The decision to close a maternity ward in Afghanistan after a militant attack that killed 24 people, including mothers, children and babies, last month has been “painful and heartbreaking’” said the director-general of humanitarian organisation Doctors Without Borders (MSF).
Speaking to The National on Wednesday following the announcement of the ward's closure, Thierry Allafort-Duverger said the decision was taken to protect its staff, patients and health workers as they see the hospital at high risk of a repeat attack.
On May 12, 24 women, children and babies – including one midwife – were killed when gunmen entered the Dasht-e-Barchi hospital in western Kabul and opened fire. Three of the 16 mothers killed were shot in the delivery room, along with their unborn babies.
Despite accusations of blame, it is not yet clear who carried out the attack because no group has claimed responsibility.
"Mothers, babies and health workers were deliberately targeted by unknown assailants with a systematic intent to kill ... Higher perimeter walls or thicker security doors won't prevent patients and health workers from being brutally killed again," Mr Allafort-Duverger said.
MSF announced in a press release on Monday that activities at the 55-bed maternity unit, which has been run by MSF since 2014, have stopped since the attack. But they said they are to continue operations in other parts of the country, including the provinces of Helmand, Herat, Kandahar, Khost and Kunduz.
"Some of them [the 350 employees] tell us they are ready to take the risk of returning. But we refuse to send them back in the current context, with courage and hope as the only means of protection against another possible massacre. This decision is painful and heartbreaking, but we believe it's necessary," Mr Allafort-Duverger said.
“What happened is not an isolated incident but follows repeated attacks on civilians and humanitarian workers in Afghanistan. It is also part of a series of attacks against MSF, with more than 70 of our patients and personnel losing their lives since 2004.”
The target of the assault appeared to be the Shia Hazara minority, a community of about a million people who live in the area around Dasht-e-Barchi and comprise most of the patients.
The maternity wing provided services to about 1,200 expectant mothers each month free of charge – a vital lifeline as government hospitals charge and many of the Hazara community do not have the means to pay for their treatment. A consultation at a private hospital can cost $32 a time, reported Afghan news outlet Tolo.
It is one of the biggest maternity hospitals supported by MSF in the world, with almost 16,000 women giving birth there last year.
Now it has closed, women will have only the nearby government-run hospital, which has seven maternity beds and no operating ward for emergency cases, and with its operations currently hampered by the pandemic.
Dasht-e-Barchi hospital midwife supervisor Zahra Koochizad said some women would arrive at the hospital in terrible condition. It may have been some time since they received medical care and they were often suffering from poverty-driven factors such as a lack of food.
“In Afghanistan, a maternity ward is one of the few spaces where women are the leaders,” Ms Koochizad said.
She said that although Afghan minorities are used to tragedy “on a daily basis”, nothing could have prepared them for the horror of the attack.
“I am hurt – my life has changed – but I am still committed to continue my work,” she said.
Other members of the community said they were saddened by the loss of the ward.
"We requested that they do not cut their aid because our people are very poor," Sakhi Bashardost, a member of Dasht-e-Barchi health delivery services, told Tolo.
Mr Allafort-Duverger said MSF regrets the closure of the Dasht-e-Barchi maternity ward, but that until the situation on the ground changes, it will not be able to reopen.
“In the current context in Afghanistan, we feel that the lives of humanitarian health workers and their patients are just an adjustment variable on the agendas of the political and military forces active in the country. Only a change in this context might change our analysis,” he said.