HERAT, Afghanistan – On an October morning at the internally displaced person’s health clinic in Kahdistan, the line of men, women and children spread around the corner. Inside, the health care workers of the small clinic, which were run by Doctors Without Borders (Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors Without Borders, Doctors, Doctors, Doctors
Across Afghanistan, women have minimal access to reproductive health care and safe delivery services. The situation is worse for displaced women. More than 4 million people are displaced within the country and thousands of citizens return from neighboring Pakistan and Iran every day, many of them by deportation. This influx threatens to bring the country’s strained health system to a breaking point, especially in poorly resourced border regions such as Herat province.
The coronavirus pandemic has already exacerbated many problems for Afghan women. Restrictions on movement have likely worsened women’s access to health care. COVID-19 has put the burden on facilities providing care for the displaced, just as donor funding for health care is gradually decreasing due to the decreasing interest and economic burden of the pandemic. Herat Province has the second highest number of COVID-19 cases in the country after Kabul.
Since 2001, international donor funding has significantly improved access to health care in Afghanistan. Non-governmental organizations provide vital services in Taliban-controlled districts and other unsafe regions. International funds currently make up more than 50 percent of the state budget of the Afghan government. But as violence in Afghanistan resumes and the United States prepares to reduce its military presence to 2,500 soldiers on the ground, donors pull out.
Last month, foreign donors met at a conference in Geneva to discuss the future of aid to Afghanistan. Despite the urgent need for continued aid, the country received $ 12 billion over the next four years – a decrease of $ 3 billion from the previous four years. The pledges also come with stricter conditions, including conditions for progress in the peace agreement with the Taliban. Many Afghans fear that if the violence continues to escalate, the funds will never reach them and remove aid when it is needed most.
The deteriorating security situation will only displace more people and increase the demand for health services. But facilities for the care of women in Afghanistan were also fatally attacked. After militants stormed a maternity ward operated by MSF in Kabul in May, the organization decided to withdraw from the hospital and leave women in the area without vital emergency obstetric care.
Afghanistan is now facing a second wave of the coronavirus, and when winter sets in and emergencies arise, the looming funding shortages could hit the displaced aid programs the hardest. Small health facilities such as the Kahdistan Health Clinic, which is often the sole care provider for many women, will be hardest hit by a decline in donor funding.
The MSF clinic targets Shahrak-e-Sabz, the largest settlement of displaced people in western Afghanistan, most of whom fled fighting and drought in 2018. Founded as a maternity clinic in 2018, it now welcomes all patients and provides basic health care including vaccinations. It bridges the gap between the camp and the hospitals in Herat and remains the single point of contact for thousands of women from the camp seeking reproductive health care.
Parisa Mohammadi, 24, is the only midwife in the clinic and works six days a week. Although the staff does not give birth to babies, the clinic is the first stop for pregnant women from the camp and there is high demand for checkups and contraceptives. “We see about 70 patients a day here and most of them are pregnant,” she said. “They don’t have the money to travel to town and we have an ambulance here so we can take them with us if there is an emergency.”
At the same time, the midwife also watched the effects of the decline in international support for aid to Afghanistan. For example, World Vision’s current program at the camp is slated to end on December 31, according to National Director Asuntha Charles. As the organization scaled back its operations, Mohammadi said an influx of female patients followed to the Kahdistan clinic.
While women in the clinic have access to basic care, medicine, and birth control, MSF cannot always address the multiple complications patients face, including malnutrition and anemia. Due to limited supply due to funding problems, only the most malnourished pregnant women are given ready-to-use therapeutic foods.
And some problems don’t even reach the front door of the Kahdistan Clinic. The clinic is unable to treat serious complications from abortion, which in most cases is illegal in Afghanistan and is often done without supervision. Marie Stopes International is the leading follow-up health care provider in Afghanistan, but Herat does not have a hospital or clinic that treats abortion complications.
Mothers in the Shahrak-e-Sabz camp have also seen outside support for maternal health care waning. Somaya, 24, a mother of four who moved from Badghis Province in 2018, gave birth to her youngest child at home in January as there were no maternity wards in the immediate vicinity of the camp.
“After the baby was born, [the MSF clinic] I vaccinated them and I am very grateful to them, ”said Somaya. “But the problem is, they only give basic medicine. If there are many problems, the clinic cannot provide the drugs or operations that we need. “
Zarmina, 25, has been living in the camp for two years and was driven from her home in Ghor Province by fighting between government forces and the Taliban. “We suffer from hunger in the camp. Some are starving. We are homeless, ”she said. “We suffer, but at least our life is safe here.” She gave birth to her third child at home in September because there was no vehicle to take her to the hospital in Herat.
Like Somaya, Zarmina said the MSF clinic has limited resources. “They just gave me some medicine to calm me down,” she said. “They didn’t have the medication I needed and I didn’t have the money to go to the hospital in town.”
Meanwhile, the conditions in the camp are deteriorating. More than 2,000 new families were added between April and June, and the pandemic has further affected the livelihoods of those who depend mainly on daily wages and humanitarian aid. Shahrak-e Sabz is state-owned land and the site has no legal recognition. Families are at risk of displacement. The Norwegian Refugee Council has reported that police have demolished houses, evicted families from the country and in some cases arrested residents.
With decreasing international support, Afghanistan is facing a humanitarian crisis. As the harsh winter sets in and more patients are brought to the MSF clinic, there will soon be more operational challenges. “The people in the camp rely on this clinic and clinics like ours cannot continue our work without foreign support,” said Mohammadi, the midwife. “When America leaves, insecurity will increase and women will be more desperate for support.”
While Afghans hold their breath at the outcome of the peace negotiations, the access of millions of vulnerable women to the most basic human services hangs in balance.
The midwives at the front
Despite increasing violence, some of Afghanistan’s key workers are fighting the stigma of providing medical care for the country’s mothers.