, numerous hurdles for aid in Afghanistan

At the moment the federal government is looking for ways to provide aid without directly supporting the Taliban.

Because one is still waiting for the promise of the new rulers to protect the rights of women.

And not just their rights.

Even when it comes to aid payments to non-governmental organizations, billions have already been pledged, this is difficult, because payments are almost impossible due to US financial sanctions.

And when it does, the money only arrives in Afghan accounts in a roundabout way.

But the Taliban are causing the next problem: Because of the shortage of money, you are not allowed to withdraw more than 25,000 euros per month.

And even this amount is not certain that it can be paid out at all.

Because there is no money.

Donation

in the Dewanbegi district in the west of Kabul: Afghanic eV, Sparkasse KölnBonn, IBAN: DE59 3705 0198 1902 083 896.

7 days in Afghanistan: Afghan Diary by Natalie Amiri 

We are all still aware of the tragic images of the days around August 30, 2021 that accompanied the withdrawal of international troops from Afghanistan.

Thousands of people desperately tried to get on one of the planes at Kabul airport to travel west.

They did not want to live in an Afghanistan ruled by the Taliban again.

Few of them were lucky enough to get a seat on board. 

Since then, the Taliban have ruled the torn and impoverished country, which many observers are predicting a humanitarian catastrophe this winter.

Natalie Amiri, international correspondent, kept an impressive diary during her most recent research stay for her new book (to be published on March 14, 2022) in Afghanistan.

IPPEN.MEDIA publishes the diary of their trip in seven parts both online and in print in some titles such as Münchner Merkur or Frankfurter Rundschau.