25.05.2008 - Source: Guardian

Kabul: Drug addicted workers expelled by Iran and Pakistan are biggest problem in regard to opiates abuse; they had fled the violence of the civil war or the Taliban era with their families and became addicted to heroin abroad; treatment facilities are only available for a few ("Refugees in new Afghan drugs crisis") [ID 23256]

Document(s): Open document

12.2007 - Source: UN High Commissioner for Refugees

Health situation and access to healthcare in Afghanistan in a bad state, particularly in rural areas; maternal and infant mortality rates are among the highest in the world ("UNHCR's Eligibility Guidelines for Assessing the International Protection Needs of Afghan Asylum-Seekers") [ID 22745]

"The average life expectancy in Afghanistan for both men and women is 42 years which is among the lowest in the world. Maternal and infant mortality rates are among the highest in the world and stand at 1600 for 100,000 births and at 210 for 1000 live births, respectively. In 2000, per 100,000 births, 1900 women died from complications in pregnancy and childbirth. Less than 15 percent of deliveries are attended by trained health workers.  A report published in September 2006 concludes that there have been some improvements in maternal health indicators but the disparity between rural and urban areas remains significant.

In terms of access to healthcare, Afghanistan’s poor healthcare system has a very strong urban bias in its existing infrastructure. Overall, there are only 210 health facilities with beds to hospitalize patients. With the exception of four provinces, the current ratio of doctors per patient stands at one doctor per 10,000 patients."

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12.2007 - Source: UN High Commissioner for Refugees

Improvements in healthcare due to the expansion of the basic package of health services ("UNHCR's Eligibility Guidelines for Assessing the International Protection Needs of Afghan Asylum-Seekers") [ID 22747]

"Nevertheless, important progress in healthcare has been made through the Government’s expansion of the basic package of health services. Under the National Health Policy 2005-2009, the Ministry of Public Health is focusing on accelerating the implementation of primary healthcare and Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). The BPHS includes maternal and newborn health, child health and immunization, public nutrition, communicable diseases, mental health, disability and supply of essential drugs.

The EPHS has three main objectives:
• to identify a standardized package of defined clinical, diagnostic and administrative services for district, provincial and national hospitals;
• to provide a guide for the Ministry, NGOs and donors on how the hospital sector should be staffed, equipped and provided with drugs for the defined set of services at each level; and
• to promote a health referral system that integrates the BPHS within hospitals.

The standard services to be offered by hospitals under the EPHS include:

• for district hospitals: 30-75 beds, basic surgery, medicine, obstetrics and gynaecology, paediatrics, mental health, dentistry, plus support services for nutrition, pharmacy, physiotherapy, laboratory, radiotherapy and blood bank;
• for provincial hospitals: 100-200 beds; in addition to services provided by district hospitals, it would provide rehabilitation services and infectious disease control; and
• for regional hospitals: 200-400 beds; in addition to services provided by provincial hospitals, it would provide general surgery, urology, neurology, orthopaedics, plastic surgery, cardiovascular medicine, endocrinology, dermatology, oncology, forensic medicine and more developed support services."

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12.2007 - Source: UN High Commissioner for Refugees

Support for persons suffering from traumas is very limited; in addition, women and men who have suffered sexual violence are surrounded by cultural taboos and in some cases rejected by their families; according to UNHCR, traumatized Afghans who are in need of treatment should be offered international protection ("UNHCR's Eligibility Guidelines for Assessing the International Protection Needs of Afghan Asylum-Seekers") [ID 22995]

"There is very limited psychosocial trauma support in Afghanistan. The concept of ‘counselling’ as a profession in public health services does not yet exist. All traumas are, if at all, dealt with by discussing it with family and friends. In this regard, of particular concern is the situation of women, many of who have suffered forms of sexual violence, including rape. In addition, for both women and men who have suffered sexual violence, strong cultural taboos surrounding disclosure as a victim inhibit discussion, even with close family members. In more conservative areas, social mores dictate that identification as a victim of rape or other sexual abuse leads to family rejection and social ostracism and, thus, to the loss of traditional protection mechanisms. As it is reasonable to conclude that victims of this form of trauma risk further persecution if their history comes to light, traumatized Afghans who are in need of treatment and counselling, which is available sporadically in Afghanistan, should, in UNHCR’s view, be offered international protection."

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09.08.2007 - Source: Integrated Regional Information Network

Helmand Province: Number of patients and other people in need of medical assistance has tripled in insurgency-hit region in last three years, health officials say ("Health services under increasing strain in Helmand Province") [ID 20975]

Document(s): Open document

02.2007 - Source: Senlis Council

Report on hospitals and health care in Southern Afghanistan ("War Zone Hospitals in Afghanistan: A Symbol of Wilful Neglect") [ID 19342]

"The hospitals in the southern provincial capitals of Kandahar and Helmand are dilapidated, barren, and filthy. After five years of international presence in Afghanistan, the absence of basic war zone trauma treatment, medical diagnostic and treatment equipment, medicines, oxygen, and trained staff, have come to symbolise to the Afghan people the international community’s disregard for the health and safety of the Afghan population, as the Afghan people are painfully aware that the international military and NATO bases benefit from sophisticated medical services. The anger that this generates further endangers the lives of the military troops who are doing their best to bring peace to Afghanistan."

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11.12.2006 - Source: Schweizerische Flüchtlingshilfe

Large distances and uncertain security situation hinder people from access to medical care ("Afghanistan; Update") [ID 18386]

"In diesem Bereich wurden Fortschritte erzielt, doch hindern grosse Distanzen sowie die unsichere Lage viele AfghanInnen am Zugang zu medizinischer Versorgung. Weiterhin gibt es auch einen Mangel an qualifiziertem Personal. Viele PatientInnen verfügen nicht über die finanziellen Mittel, um für verfügbare Behandlungen aufzukommen. Die Behandlung von Personen mit chronischen, schwer wiegenden oder ansteckenden Erkrankungen oder psychotraumatischen Beschwerden ist kaum oder an sehr wenigen Orten und nur unzureichend möglich."

Document(s): Open document

14.05.2005 - Source: World Health Organization

Report on health care system in Afghanistan: Socio-cultural backgrounds, history of health care system, information on pubic and private health care, reforms ("Health Systems Profile"), Autor: WHO, EMRO, DHS [ID 22395]

Document(s): Open document

26.11.2004 - Source: UN General Assembly

Report focused on political developments, security situation (disarmament, demobilization and reintegration, police and justice reform) human rights situation, health and nutrition, voluntary repatriation and reintegration ("Report of the Secretary-General on the situation in Afghanistan and its implications for international peace and security - Emergency international assistance for peace, normalcy and reconstruction of war-stricken Afghanistan A/59/581 S/2004/925") [#27496],  [ID 2374]

"43. The maternal mortality rate in Afghanistan is 1,600 per 100,000 live births. Maternal health-care services are not equally distributed, and the majority of women, especially from rural areas, do not have access to essential obstetric care. Moreover, pregnant women, as well as children under five, are at high risk of contracting malaria."

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13.08.2004 - Source: Institute for War and Peace Reporting

A shortage of trained physicians leads to many unqualified individuals offering medical treatment, prescribing drugs and even carrying out surgeries at unregulated private clinics, often with disastrous results ("Medical Treatments That Do More Harm Than Good") [#24735],  [ID 2383]

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03.12.2003 - Source: UN General Assembly

Emergency obstetric care centres in response to highest maternal mortality worldwide ("Report of the Secretary General on the situation in Afghanistan and its implications for international peace and security (A/58/616)") [#18064],  [ID 2375]

"[...] 55. During the reporting period, the Ministry of Health has focused on providing all rural communities with access to primary care by the end of 2003 through the Basic Package of Health Services programme, which is supported by the World Bank, the United States Agency for International Development, the European Union and the United Nations Children’s Fund (UNICEF). In response to maternal mortality in Afghanistan, which is the highest in the world, the Ministry of Health, with support from UNICEF, the World Health Organization (WHO) and UNFPA, is establishing an emergency obstetric care centre in each province. As the availability of safe blood is a key function of emergency obstetric care services, further reductions in maternal mortality are expected to result from the Central Blood Bank, which opened on 15 June. [...]"

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03.11.2003 - Source: International Federation of Red Cross and Red Crescent Societies

IFRC: Maternal mortality - 1,600 maternal deaths per 100,000 live births - is among the leading causes of death in Afghanistan ("Delivering midwifery skills to Afghanistan’s remote east") [#30521],  [ID 2368]

"The Dar-i-Noor valley is only some 50 km from Jalalabad, the capital of Afghanistan’s eastern province of Nangarhar. But, lying deep in the Hindu Kush mountains, many of its villages cling to its precipitous slopes that are inaccessible, even by donkey.

“When a woman from one of the isolated hamlets needs medical help, her husband or brother has to carry her on his back down the narrow paths,” says Salma, a 30-year-old midwife from Jalalabad who has been helping to deliver babies and train traditional birth attendants in the remote valley for the past two years.

“A few days ago a mother died in childbirth because her husband would not allow her to leave the house,” Salma remarks.

“There are three main problems facing women in Dar-i-Noor. The first is ignorance, the second is transport and the third is poverty,” she adds.

Most families in the valley are subsistence farmers. Others earn a pittance cutting wood and selling it locally. All are poor. They can neither afford transport to take them to the hospital in Jalalabad when they fall ill, nor pay for medical treatment should they be lucky enough to find some way of getting there.

It is for this reason that the ARCS clinic in Bamba Kot, although offering only basic outpatient services, plays a crucial role in the life of the valley, for all the treatment and medicines are free.

It means that the health education sessions Salma runs are vital too. She teaches family planning, monitors the growth of children and advises women on pre- and postnatal care. During her two years in Bamba Kot, she has trained 29 traditional birth attendants, and supervises their work.

Their work is essential, since maternal mortality - 1,600 maternal deaths per 100,000 live births - is among the leading causes of death in Afghanistan. The UN Children’s Fund, UNICEF, says that more than 40 per cent of deaths among women of child-bearing age are caused by complications in pregnancy that are preventable.

Last June, as part of a ‘safe motherhood’ initiative, Salma attended a month-long training at the local Ministry of Health-run hospital in Jalalabad on how to set up a basic emergency obstetrics centre (EOC). Her training was funded by the International Federation.

Afterwards, UNICEF provided each participant with a basic EOC kit containing forceps, a fetoscope, a ventouse suction cap, instruments for minor surgery and other essentials."

Document(s): Open document