{"id":8712,"date":"2017-11-10T14:00:32","date_gmt":"2017-11-10T12:00:32","guid":{"rendered":"https:\/\/openasia.org\/en\/?p=8712"},"modified":"2017-11-10T14:00:32","modified_gmt":"2017-11-10T12:00:32","slug":"afghan-healthcare-under-siege-as-escalating-conflict-cuts-off-access","status":"publish","type":"post","link":"https:\/\/openasia.org\/en\/2017\/11\/afghan-healthcare-under-siege-as-escalating-conflict-cuts-off-access\/","title":{"rendered":"Afghan healthcare under siege as escalating conflict cuts off access"},"content":{"rendered":"
\"\"Photo by Ashley Hamer|IRIN<\/a><\/h6>\n

IRIN<\/a>\u00a0– Ihsanullah, 17 months, suffers from a virulent, drug-resistant strain of tuberculosis, which has\u00a0alarmed his father and challenged the doctors.<\/p>\n

“There are injections and so many pills,\u201d said his father, Bismillah. \u201cThe baby sees everyday the doctors with a white coat coming to inject him, so he is afraid.”<\/p>\n

But despite the\u00a0daily\u00a0needles and pills, Ihsanullah is\u00a0fortunate: his father left his job as a soldier in the north of Afghanistan so he could bring Ihsanullah to receive\u00a0cutting-edge treatment at a specialised clinic\u00a0in the southern province of Kandahar\u00a0\u2013 the country’s\u00a0ethnic\u00a0Pashtun heartland and a former Taliban stronghold.<\/p>\n

Throughout Afghanistan, however, an increasingly violent struggle for control\u00a0is threatening access\u00a0to vital healthcare. Pressure from a web of armed groups, including a resurgent Taliban, has seen medical workers targeted and health clinics commandeered or shut.<\/p>\n

This has\u00a0obstructed\u00a0access to lifesaving care for hundreds of thousands of Afghans this year \u2013 and heightened the risk from deadly but treatable diseases like Ihsanullah\u2019s tuberculosis.<\/p>\n

New treatments, limited reach<\/h3>\n

For the past two months, Ihsanullah has been a patient with aid group M\u00e9decins Sans Fronti\u00e8res, which runs one of only two\u00a0facilities\u00a0in the entire country where his complex strain of drug-resistant TB can be treated.<\/p>\n

The baby’s case is particularly troubling because tuberculosis is airborne and spread in close quarters, yet none of Ihsanullah’s immediate family tested positive for the disease.\u00a0He has nine months of heavy daily medication ahead of him.<\/p>\n

The clinic in Kandahar was launched a year ago \u2013 the first of its kind for MSF in an active conflict setting.\u00a0There is limited clinic bed space and a small patient guesthouse,\u00a0both designed for long-term treatment. New technology allows health workers to speed up the cumbersome diagnosis process and fast-track treatment.<\/p>\n

A state-of-the-art molecular testing machine brought in by MSF can now identify specific strains of TB on the spot. Previously, smear samples had to be sent to the capital, Kabul, or even to Europe.<\/p>\n

Once diagnosed positive for\u00a0a drug-resistant strain, the patient begins a newly-introduced treatment programme that lasts only nine months \u2013 the usual treatment\u00a0for drug-resistant TB\u00a0takes two years and requires close medical monitoring throughout.<\/p>\n

\u201cIt is essential that people complete the standard TB treatment regime, because if they stop halfway or take the wrong drugs \u2013 which they do \u2013 they build up resistance,\u201d said Rod Miller, project coordinator for MSF in Kandahar.<\/p>\n

If left untreated, the drug-resistant TB is passed onto others; sufferers face a prolonged, excruciating death.<\/p>\n

Afghanistan, a nation of 34 million people beset by decades of conflict, counts at least 60,000 ordinary TB cases annually. The disease kills some 12,000 people each year.<\/p>\n

Globally, the TB epidemic killed 1.4 million people in 2015. Only two new anti-TB drugs have been developed in the last 50 years, which means the same medicines have been in circulation for decades. Naturally, bacteria evolve to resist them.<\/p>\n

MSF calculates there are at least 2,000 new cases of multi drug-resistant TB across Afghanistan every year \u2013 driven by inadequate or incomplete treatment, misdiagnoses and a flood of smuggled or substandard drugs.<\/p>\n

But reaching\u00a0Afghans\u00a0to diagnose and treat TB\u00a0is becoming\u00a0a colossal challenge.<\/p>\n

Access denied<\/h3>\n

Less than 60 percent of the country is under\u00a0government control<\/a>. Outside of urban centres, people live in remote communities where infrastructure is minimal and access is thwarted by a harsh landscape and armed conflict.<\/p>\n

\u201cWe do not leave the city. We can’t follow up with every patient and trace their families because of security,\u201d\u00a0Miller told IRIN. \u201cYou are a stranger in every area.\u201d<\/p>\n

Kandahar, Afghanistan’s second-largest city, has been relatively stable for the last two years. But the city is strategically located; supply lines connect it to Kabul and Quetta,\u00a0a provincial hub in neighbouring Pakistan.<\/p>\n

Beyond Kandahar city, government forces have a limited presence. This territory, along with Helmand province next door,\u00a0is an old bastion of the Taliban insurgency.<\/p>\n

Kandahar’s uneasy peace was shaken last week, when Taliban militants launched a suicide attack on an Afghan army outpost,\u00a0killing<\/a>\u00a0at least 43 soldiers.<\/p>\n

\"\"<\/a>The rugged landscape of Kandahar, where the Taliban maintain a firm presence outside of major urban centres and much of the rural population is cut off from regular healthcare.<\/h6>\n

\u201cThe most vulnerable people cannot travel from remote areas or places where there is fighting and our drug transportation is ruptured. We cannot move the drugs to them,\u201d\u00a0said Dr. Mujib Ahmad, the medical manager for MSF in Kandahar.<\/p>\n

Those making it to the\u00a0MSF\u00a0clinic \u2013 currently treating 18 patients \u2013 are the ones with enough strength and money to do so.<\/p>\n

\u201cIf we could reach the most rural villages, we would see the numbers of [TB] cases increase so much,\u201d he said.<\/p>\n

Zakira, in her early twenties, travelled some 200 kilometres to reach the clinic from her home in southern Helmand.<\/p>\n

\u201cI was coughing and weak for a long time and struggled to care for my children,\u201d she said. \u201cI was diagnosed with TB in Helmand and took antibiotics but it didn’t work.\u201d<\/p>\n

Zakira’s husband and family have agreed to allow her to undergo treatment, which is not always the case for women whose place in traditional Pashtun culture is within the home, explained Mohammad Mutawazee, the MSF project coordinator assistant.\u00a0This is another barrier\u00a0for health workers, as women account for two thirds of Afghanistan\u2019s tuberculosis patients,\u00a0according to<\/a>\u00a0the World Health Organization.<\/p>\n

\"\"<\/a><\/p>\n

Clinics shut, health workers killed<\/h3>\n

The conflict is gaining momentum, engulfing parts of the country that had been relatively secure and\u00a0placing added pressure on healthcare providers.<\/p>\n

In Uruzgan Province to the north of Kandahar, the Taliban are accused of forcing the closure of medical facilities in a bid to\u00a0control<\/a>\u00a0healthcare in disputed areas. The\u00a0United Nations\u00a0says more than 80 percent of the health facilities in the province were\u00a0shut<\/a>\u00a0through September, cutting off some 420,000 people from healthcare.\u00a0MSF says many patients are arriving in Kandahar from Uruzgan and Helmand because treatment isn’t available in their home areas.<\/p>\n

Similarly, combatants\u00a0forced<\/a>\u00a0a Swedish NGO to shut the majority of its health facilities in eastern Afghanistan\u2019s Laghman Province in June and July, affecting half a million people and causing 70,000 children to miss a polio immunisation campaign.<\/p>\n

OCHA, the UN\u2019s emergency aid coordination body,\u00a0reported<\/a>\u00a0more than 100 incidents against health workers and clinics through September \u2013 more than\u00a0double<\/a>\u00a0the amount for the whole of 2016. Aid groups estimate that\u00a036 percent<\/a>\u00a0of Afghanistan\u2019s population has no access to primary healthcare.<\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

In a pivotal sign, the International Committee of the Red Cross this month\u00a0announced<\/a>\u00a0a drastic reduction of its operations after 30 years in Afghanistan.<\/p>\n

Seven ICRC health workers have been killed in the last year alone \u2013 victims of targeted attacks. Thomas Glass, the ICRC\u2019s head of communications in the country, said a proliferation of armed groups competing for control has created a \u201cgrey zone\u201d of dangerous uncertainty.<\/p>\n

\u201cAs soon as you step out of the urban areas, there are strong shadows cast over who controls what area and who belongs to whom,\u201d Glass told IRIN. \u201cWe cannot help people if we are going to be targeted.\u201d<\/p>\n

\u2018I want to fly\u2019<\/h3>\n

Back at MSF\u2019s Kandahar clinic, Ahmad Shah is living proof of the importance of health access.<\/p>\n

Six months ago, drug-resistant TB had sapped his strength. Now, he\u2019s hopeful he\u2019ll be discharged early.<\/p>\n

\u201cI have put on so much weight and I feel so well that I want to fly,\u201d he told IRIN.<\/p>\n

But the conflict and narrowing access make the fight against tuberculosis an uphill struggle. The WHO says health providers were only able to treat\u00a0138 cases<\/a>\u00a0of\u00a0drug-resistant TB\u00a0in Afghanistan\u00a0last year.<\/p>\n","protected":false},"excerpt":{"rendered":"

Photo by Ashley Hamer|IRIN IRIN\u00a0– Ihsanullah, 17 months, suffers from a virulent, drug-resistant strain of tuberculosis, which has\u00a0alarmed his father and challenged the doctors. “There are injections and so many pills,\u201d said his father, Bismillah. […]<\/p>\n","protected":false},"author":14,"featured_media":8715,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[6,90,5,88],"tags":[801,802],"class_list":["post-8712","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-afghanistan","category-editor-selection","category-geography","category-slider","tag-healthcare","tag-red-cross"],"acf":[],"_links":{"self":[{"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/posts\/8712","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/comments?post=8712"}],"version-history":[{"count":4,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/posts\/8712\/revisions"}],"predecessor-version":[{"id":8720,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/posts\/8712\/revisions\/8720"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/media\/8715"}],"wp:attachment":[{"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/media?parent=8712"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/categories?post=8712"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/openasia.org\/en\/wp-json\/wp\/v2\/tags?post=8712"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}