Voices on Afghanistan: Healthcare to suffer after withdrawal

Afghanistan faces vast challenges when it comes to healthcare, says Dr Fazel Fazly.

One of Afghanistan's few woman doctors examines a female passenger injured when a bus hit a mine, as other victims are seen on the background at a hospital in Kandahar. Allauddin Khan / AP Photo

The withdrawal of international forces from Afghanistan will make the challenge of providing health care more significant, says Afghan doctor Fazel Fazly. Follow him on Twitter: @FFazly

Doctors in Afghanistan face complex challenges when it comes to providing health care. Though similar throughout the country, I will focus on describing the challenges in the east of the country, where the city of Jalalabad is the political hub.

Jalalabad alone provides the healthcare facilities for four eastern provinces: Nangarhar, Kunar, Laghman and Nuristan.

There is a lack of ambulances, resources, and healthcare infrastructure.

We also lack qualified staff. I don’t mean only physicians. Paramedics, nursing staff, physiotherapists and psychotherapists – we lack of all of these.

When we talk about staff, the lack of female staff is the main challenge.

At the management level, we have problems with allegations of corruption and the mismanagement of resources.

Then, we are a conflict zone. There are sporadic explosions across the country. There’s an unequal ratio between the number of casualties and the number of health facilities at the local level.

The other day we had a tragedy in Paktika province. We suddenly had 200 injured patients in an area where the biggest hospital has the a maximum of 30 surgical beds.

You can imagine the burden and the problem facing both the patients and the medical staff.

Where could doctors treat the patients? In these situations, there will be two outcomes. The patients will lose their lives or get permanent disabilities.

While we haven’t developed more infrastructure over the last 30 years, the rapid birth rate in Afghanistan has seen the population almost double since the early 1980s.

The biggest children’s hospital in Jalalabad has 40 beds for a population of well over 2.5 million in four provinces.

There is also drug smuggling. Counterfeit medicine is regularly smuggled from neighbouring Pakistan into Afghanistan, mainly through Jalalabad.

There is no central laboratory for quality control. Ultimately the victims are the patients and their relatives who pay for the medicine. The medicine is not only ineffective, but also dangerous to their lives.

When the international forces withdraw from Afghanistan around the end of 2014, most of the donor funds are expected to go with them.

A big chunk of the money that is running hospitals in Afghanistan is coming from donor countries. Some of the hospitals are even run directly by international forces.

There will also be a sizeable effect in terms of transportation of the patients. If we are hit by a big disaster it is the international forces that help us transport the patients from rural or remote areas to the cities. And in certain cases patients are taken to hospitals run by international forces.

So the effect of the international forces leaving will be big and very negative for health care in Afghanistan.

Since we don’t have a nationwide medical association, there is no system to help doctors plan a strategy for the future. The doctors are trying to survive at an individual level.

Despite the challenges, I have seen some improvements over the past decade. We have a number of private hospitals in Jalalabad that will decrease the burden on state hospitals. People who can afford to pay can go to the private hospitals.

The second is, of course, in education. We have three private medical schools in Jalalabad. We also have one state-run medical school.

Another improvement is that there is finally a hospital for drug abusers. The number of drug abusers has increased significantly in recent years – there are now about 2 million in Afghanistan.

One reason for this is that many Afghans living Iran who were forced to come back were already addicted. Then there is the increased cultivation of poppy in the country. There is a direct correlation between the increase in the growth of poppy and the number of drug abusers in a given province. There is also no strict regulation of medications sold in the country. You can buy any type of medication or narcotic without a prescription.

Other reasons are the lack of education, lack employment for all, and post-traumatic stress due to the war.