Afghan health system crumbles under pressure

KABUL, Afghanistan — Seven-month-old Amena lay silent in her hospital crib amid the meows of desperately ill infants in the malnutrition ward.

His mother, Balqisa, had brought the child to Indira Gandhi Children’s Hospital in Kabul, the Afghan capital, the night before. “His body was so warm,” she said, stroking her daughter’s emaciated leg.

The baby had a high fever, convulsions and sepsis, said Dr Mohammad Iqbal Sadiq, a pediatrician, looking at his chart.

“His chances are not good,” the doctor said. “We got it too late.”

At Indira Gandhi Hospital and in failing hospitals across Afghanistan, starving children arrive in cars, taxis and ambulances day and night. Acute malnutrition is just one of many diseases that threaten to overthrow the country’s fragile health system.

Late last month, António Guterres, the UN secretary-general, told the Security Council that Afghanistan was “hanging by a thread”, as he called on countries to suspend all sanctions that restricted the delivery of humanitarian aid to the country.

“For 20 years, we have kept Afghanistan on transfusion,” said Filipe Ribeiro, national representative of Medecins Sans Frontieres, or Doctors Without Borders, in Kabul. “Overnight, we removed the drip. Now we have to find a way to put it back.

According to the United Nations, three quarters of the Afghan population have been plunged into extreme poverty, and 4.7 million Afghans are at risk of severe malnutrition this year. Last month, the organization issued its largest-ever appeal to a single country, asking international donors to donate more than $5 billion to avert a humanitarian catastrophe.

Save the Children said the number of critically malnourished children visiting its clinics in Afghanistan had doubled since augustwith 40 children dying in December while on their way to receive medical treatment.

Jonas Gahr Store, the Norwegian prime minister, whose country last week hosted meetings between representatives of the Taliban and Afghan civil society groups, spoke to the Security Council on the urgency of accelerating aid.

“We need new agreements and commitments in place to be able to assist and assist an extremely vulnerable civilian population, and the most vulnerable among them, children who face hunger and suffering,” he said. declared.

Before the US-backed Afghan government disintegrated in August as the Taliban overran the country, the health system depended on international aid to survive. But much of that funding has been frozen to comply with Taliban sanctions.

As a result, the International Rescue Committee recently predicted that 90 percent Afghan health centers were likely to close in the coming months. The World Health Organization has stated that epidemics diarrhea, measles, dengue fever, malaria and Covid-19 threaten to overwhelm overwhelmed hospitals.

Kabul’s Indira Gandhi Hospital nearly closed in October when unpaid staff had to chop down trees to make kitchen fires. A wave of funding in November from the International Committee of the Red Cross enabled it to keep its doors open and provide desperately needed medical supplies.

The infusion could keep the hospital afloat for the next few months, according to Dr Sadiq, the pediatrician.

“After that, nobody knows what will happen,” he said.

Although there were further injections of aid, including $308 million in US-authorized relief, they were not enough to cover 1,200 health facilities and 11,000 health workers.

Although the drastic drop in the number of war-related casualties has eased the burden of these patients for many hospitals, the suspension of operations by private facilities and the ability to travel safely on Afghan roads have left others crowded hospitals.

On a recent morning, the corridors of Indira Gandhi Hospital were filled with beds as family members of patients squatted on the floor amidst food parcels bought from the local bazaar.

Meals for patients consist of an egg, two apples, a packet of milk, rice and juice, so many families supplement them with outside food. Some buy drugs from local pharmacies because the hospital can only provide about 70% of the drugs needed, Dr Sadiq said.

In the children’s intensive care unit, many small cradles held two or three infants. In the premature babies ward, two newborns had been placed in single-child incubators.

“I’ve never seen it like this,” said Dr Sadiq, who has worked at the hospital for more than three years. “And just imagine this same situation in all the hospitals in Afghanistan.”

The hospital, the largest in Afghanistan, accommodates 500 patients in the 360-bed facility, said Dr. Hasibullah Rahimzay Wardak, director of the hospital. More than 1,000 patients arrive in a typical day, many of them from distant provinces. About 250 to 300 are admitted daily.

In the overcrowded malnutrition ward, 15 to 20 emaciated babies arrived each day, with around 60 infants filling the overcrowded malnutrition ward each day. The death rate is 2-3%, Dr Sadiq said.

Soraya, 2, had arrived 20 days earlier, dangerously thin and out of breath. Her mother, Sara, 17, sat by her child’s bed as the girl’s bony chest heaved up and down. Dr. Sadiq tenderly lifted the girl’s legs, which were limp and swollen.

Soraya weighed 14 pounds when she arrived, the doctor said, but weighs just 12 pounds now. Even so, he said, his condition had improved. His chances of survival were good.

Adding more strain to Afghanistan’s overburdened healthcare system is a fourth wave of Covid-19. Yet the virus is an afterthought in Afghanistan, where many people struggle to find enough to eat each day.

Few Afghans wear masks, even at the Ministry of Public Health in Kabul. There, officials huddled in groups on a recent weekday, greeting visitors with hugs and kisses, and ignoring faded signs saying masks were needed throughout the building.

At the Afghan-Japanese Communicable Diseases Hospital in Kabul, the only Covid-19 facility remaining in the capital, few staff or patients complied with the worn stickers on the floors that proclaimed: “Let’s beat the coronavirus – Please keep at least 2 meters away from people around you.

“When I try to talk to people about Covid-19 they say we have no food, water or electricity – why should we care about this virus?” said Dr. Tariq Ahmad Akbari, medical director of the hospital.

Dr. Akbari suspected that the Omicron variant had entered the country, but the hospital lacked the medical equipment to test the variants. He and his staff had not been paid for five months, he said, and the hospital was severely short of oxygen and health personnel.

Seven of the hospital’s eight female doctors fled after the Taliban takeover in August, part of a recess that has cut staff from 350 to 190 in the past five months. Four of the five staff microbiologists have resigned. And only five of the country’s 34 Covid-19 centers were still functioning, Dr Akbari said.

Several staff members lived in the Kabul hospital because without a salary they could not pay rent, he said.

The hospital was recently supported by a two-month, $800,000 palliative grant from an affiliate of Johns Hopkins Hospital, Dr. Akbari said. And Afghanistan’s relative isolation after the Taliban takeover likely helped contain the spread of Covid-19, he said.

Up to 20 patients died a day in the previous wave, but only one or two a day now. And the hospital is testing about 150 patients a day now, compared to 600 to 700 daily tests during the second wave, Dr Akbari said.

He speculated that Afghans are so overwhelmed with other survival issues that they are less likely to seek treatment for Covid-19.

Before the Taliban takeover, the Public Health Ministry released detailed daily charts showing the number of coronavirus cases, hospitalizations and deaths – and the rate of test positivity. But now the poorly funded ministry is struggling to keep tabs on the pandemic.

Of more than 856,000 tests carried out since the first wave of Covid-19 in early 2020 – out of an estimated population of nearly 40 million – around 163,000 were positive, a spokesman for the Ministry of Health said. More than 7,400 Covid-19 deaths have been confirmed since 2020, he said.

But because testing is extremely limited and the cause of death is not recorded in many cases, especially in rural areas of Afghanistan, no one knows the true scale of the pandemic.

Dr Akbari shook his head in frustration as he described how little was known about the virus in Afghanistan.

Looking defeated, he said: “If we had a surge like the one we had in the second and third wave, we wouldn’t be equipped to deal with it.”

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