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Afghanistan: “As midwives, we are the silent leaders of our country”

18 Jun 20 | 23 Oct 20

Afghanistan: “As midwives, we are the silent leaders of our country”

Giving birth in DeB Caption
MSF patient Zakia, with newborn twins Qassim and Abbas, talks to an MSF midwife at Dasht-e-Barchi hospital
Zahra Koochizad

Zahra Koochizad

Midwife supervisor

On 12 May, the MSF maternity ward at Dasht-e-Barchi hospital in Kabul was the target of a brutal attack that left 24 people dead – including mothers, children and one of our midwives. Zahra Koochizad, an MSF midwife supervisor who was working at the hospital on that tragic day, shares her story in the echoes of the attack.

“As midwives in Afghanistan, we bring new life into this country under conditions more difficult than in most.

Approximately 130 million babies are born worldwide every year, and there are millions of women needing assistance to go through their pregnancy and labour. Giving birth, in my opinion, is one of the most glorious and most critical moments in a woman’s life.  

Maternal mortality

My passion to see new life coming into the world and my strong desire to serve my own people made me choose to become a midwife.

It also comes from my family’s involvement in this vocation. Some of my aunts and cousins also work as midwives in different hospitals in Kabul. They also chose this profession because of their desire to serve, and because they learned that, in Afghanistan, most women who die in childbirth, die from preventable complications.

Despite some improvements over the past years, Afghanistan has one of the highest maternal and newborn mortality rates in the world, and the need for specialised care is vital. 

In Switzerland, five mothers will die per 100,000 live births. In Afghanistan, this number jumps to 638 who will die…

This does not include the 16 mothers and five unborn babies who were systematically shot dead in the maternity ward where I work a month ago.

That day at Dasht-e-Barchi

One of the biggest challenges that every midwife and pregnant woman in Afghanistan faces is insecurity. I’ve painfully experienced this first-hand.

out-patient department in Batil refugee camp

Help us prepare for the next emergency

In Afghanistan, a maternity ward is one of the few spaces where women are the leaders

Zahra Koochizad
|
MSF midwife supervisor

I’m the midwife supervisor in the MSF-run maternity wing of Dasht-e-Barchi hospital in Kabul. The attack there occurred on 12 May.

Revolting attack on pregnant women and babies Caption
Visible damage sustained to the main building at Dasht-e-Barchi

I remember that day; we had very nice weather, the air was fresh, and I felt a sense of peace when entering the hospital.  Once I arrived, I saw my colleagues working; they all looked motivated and eager to start a new day of providing services to pregnant women in need.

On a daily basis, we are used to tragedy in our communities but nothing could have prepared us for the horror to come.

In Afghanistan, a maternity ward is one of the few spaces where women are the leaders. However, the terrorists entered an area where no men are ever allowed to go. They stormed the maternity wing armed with guns, killing pregnant women, new mothers and newborns. Their leader must be very proud; celebrating a victory over an army of one-day-old babies and women wearing only their hospital robes.

Remembering Maryam

A hospital is supposed to be a protected space. It says this under international humanitarian law and yet the assault on my maternity wing is not an exceptional case – attacks on healthcare happen frequently here. But what is different about this attack than all the others?

I am scared to think about what will happen to those women who would have otherwise come to us

Zahra Koochizad
|
MSF midwife supervisor

Because, as midwives in Afghanistan, we are the silent leaders of our country.  We are at the bedside of pregnant women giving birth to the country’s future and we need to be protected.

To safeguard a maternity wing like mine is to safeguard our future, along with the midwives working there. Midwives like our beloved Maryam, who was killed in the most incomprehensible way as she assisted soon-to-be mothers giving birth.

Uncertain survival

On the day of the four-hour assault on Dasht-e-Barchi maternity wing, the terrorists not only attacked pregnant women and newborns, but also the decades of work involved to reduce maternal and newborn mortality in Afghanistan.

Giving birth in DeB Caption
The postpartum recovery room at Dasht-e-Barchi, before the attack

Because of this attack, the western area of Kabul, with more than one million inhabitants, and women coming from far-away provinces, no longer have access to any comprehensive obstetric and newborn care.

Their only option now is a 50-bed hospital close by. But with only seven beds devoted to maternity services, I do not know if the pregnant women who go there, or to other hospitals, are being cared for as they need.

Will they receive the help they need? Will they have the means to pay for hospital services? Will they survive their labour if they are not admitted to any hospital?

I am scared to think about what will happen to those women who would have otherwise come to us.

Complications and COVID-19

Each month, the MSF-run maternity wing provided quality services to more than 1,200 mothers who delivered their babies there.

I know that if the women in the Dasht-e-Barchi area need childbirth assistance they will now go to the 50-bed hospital. But, if they have any complications, they will not be admitted there. There is no operating theatre for emergency cases, for example.

And, with the COVID-19 pandemic, the options for women who have complications or special needs are even fewer, and farther away, than before.

Caring for the community

Most patients that come to Dasht-e-Barchi belong to the Hazara community – a marginalised Persian-speaking minority – and don’t have the means to pay for their treatment in other places. Some of the women arrive at the hospital in terrible conditions. 

I am hurt, my life has changed, but I am still committed to continue my work

Zahra Koochizad
|
MSF midwife supervisor

I can recall one patient in particular.  She came to us for the first time, but she could hardly walk and looked very pale.  She came from an area that’s on the outskirts of Kabul. I examined her and realised she had severe anaemia, however there was no antenatal care available where she lived. 

Due to the lack of means to buy food, she was not eating properly, and when I asked her when she had last eaten, her answer was “yesterday”. My heart broke when upon hearing that, but I was so happy to see her recover and give birth to a healthy baby.

Giving birth in DeB Caption
New mother Hosnia (here with her family) gave birth to baby Ilina at Dasht-e-Barchi in late 2019

Her story is just one of the thousands that describes the reality of life for patients in the Dasht-e-Barchi area; some of whom would come to the hospital and not have money to get back home. 

All of our patients and the wider community were very happy to count on our maternity wing that provided services for free, especially since government hospitals charge some amount of money.

I am saddened to see how poverty, lack of a good health system, lack of resources, insecurity and the COVID-19 pandemic are limiting possibilities for people to receive proper healthcare. Healthcare centres in Kabul are already operating at reduced capacity because of some of their staff are infected with COVID-19.

The need has never been greater

I am hurt, my life has changed, but I am still committed to continue my work.

I know my people need us and expect me to get back on my feet again with the support of MSF. I cannot forget all those patients who need a helping hand and a good level of care. 

I also want to honour all of those patients who have become our friends and have been praying for me. I do not want to disappoint them, especially now, when many are also suffering because of COVID-19.

I see our people suffering from greater obstacles, in a situation which is already critical – and the need for healthcare services has never been greater.”

On 15 June 2020, MSF sadly announced that we will be withdrawing from Dasht-e-Barchi in Kabul due to ongoing insecurity and the risk of further targeted violence towards our patients and staff