Afghanistan: Nine months of conflict, crisis and hope in Herat
When Mamman Mustapha joined the Médecins Sans Frontières / Doctors Without Borders (MSF) team in Afghanistan, it was for a short assignment in a ‘relatively quiet' part of the country.
Nine months later he had witnessed an escalating conflict, a change in government and a growing humanitarian crisis.
I arrived in Herat, in western Afghanistan, on 31 December 2020, a little over a year ago.
My assignment was meant to be short – just three months initially. I was there to work as the project coordinator, responsible for coordinating our medical operations, negotiations with authorities, and security management of the team.
MSF has been working in Herat since 2018. We run a 74-bed therapeutic feeding centre for malnourished children in the regional hospital.
On the outskirts of a camp for internally displaced people, we run a clinic that offers general medical consultations, including for non-communicable diseases, ante and post-natal care, childhood vaccinations and malnutrition screening and treatment.
"[We were] providing life-saving assistance to the sick and wounded even during the height of the conflict. It still makes me incredibly happy that we were able to do this."
We also support the COVID-19 pandemic response by triaging suspected cases at the regional hospital and running a COVID-19 treatment centre.
In those early months of 2021, the armed conflict was ongoing in Afghanistan, but Herat was relatively safe compared to other provinces in the country.
I soon decided to extend my assignment by another six months: I wanted to better understand the environment and the health needs of communities here.
However, from 1 May, almost everything began to change. By July, the conflict had reached several major cities.
Negotiation was my daily job, and we regularly explained to all the parties in the conflict that we are here to provide emergency medical services, we are neutral to the conflict, and we are independent in the cause of our actions, we treat patients irrespective of their religion, gender or political affiliation, based on their medical needs alone.
Throughout the fighting, our staff were able to keep coming to work and our doors stayed open, providing life-saving assistance to the sick and wounded even during the height of the conflict.
It still makes me incredibly happy that we were able to do this.
By mid-August, the fighting was over and Afghanistan had a new government.
The safety and security of my team, patients and caretakers remained my number one priority, and I had to rapidly establish new contacts with the government (starting every relationship from scratch).
It was challenging but fruitful.
I met the new health representative the morning following the take-over. This was my first meeting with the new government and it gave my team the courage to continue our work without hindrance.
But, even though the fighting had ended, there were still huge challenges.
Airports and banks were closed, and throughout August and September, many other medical organisations were scaling down their work as funding was suspended by the EU, World Bank and others. The assets of the Afghan Central Bank were frozen by the US Federal Reserve.
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Lack of supplies and equipment
As a result, the healthcare system almost collapsed.
For a time in the hospital where we work, non-MSF staff weren’t paid their salaries and many left their jobs because they needed to earn money. Staff in Herat Regional Hospital are now receiving salaries again, but in some health facilities across the country there are not enough medical supplies or functional equipment.
But, of course, people still need healthcare.
As an organisation funded directly by private donations, we didn’t face the same funding challenges. So, we were able to keep working, though under increased pressure. The medical and non-medical needs in Herat are enormous, especially in the context of the current economic crisis.
There is no armed conflict in Herat, but people are still dying as many cannot afford to buy food. In September, October and November, the number of malnourished children arriving at our feeding centre was significantly higher than in the same months the previous year. This is an indicator of poverty, hunger and a general malnutrition crisis.
I finished my assignment in Afghanistan in October, saying goodbye to my Afghan colleagues whose dedication and zeal had encouraged me a lot throughout my time there, as well as putting smiles on our patients’ faces.
The work was challenging, incredibly intense and demanding, but seeing the results kept me positive. And the work is continuing.
In December, the team started paediatric services in Herat Regional Hospital, improving access to medical care for the sickest children in the district.
Herat is a fulfilling place to come and work and it is a place that most people would like. However, the humanitarian situation is complex and needs to be addressed without delay otherwise there will be a catastrophe.
The future of almost everything is uncertain, and our activities are still under pressure. The challenges we face will evolve and the security of our teams and patients remain a concern.
What is clear to me is that we are needed there, that our team is motivated and dedicated, and that we are doing our best as much as we can.
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Afghanistan's struggling healthcare system is now at a breaking point after years of instability, lack of funding and devastating conflict
We're running five projects, including hospitals, in some of the largest cities to provide both emergency and everyday medical care
We’re independently funded and free to act fast: when other organisations left or had funding cut after the Taliban takeover, we continued saving lives