KABUL, Afghanistan (AP) — Gaping holes in Afghanistan's health care system are being obscured by misleading narratives of success ahead of the international troop withdrawal in 2014, aid organization Medecins Sans Frontieres warns in a new report published Tuesday.
MSF — or Doctors Without Borders — said that while some progress has been made from the last decade of international investment, access to medical care in Afghanistan remains severely limited and poorly adapted to meet the needs of an ongoing conflict — partly because decisions about humanitarian aid have been influenced by political and military objectives instead of Afghans' pressing needs.
"As troops pack their bags, MSF sees a war that still rages in many parts of the country and a failure to meet people's increasing medical and humanitarian needs," the group said. "International donors, aid providers and Afghan authorities must urgently address serious shortcomings in health care provision."
Efforts to shape and define a legacy of international intervention in Afghanistan have contributed to overly rosy assessments of progress, emphasizing achievements while neglecting unmet humanitarian needs, according to the aid organization's report, which was provided to The Associated Press ahead of its public release.
"It is striking how far the accounts of ordinary Afghans differ from prevailing narratives of progress," the report said. "Any desire to package Afghanistan into a simplified political or military success story risks masking the reality of the ongoing conflict and the suffering of hundreds of thousands of people who do not have access to adequate medical assistance."
MSF was careful to note that more than ten years of investment in Afghanistan have produced some signs of progress. But international donors are cutting aid as casualty rates from violence are climbing, and maternal and infant mortality rates remain among the highest in the world. Civilian casualties in 2013 rose by 14 percent, according to a recent U.N. report.
Christopher Stokes, MSF's general director, said his group wants to "provide a reality check."
"With the conflict spreading to once-stable areas of the country and indications that the war will only intensify in many places, the humanitarian situation in Afghanistan cannot be overlooked."
With interest in Afghanistan expected to wane after troops withdraw, MSF said it is critical that steps are taken to produce tangible results for Afghans before the world's attention turns away.
"Now is the time to face up to the reality of their situation in order to save lives and alleviate their suffering."
Reliable statistics in Afghanistan are hard to come by, in large part due to insecurity gripping many parts of the country.
In an attempt to reconcile the rhetoric and real-life treatment picture for Afghans, MSF surveyed more than 800 patients and their caretakers over a six-month period at the four hospitals where it does work in Afghanistan.
The findings — outlined in the report given to the AP — showed that the majority of people surveyed reported struggles to access medical care, with nearly 20 percent saying a family member or close friend had died in the preceding year due to lack of access.
Nearly half of those surveyed — 49 percent — said the biggest obstacle was related to armed conflict, with high costs and proximity to trustworthy health facilities also posing great challenges.
Patients spoke of clinics without medicine or electricity and selling personal objects to pay for treatments. Others, according to MSF, spoke of watching over sick or injured relatives throughout the night, hoping they would survive until morning when it might be safer to seek treatment.
Reaching a hospital can mean taking treacherous roads, confronting land mines, dangerous checkpoints, harassment and crossfire — 40 percent of those surveyed by MSF who had reached hospitals had encountered such obstacles. But the battle is only half over for those who reach medical facilities. According to the report, many clinics also lack proper equipment or enough women on staff to tend to female patients.
At the Ahmad Shah Baba Hospital in eastern Kabul, visited by the AP on a recent afternoon, 35-year-old Hatima sat in the emergency room and tended to her wheezing and feverish 3-year-old niece.
Hatima — who like many Afghans goes by one name — said the family had initially paid for a visit to a private clinic for Basmina, who'd been diagnosed with pneumonia. When the clinic could only offer paracetamol, the family paid for a taxi from outside the capital into Kabul city to the hospital, where MSF works and offers its services free of charge.
Perched on a bed as her son slept with an oxygen tube, Nari — who did not know her age — recounted walking for over an hour and then having to find public transport to bring little Bahar Gul back to the hospital after he developed a troubling cough.
Doctors said they had found pneumonia, sepsis and signs of a possible congenital heart defect in her two month old baby.
"There is no other clinic — we live in an area like the desert," she said. "We don't have money, we don't have a car... we can become hopeless."
Benoit de Gryse, MSF's country director for Afghanistan, said that there are some health care facilities that may exist on paper but are hardly operational in practice, such as with unopened or missing equipment.
Those issues were highlighted in a recent report from The Office of the Special Inspector General for Afghanistan Reconstruction on the $600,000 Salang hospital — which lacked clean water, electricity, furniture and equipment.
MSF said attacks on medical vehicles and personnel also present challenges. With an Afghan election slated for April 5 — and the Taliban threatening to disrupt the poll — MSF said that the government's move to designate a number of health facilities as polling stations puts those facilities at greater risk of attack, hurts the perception of health centers as neutral environments and endangers the lives of health workers and patients.
De Gryse said that the overall picture of medical access could be even worse: insecurity means his organization could only speak to patients already inside their four hospitals, limiting the scope of their survey.
"We actually are concerned that a lot of people have not reached our facilities," said de Gryse. "If this is the reality for people that reach our hospital, what about those that didn't?"
Last month, Congress cut the U.S. budget for aid to Afghanistan in half to $1.12 billion for the fiscal year 2014. Moves like that are worrying to aid organizations and De Gryse.
He said donors "need to be confronted" about the consequences of shifting focus away from Afghanistan.
"People are still dying for silly reasons," he said. "There's a worry that the gains that have been made will now be lost because of the lack of interest."
When asked about the MSF report, the U.S. Agency for International Development noted that Afghanistan has made "dramatic" health progress in the last decade, including a 20-year increase in life expectancy.
"USAID is committed to working with our partners and with the people and government of Afghanistan to help ensure the gains are not lost," it said in a statement.
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