LONDON (Thomson Reuters Foundation) – Afghanistan risks losing even the basic health gains it has made over the past decade if it becomes a “forgotten crisis” when international troops leave the country at the end of the year, MSF’s Afghanistan chief said.
Basic healthcare has improved since the U.S.-led invasion in 2001, after large amounts of aid were poured into the country. Fewer children die of easily preventable diseases thanks to improved vaccinations, and women are now more likely to survive pregnancy and childbirth. The number of deaths in pregnancy and childbirth has fallen by nearly two thirds since 2000.
“A lot of improvements have been made, but they are very precarious,” Benoit De Gryse, head of medical charity Medecins Sans Frontieres in Afghanistan, told Thomson Reuters Foundation on a visit to London.
If donors cut funding after the troops leave, healthcare is likely to worsen quickly too, he said. About 90 percent of the government’s entire budget is funded by donors, so any cuts to that are likely to result in the government charging patients, closing district clinics and losing staff to a private sector which is completely unregulated, he said.
“The worst-case scenario is that everything that was built gets lost,” he said. That would mean fewer vaccinations, more outbreaks of measles and polio, and a return to the very high levels of maternal deaths of the early 2000s.
“I think that donors have to be aware that this is possible ... The country cannot sustain itself.”
The best-case scenario is that the funding remains stable, and there is more oversight of the way money is spent, De Gryse added. Many rural areas are inaccessible to the government and donors, and many NGOs that implement government health programmes are not fully monitored - they submit their own data to the ministry of health.
INCREASED DANGER FOR PATIENTS
The conflict itself has spread and worsened in recent years, and has become more dangerous for civilians. The number of civilians killed and injured has soared 24 percent so far this year, compared with the first half of 2013, according to U.N. figures.
Many people face a dangerous journey to hospital. An MSF report earlier this year found that 40 percent of those who reached an MSF hospital had faced fighting, landmines, checkpoints or harassment on their journey.
Many do not make it at all because of the dangers involved or the cost of transport. “One in every five of the patients we interviewed had a family member or close friend who had died within the last year due to a lack of access to medical care,” Christopher Stokes, MSF’s general director, was quoted as saying in the report.
Health services themselves are not immune from pressure. They are looted by both opposition and government forces, and illegally taxed.
But patients could face greater dangers once international troops leave, De Gryse said. Local opposition and government forces have less respect for health facilities, and less understanding of humanitarian law which protects the rights of all people to receive healthcare, irrespective of which side they are on.
But there’s a twist in the tale. Having fewer international forces around will probably be a relief for MSF staff, De Gryse said.
Aid agencies in Afghanistan have struggled for years to be seen as neutral, because international troops have also been involved in distributing aid in a bid to win local hearts and minds.
“It’s probably going to be easier for us and safer” when the foreign troops have left, De Gryse said.
(Editing by Tim Pearce; firstname.lastname@example.org)