Fighting in Afghanistan has been intense since May, but in recent weeks the clashes between the Afghan army and the Islamic Emirates of Afghanistan (also known as the Taliban) have increased in intensity and have moved into more urban areas such as Lashkar Gah city in Helmand Province. 

“There has been relentless gunfire, air strikes and mortars in densely populated areas. Houses are being bombed, and many people are suffering severe injuries,” says Sarah Leahy, coordinator of the MSF Helmand project.

“Fighting within the city makes it harder for us to respond; our staff are part of the community and they, like many people, are afraid to leave their homes. It’s just far too dangerous and life is at a standstill,” says Leahy.

“Some of our colleagues are staying overnight in the hospital so they can keep on treating patients. The situation has been dire for months but now it is even worse.”

Despite the challenges, the MSF-supported Boost hospital remains operational and has seen a marked increase in trauma needs over the past week. 

“In just one day we performed 10 surgeries on people injured by violence, which is unheard of for us as we are not Lashkar Gah’s main provider of trauma care,” says Leahy. “Before last week we were operating on average on two war-wounded people per day.”
 
The main trauma centre in the city is run by another organisation, and is also under immense pressure; the people they cannot admit are sent to MSF for care.  

Between 29 and 31 July alone, MSF treated 70 war-wounded patients. In total from 3 May until 31 July, we have treated 482 war-wounded people, nearly all (92 per cent) for injuries caused by shells and bullets, and around a quarter (26 per cent) aged under 18. The patients seen by MSF are just a fraction of the total number injured by the violence. 

The fighting exacerbates health needs beyond trauma care. Given the lack of well-functioning and affordable medical facilities in Helmand, people rely on the 300-bed Boost hospital, the only referral hospital in the province, for essential neonatal, paediatric, inpatient, intensive care, maternity, malnutrition, and surgical services among others.

Since May, however, MSF staff have witnessed an alarming increase in the severity of patients’ illnesses when they arrive at the hospital. People have described how, despite needing medical care, they have been forced to wait at home until the fighting subsides or to take dangerous alternate routes. With fighting taking place not far from Boost hospital, and people too afraid to leave their homes due to the violence, access to healthcare is dangerously limited.

“We have had patients who were caught in crossfire. On top of something like severe diarrhoea, they have also arrived with a bullet in their shoulder or their leg,” says an MSF doctor working in the emergency room and intensive care unit at Boost hospital.

“The conflict leads people to think 10 times about whether they really want to make the journey. They delay until they can’t wait anymore, when their relatives haven’t opened their eyes for two or three days, have shallow breathing and are unresponsive. From a medical perspective, that’s almost too late.”

When people do make it to care, that is just the first step. The effects of the conflict have long-term consequences.

“All my family depend on me, but I feel like in the future I won’t be able to work because of my injuries. It’ll be very hard for me to feed my family. I’ve left my home and I cannot go back there,” says an MSF patient with bullets wounds to both his arms.

Even amongst MSF staff, the impact of the fighting is clearly visible. “Healthcare staff are exhausted. The work itself, seeing all these patients, is hugely difficult. And then on top of that, people have to deal a lot with outside pressures and worries,”  says an MSF doctor.

Our teams continue to provide much-needed healthcare in Boost hospital, while continuing to run projects in four other locations around the country; Herat, Kandahar, Khost and Kunduz.