Intercross will regularly commission reporting by seasoned independent journalists on issues and contexts of ICRC concern. Our first Dispatch is by Monica Campbell, a San Francisco-based freelancer. This article is the first in a series by Ms. Campbell, who reports from Southern Afghanistan.
It was time to go. The girl’s cough worsened and red blotches now covered her face. The village shaman’s herbal potions didn’t work and neither did the non-prescribed pills and injections. What had seemed curable, suddenly looked dire.
As a last resort, the mother took her ailing six-year-old daughter, grasped one of her young sons for support, and crammed into a minibus. She handed the driver a month’s earnings for the trek from her mud-walled compound to Lashkar Gah, the capital of Afghanistan’s southern Helmand Province. A high cost that buys you a 50-mile trek though rutted desert roads—and one of the country’s biggest battlefields. Only days earlier, a roadside bomb killed five Afghans in a similar bus.
Seven hours later, the family reached Boost Hospital, one of only a few Afghan government-run facilities in the country’s violent south. They were escorted to a basketball court-sized waiting area filled with other, newly arrived families on rows of wooden benches. The girl’s brother, less then 10 years old, vigilantly clutched a piece of wood marked with the number 53, his sister’s place in line. He, too, would see a doctor, a passing nurse ordered. The boy's speckled grey hair suggested malnutrition.
“We spent everything to get here,” the mother said, lifting her blue burqa over her head. “But we’ve made it.”
In Afghanistan, in its tenth year of war, stories like this are now common as Afghans, particularly those in the volatile south, live in the firing line and are unable to seek medical attention near home. With few options, they make desperate sprints through a murky conflict zone, which pits armed groups, who have resorted to roadside bombs and suicide attacks to battle foreign troops and the Afghan government. The mixture also includes a weak government and military operations by coalition forces.
It all leaves more than half of Afghanistan’s population isolated, afraid and cut off to health care, aid groups said.
Further, away from provincial capitals, in isolated rural areas, small community health clinics are often left without supplies and staffless, as doctors and nurses avoid war zones--and the risk of being trapped between warring sides, tagged as strategic targets. Coalition forces have raided doctor’s office looking for armed opposition commanders, while insurgents have attacked clinics they suspect of affiliating with U.S. forces.
In one example, in a district of Helmand Province, only one small, privately-owned health clinic existed for some 300 families living in surrounding desert settlements. The clinic was ill-equipped, with faulty power and scant medicine. In an interview there, the clinic’s sole doctor alleged that he had been threatened for negotiating with Coalition forces to get medical supplies. Families, he said, were warned away from the clinic. “Nobody comes here,” the doctor said, who requested anonymity for his safety.
The untenable state also means relief workers can no longer rely on their neutral status—their main calling card to cross war zones—to establish outposts in remote areas. In 2003, Ricardo Munguía, an International Committee of the Red Cross (ICRC) water engineer, was killed by gunmen in Afghanistan’s south-central Oruzgan Province. Although the killing did not stop ICRC operations, it did force the organization to curtail its presence in the field in the country’s south, a presence that took several years to regain. Other humanitarian organizations in Afghanistan, from Italy’s Emergency and the Swedish Committee to Doctors Without Borders, which saw five of its staff members ambushed and murdered in 2004, have also severely limited their physical movement in Afghanistan.
"Frontlines are blurred," said Reto Stocker, who directs the ICRC in Afghanistan. “Anyone can be a target. Anyone can get hit.”
In Afghanistan's violent south, the reality leaves families trekking to one of two full-service, government-run hospitals: Boost Hospital in Helmand Province and Mirwais Hospital in neighboring Kandahar. They are now “front line” war hospitals for an area of four million-plus people.
The range of conditions afflicting the Afghans who reach the hospitals is enormous. “We read headlines about civilian casualties, but that’s just the tip of what we see here,” said Stefano Argenziano, who coordinates the Doctors Without Borders team that supports and trains the Afghan staff at Boost Hospital. “The range of needs we treat here beyond those wounded by bullets and landmines is staggering.”
Indeed, the vast majority of the patients are Afghans suffering the full spectrum of disease and afflictions common in a country with rock-bottom health indicators. It’s all here: measles, polio, meningitis. Some of the world’s worst infant and maternal mortality rates.
In turn, aid groups at the hospitals have piled on beds, and equipped new operating rooms and pediatric wards. Training programs for local surgeons and nurses have expanded.
The crisis is clear at Mirwais Hospital, the largest public health facility in southern Afghanistan and perhaps the busiest in the country. The avocado green, sun-scorched Chinese-built structure houses over 420 beds, is typically beyond capacity, and is heavily supported by the ICRC. Last year, more than 3,500 people wounded by weapons or through direct contact with the war arrived to the hospital, a number set to double this year.
Inside, the realities of life in an Afghan war zone are on view. In the women’s ward, a woman's back was crushed, when a wall crashed on her during a bombing, she said. In the bed next to her, a young mother was left immobilized by two gunshots to her abdomen. Before the shooting, she said she had been threatened and ordered to stop cleaning the house of the government official she worked for. “I kept working,” she said. “I must support my children.”
In another room, Hatima, a 40-year-old woman who only gave her first name, winced as she adjusted herself in her hospital bed. She recently lost her right leg after an untreated diabetic wound led to amputation. Lilian Seitz, an ICRC nurse from Switzerland, asked Hatima questions through an interpreter. Did she realize that remaining still could generate bedsores? Sites motioned over to Hatima’s daughters so that they could see how to shift her mother within the bed.
When asked why she didn't see out treatment earlier, Hatima said, “There are no doctors in our village. Only men with guns.”
Later that afternoon, Seitz, the nurse, took a break in the hospital's courtyard area. For a few moments, it seemed calm in contrast to what goes on inside. Turbaned men sat cross-legged under fruit trees until they could visit relatives. Women in blue and pastel green burqas grouped together, while bored children grabbed at tufts of grass. A young man in a wheelchair recuperating from a gunshot took in sun and escaped the hospital smell.
“I think about what happens to the patients once they leave the hospital," Seitz said. "I wonder if they’ll seek out some strange remedy instead of getting the care they need. Sometimes they arrive here with all sorts of strange pills in their pockets. The more the better, they say. I wonder, who gives them these pills? But we can’t worry about that. Not now. We can just do what we can.”
The serenity ended when a three-seater rickshaw taxi decorated with fringe and flashing mirrors, careened into the hospital's entrance to deliver a man with a severely bleeding leg. In a country where ambulances are rare, it was a typical scene for a hospital.
Back inside, the children’s intensive ward bustled. Nurses watched over underweight newborns and trembling children. A young girl with meningitis strained to breathe. Like many cases here, she arrived here only after a series of alternative paths, including a series of healing prayers at a village Islamic shrine and a mullah’s promise that the felt amulet tucked with a Koranic verse boding good health, now pinned to the girl’s hospital gown, would bring down her fever. It didn’t. At last, the family hired a taxi for 3,000 Afghanis, about $65 and a fortune for the family that survives off making small piles of bricks.
The next worry would be to find the money for return trips for further treatment. For now, though, the girl was stable and not everything seemed hopeless. “God will find a way for her to heal,” the mother said, smoothing the girl’s black hair, tufted from sweat.
Looking on was Mohammad Sadid, a neatly bearded 55-year-old pediatrician from Kandahar who oversaw the children’s intensive care unit. It’s the only public-run facility of its kind in one of Afghanistan’s toughest areas. More than one child shared many of the unit’s 80 beds. Nobody would be turned away and Sadid vowed to make sure of that.
Still, it is the unseen that haunts Sadid. “I can tell you the number of patients filling our beds today,” he said. “But how can we count those who didn’t make it here in time?”
Monica Campbell was commissioned by Intercross to report from Afghanistan. Her work has appeared in The Christian Science Monitor, The Chronicle of Higher Education, Boston Globe, The San Francisco Chronicle, Public Radio International's The World and Newsweek. From 2009 to 2010, she was a Nieman Fellow at Harvard University.