The Continued Struggle to Access Medical Care in Afghanistan

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Executive summary

After 40 years of conflict, Afghanistan faces yet another period of instability in 2021. Peace negotiations between the Afghan government and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban) have made little to no progress since they began in September 2020. Fighting between government forces and armed opposition groups continues to claim thousands of civilian lives each year while crippling public infrastructure.
Violence and insecurity are pervasive throughout the country and show no sign of abating. Healthcare facilities in Afghanistan are attacked more often than almost anywhere in the world, forcing their temporary or permanent closure and depriving millions of access to vital medical services. The humanitarian crisis, compounded by the health and socioeconomic shocks of the COVID-19 pandemic, is worsening throughout the country.

This briefing paper, produced by international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF), features new medical data and accounts from patients, caretakers and MSF clinical staff in Helmand, Herat,
Kandahar and Khost provinces. In surveying these groups,
MSF found that Afghans today are struggling to access basic necessities, including medical care, as a result of violence and insecurity, poverty, and an under-funded and under-resourced health system. Every day, Afghans must undertake dangerous journeys across active frontlines and mined roads, through checkpoints and areas controlled by armed groups to seek medical care. They are often unable or too afraid to leave their homes, and, when medical emergencies happen, such delays can prove fatal.

MSF brought these issues to public attention in reports released in 2014 and 2020. We publish this new briefing to show that the persistent barriers that Afghans face when seeking healthcare continue to this day.

Poverty in Afghanistan is on the rise. The COVID-19 pandemic has worsened the financial hardship for Afghans. Many have lost their livelihoods as a result of border closures, reduced commercial activity and job losses, and are receiving less in overseas remittances. It is getting harder and harder to feed themselves and their families, as consumer prices soar. Many Afghans still rely heavily on humanitarian assistance to survive.
Direct medical and non-medical costs put healthcare further out of reach for people living in poverty. In responding to our survey, patients and their caretakers reported having to borrow money, sell household goods or reduce spending on other essentials, such as food, in order to afford treatment, medicines and transportation. Many were unable to seek or continue their treatment, with disastrous consequences to their health. MSF is one of the few organisations in Afghanistan offering medical services completely free of charge.

In recent years, the international community has touted the achievements of Afghanistan’s healthcare delivery model, despite strong evidence that the health system is unable to meet Afghans’ basic medical needs. Public health facilities in Afghanistan are under-funded and under-resourced, lacking qualified personnel, equipment, medicines and medical supplies. Actors, such as MSF, have stepped in to fill important gaps in health service provision. However, the situation is not sustainable, as humanitarian needs multiply and add further pressure on to already overburdened medical facilities. When desperate patients turn to private facilities, in the hope of receiving better medical care, they accrue crippling debts and no guarantees of quality treatment.

At the end of 2020, international donors announced considerable reductions in future funding assistance for the country, and some placed conditions on that assistance. This will increase the pressure on the fragile public health system and on health partners to meet the rapidly growing medical needs of the Afghan population.

National and international stakeholders must recognise that basic services, such as healthcare, are insufficient and incapable of addressing Afghans’ immediate needs, and that now is not the moment to reduce humanitarian support to Afghanistan. Access to quality and affordable medical care for all must be made an urgent priority