Earlier in 2021, our Director Prof. Karl Blanchet visited Afghanistan several times to initiate with national partners two research projects related to the Researching Impact of Attacks on Health (RIAH), and a situation analysis on diabetes and hypertension care management. In this blog, Prof. Blanchet expresses his deep concerns about the critical situation in the country and commends the dedication and bravery of health care workers and professionals who keep on doing their jobs knowing that their lives may be at risk.
The month of August 2021. We are watching in front of our eyes the provincial capitals in Afghanistan including Kunduz, Herat, Ghazni, Kandahar, and now Kabul falling one by one to the power of the Taliban. Every new conquest by the Taliban is followed by the destruction of public buildings, fires and deterioration of roads. Female officials and journalists are hunted and threatened with death.
Afghanistan has experienced for the last twenty years continuous conflict and violence. It is estimated that between 2001 and 2019, around 150,000 people died directly from the conflict, a third of them being civilians (1). However, a particularly sharp rise in casualties occurred in May this year when American military troops began withdrawing from Afghanistan and fighting intensified following the Taliban offensive to take territory from Government forces. In the first half of 2021, more women and children were killed and wounded in Afghanistan than in the first six months of any year since records began in 2009. From January to June 2021, the United Nations Assistance Mission in Afghanistan (UNAMA) reported 1,659 civilians killed and 3,254 wounded, a 47 per cent increase compared with the same period in 2020 (2).
In 2020 and 2021, Afghanistan was extensively affected by the COVID-19 pandemic (3). The massive displacement of populations created by the war will make it significantly more challenging to contain the transmission of the virus. During this time, there were a number of bombings in Afghanistan, further hampering the containment of COVID-19 (4). Conflict in the southern part of the country has displaced around 10,000 people so far this year. The Humanitarian Access Group reports that a total of 227 incidents impeding access of humanitarians have occurred as well .
Amid this violence, healthcare workers continue to go to work. Officials at the Ministry of Public Health (MoPH) continue to work on the new Integrated Package of Essential Services (IPEHS) we have co-developed during the last three years(5), a set of essential health services that can improve public health and that will guide every health facility and health professional in the country. We finalised the list of interventions in July 2021 following recent rounds of national consultation in Kabul – the latest one happened in May 2021. They are now working on the costing of this new package, and almost every day, the MoPH team meets online with our academic team to discuss technical aspects of the costing.
The dedication and bravery of all these health professionals are admirable. All these individuals continue to work and build the future of the Afghanistan health system, knowing that their own lives and the lives of their families are at risk. But instead of hiding or fleeing the country, they dedicate their time to continue building the future health system. The Taliban are not really mentioned in our discussions, but, of course, they are the implicit variable that will affect all the progress achieved during the last ten years (6): Afghanistan had achieved so much significant progress towards the sustainable development goals: For example, the under-5 mortality rate dropped from 60 per cent from 137 to 55 per 1,000 live births between 2002 and 2016. Births attended by skilled health personnel increased to 58 per cent from 14.3 per cent over the same period (7).
We sincerely hope that all the collective efforts invested by the former Minister of Health, Dr Feroz, and the new acting Minister, Dr Majrooh and his team at MoPH, the provincial authorities, the healthcare providers, the international donors, the non-governmental organisations (NGOs) in charge of service delivery and the international NGOs will not be lost in the next few months. I am deeply concerned that the primary victims of these exactions will be, once more, the Afghan population, who will be the direct victims of the armed conflict and will further suffer by not having access to healthcare. The cycle of violence experienced by people and healthcare workers will profoundly affect their mental health. I am sure that the public health community in Afghanistan and elsewhere will continue to support the Afghanistan health system even if we are entering a long phase of uncertainty.
1. Watson Institute. Human Cost of Post-9/11 Wars, A Costs of War Research Series. 2019.
2. United Nations Assistance Mission in Afghanistan (UNAMA). Annual Reports on the Protection of Civilians in Armed Conflict, . Kabul, Afghanistan; 2019.
3. Cousins S. Afghanistan braced for second wave of COVID-19. The Lancet. 2020;396(10264):1716-7.
4. Devi S. Access to health care under threat in Afghanistan. The Lancet. 2020;395(10242):1962.
5. Blanchet K, Ferozuddin F, Naeem AJJ, Farewar F, Saeedzai SA, Simmonds S. Priority setting in a context of insecurity, epidemiological transition and low financial risk protection, Afghanistan. Bull World Health Organ. 2019;97(5):374-6.
6. Mirzazada S, Padhani ZA, Jabeen S, Fatima M, Rizvi A, Ansari U, et al. Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan. Conflict and health. 2020;14(1):38.
7. Strong Progress but Challenges Remain in Health Sector in Afghanistan [press release]. 2017.