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Afghan health system on the brink of collapse

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A woman looks out the window of the Malalai maternity hospital in Kabul, Afghanistan, Thursday, December 9, 2021. The Afghan health system is on the verge of collapse and can only function with a lifeline from aid agencies. (AP Photo / Petros Giannakouris)


The diesel fuel needed to produce oxygen for coronavirus patients has run out. So have dozens of essential medicines in reserve. Staff, who have been unpaid for months, still show up for work, but struggle to make ends meet at home.

This is the fate of the Afghan-Japan Hospital for Communicable Diseases, the only COVID-19 facility for the more than 4 million people who live in the capital of Kabul. While the coronavirus situation in Afghanistan appears to have improved from a few months ago, when cases peaked, it is now the hospital itself that is in need of resuscitation.

His predicament is a symptom of the crisis in the Afghan health system, which is on the verge of collapse and can only function with the lifeline of humanitarian organizations.

“We are facing a lot of problems here,” said Dr Ahmad Fatah Habibyar, head of administrative logistics at the hospital, citing three months of unpaid salaries, shortages of equipment and medicine and a lack of food.

Some staff are experiencing such financial hardship that they sell their furniture to make ends meet, he said.

“Oxygen is a big problem for us because we can’t run the generators,” he said, noting that the hospital’s production plant has not been running for months “because that we can’t afford diesel. ” Instead, oxygen cylinders for COVID-19 patients are purchased from a local supplier.

And doctors are bracing for more infections than they fear are inevitable with the omicron variant.

Without outside help, “we are not ready for omicron. A disaster will be here, ”said Dr Shereen Agha, 38, head of the hospital’s intensive care unit. The hospital was even lacking basic supplies like examination gloves, he said, and his two ambulances are inactive for lack of fuel.

The previous government contracted with a Netherlands-based aid group, HealthNet TPO, to run the hospital. But the contract expired in November and was financed by a fund run by the World Bank which, like most of the international community, froze payments to the new Taliban government.

HealthNet TPO program director Willem Reussing said the organization was in negotiations for funding, “but the donor community is very reluctant to continue supporting and has strict conditions.” The World Health Organization and UNICEF were only managing to maintain minimal services and not covering the coronavirus response, he added.

“The health care system (…) is really on the verge of collapse,” said Reussing. “The Afghan-Japan hospital is a disastrous example, where we are almost begging donors to step in and save lives.

When the Taliban took control of Afghanistan in August amid a chaotic withdrawal of US and NATO troops, the international community withdrew all funding and froze billions of dollars in Afghan assets to the foreigner. For a country heavily dependent on foreign aid, the consequences have been devastating.

The economy was already deeply troubled under the previous government, with government employees often unpaid. Last year, nearly half of the population lived in poverty, the situation being made worse by the pandemic and a drought that has pushed up food prices.

The Taliban government wants the international community to ease sanctions and release Afghan assets abroad so they can pay civil servants, including doctors and teachers.

The United Nations has sounded the alarm bells about a food crisis, with 22% of Afghanistan’s 38 million people on the brink of famine and 36% facing acute food insecurity.

“We are finding that the economic collapse is exponential,” UN humanitarian chief Martin Griffiths said in an interview last week with The Associated Press. “It gets more and more serious from week to week. “

Nowhere is this more evident than the malnutrition ward at Indira Gandhi Children’s Hospital, where anxious mothers sit next to emaciated children.

Mohammad, two, with hollow cheeks and thinning hair, sipped a cup of nutritious milk with his mother, Parwana, next to him. Originally from central Wardak province, she had been sleeping in the hospital for six nights.

“I don’t even have the money to change his diapers,” the 20-year-old said. Her husband, a tailor, lost both of his legs in a roadside bomb several years ago and has difficulty sitting up. Work is hard to find, and Parwana said her father and brothers are helping the family of three survive.

In the next bed, 1.5-year-old Talwasa was covered with blankets. Only his eyes moved behind half-closed lids.

“We are in a very bad situation,” said her mother, Noor Bibi, who has six other children. Her husband can’t find a job, she said, and “we only eat dried bread and we can’t find food for weeks and weeks.”

Deputy Health Minister Dr Abdul Bari Omar said last week that Afghanistan has 3.5 million malnourished children, although he noted the data came from the previous government.

“This has not happened in the past four months. Malnutrition was inherited from the previous system, but we are trying to find a solution to this problem, ”he said, adding that the old administration also failed to address the shortages of medical supplies.

Deputy director of the children’s hospital, Mohammad Latif Baher, said the facility had seen 3,000 cases of malnutrition in the past four months. Of these, 250 were hospitalized and the rest were treated at home.

Hospital workers are also struggling with shortages and have not been paid for months.

“We are faithful to our homeland and to our profession. This is why we continue to work and provide services to our patients, ”Baher said, noting that they were without pay for five months. He said the hospital was also running low on drugs, including special dietary supplements for malnutrition, as well as antibiotics, pain relievers and anesthetics. Some supplies had arrived from aid agencies, he added, but more was needed.

The situation was similar at the Wazir Mohammed Akhbar Khan National Hospital, where stocks are dwindling. Like most other public hospitals, its patients have to buy their own medicine, with staff only tapping into emergency supplies for those who really cannot afford them.

Sometimes doctors are forced to give smaller doses of the medicine because they just don’t have enough, said Ghulam Nabi Pahlawi, the head nurse of the emergency department.

But it is at the COVID-19 hospital in Kabul that the situation seems most serious. Pharmacist Bilal Ahmad said more than 36 essential drugs have run out and many more have expired. In three months, he said, 55 other drugs will be exhausted.

“The requirements, we cannot meet them,” Ahmad said.