The violence in Afghanistan has surged since May with fighting around and inside provincial capitals between the Afghan forces and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban). This is impeding access to medical care, increasing the number of people killed and wounded by bullets and explosions, and causing widespread displacement.

In three areas where we work, Lashkar Gah (Helmand province) and Kandahar both in the south, and Kunduz in the north, these consequences have been felt acutely. But fighting is ongoing around the city of Herat, too, where there is also an MSF project. 

“The situation in the country has deteriorated to a point that in some cities, like Lashkar Gah and Kunduz, the medical facilities are on the frontlines,” says Laura Bourjolly, MSF Afghanistan humanitarian affairs manager. “We continue to treat patients in all of our projects, under dire circumstances, and we have adapted our medical activities to respond to the acute needs.”

In Lashkar Gah, where we support Boost hospital, intense fighting has been taking place within the city for over a week now, life is at a standstill and healthcare staff are treating medical, obstetric and surgical emergencies. The team is staying in the hospital to treat patients, while shelling, mortar and rocket attacks, and airstrikes are taking place extremely close by. On 9 August a rocket exploded in the compound, very close to the emergency room, but fortunately there were no casualties. 

The sounds of war make it very difficult to sleep yet the staff have kept all departments of the hospital open to-date. Last week our teams in Boost treated many war-wounded patients and performed 20 surgeries in just one day. Many people have now fled the city and in the past few days we’ve seen a significant reduction in the number of patients coming to the hospital for care.

Fighting also surged recently in and around Kunduz, and at the end of last week the city fell to the IEA. When the violence intensified in July, the MSF office space was transformed into a 25-bed trauma unit with the team providing care to people injured by explosions, bullets, and shrapnel. Between 1-9 August, 127 patients were treated for bullet and blast injuries, including 27 children aged under 16. 

We continue to provide care in the trauma unit but our teams have started to transfer outpatient services to the new Kunduz Trauma Centre (KTC), which has been under construction since 2018. We are also continuing to support the district advanced post in Chahar Dara, a stabilisation unit in a district outside Kunduz city, which saw 126 war-wounded patients between 1-8 August.   

In a country with a poorly functioning health system, violence is severely exacerbating people’s access to care. In areas with heavy fighting it is too dangerous for people to leave their homes for medical treatment, or they delay until they are very sick. We have seen that the number of patients in our emergency rooms, COVID-19 treatment centre, or outpatient clinics has decreased as the violence increases. 

In Kandahar, where we run a project for patients with drug-resistant tuberculosis (DR-TB), people are being provided with remote consultations and buffer stocks of medication to avoid having to cross frontlines. And in Lashkar Gah a couple of days ago, the number of pregnant women seeking care increased when the situation was calmer. Medical emergencies, births and chronic conditions do not stop during times of war.  

“We only had one pregnant woman in the hospital,” says Sarah Leahy, MSF Helmand project coordinator, “but the next day, after the fighting died down for a bit, 10 pregnant women managed to reach us, so we know the needs are out there. We’re really worried that women are having to give birth at home with no medical help available if they have complications,” she says.

The clashes between the warring parties have also forced hundreds of thousands of people from their homes. Some have sought safety in urban areas and are living in informal settlements with little access to basics such as food, shelter and medical care. 

In July in Kunduz, we opened a small clinic providing outpatient consultations for displaced women and children in Sar Dawra, and began providing safe drinking water to internally displaced people. The clinic treated around 300 patients a day and in early August we handed over the activities to another organisation to allow teams to focus on trauma care.

In Kandahar city, our teams have set up a temporary clinic providing medical care to children under five in Haji camp, an informal settlement where 5,000 displaced people are currently living. We have also been rehabilitating water points and ensuring access to toilets and showers. As of last week, since 28 July over 170 children had been treated, the majority for respiratory illnesses, diarrhoea and anaemia. 

The conflict remains very dynamic with violence flaring in different areas of the country, and we are adapting our projects as much as possible to address the changing needs. But medical staff around Afghanistan are faced with fighting taking place in the streets around medical facilities, and with little rest or respite; constantly worried about the families they have left at home. As fighting enters cities, hospitals continue to function but the threat of being in the wrong place is ever-present, as we saw yesterday in Lashkar Gah. All working medical facilities must be respected.