Despite decades of international aid and investment, Afghans still struggle to access basic and emergency medical care due to insecurity, distance, cost and the fact that many health facilities lack the staff and equipment they need, said Médecins Sans Frontières (MSF) on the release of a new report, Reality Check: Afghanistan’s neglected healthcare crisis.

In-depth interviews with patients, their caretakers and MSF staff in Herat and Helmand provinces, Afghanistan, reveal that many Afghans face significant barriers getting medical care – a situation that has seen no improvement since MSF last released a report on it in 2014. Insecurity and widespread poverty continue to put healthcare out of reach for many people, and ensuring access to free, high quality healthcare is essential.

The effects of active fighting and indiscriminate violence permeate every aspect of daily life, and this includes seeking medical care. Many of our patients in Boost hospital in Lashkar Gah, Helmand province, have to weigh up various factors before embarking on a journey to or from the hospital, including whether the roads have been mined, whether there are checkpoints along the way and whether it is safe to travel in the dark or when fighting is ongoing.

“We are scared to leave at night, so we always have to wait until daytime to go to the hospital,” said a patient’s caretaker in the maternity ward of Boost hospital. “With everyone in our family, when they are sick, we wait, even if the person is dying.”

The medical staff working in health facilities managed and supported by MSF regularly see the impact these delays have on patients’ health – delays that can mean the difference between life and death. During the first six months of 2019, 44 per cent of the children who died within 24 hours of arriving at the paediatric intensive care unit in Boost hospital came too late and at a very advanced stage of illness.

Poverty also has a significant impact on people’s access to medical care. Up to 89 per cent of patients and caretakers surveyed in Herat Regional Hospital said that they had postponed seeking medical care due to financial pressures. One parent explained that they had waited eight days to bring their malnourished baby for treatment while they scraped together the money to hire a car, eventually borrowing the funds from friends and relatives. Another simply said: “We cannot buy food for tonight. How can we pay for medicines and doctors?”

People in Afghanistan are living with the impact decades of violence and insecurity have wrought. The interviews in Reality Check: Afghanistan’s neglected healthcare crisis clearly show the realities of trying to access medical care for many Afghans. They emphasise the discrepancy between the official narrative regarding the Afghan health system and its ability to cope with the needs of the population, and what our patients are experiencing in their daily life.

“Our patients tell us of long, dangerous journeys to bring malnourished babies, pregnant relatives, or injured loved-ones to hospital,” says Julien Raickman, MSF’s Country Representative in Afghanistan. “They describe clinics with insufficient drugs or qualified staff, and they have to contend with mounting debt to pay for treatment.”