Shaima, 38, came to Parwan’s government hospital in the throes of labour to receive medical attention. Instead, she said, she was hit and verbally abused by the very people who were supposed to be looking after her.

“When I was taken to hospital, two caregivers asked me how many children I already had. I replied that this was going to be my seventh child, so suddenly they started mistreating me and used foul language and started beating me very hard.”

She said that the experience had left her traumatised.

“Since that day I began to hate hospitals,” she added. “In the future, even if I develop a fatal disease, I will never go to that hospital again.”

An IWPR investigation has discovered widespread reports of abuses by medical staff in Parwan’s 200-bed government-run hospital. Local officials confirm these reports and add that corruption and mistreatment are rife in hospitals across the province. Women in labour are particularly vulnerable to such mistreatment.

Binazir, 28, was pregnant for the first time and sought treatment at Parwan state hospital because she was carrying twins.

The behaviour of the staff there shocked her, she continued.

“The midwives asked one woman for money to help deliver her child,” Binazir continued. “At the beginning she agreed to pay them [but] when she gave birth to her child, she said that she didn’t have money. As a result, the midwives slapped her a few times, and left cursing her. I witnessed this whole scene.”

Asking for money from patients was an everyday occurrence, she added. Sick people who did not agree received all kinds of awful threats with no-one prepared to come to their aid.

“This wasn’t just a problem with the medical workers who misbehaved toward the patients, the cleaners weren’t kind either,” she said. “They insulted the patients as much as they could, too.”

Binazir explained that she had been so shocked that she asked her husband to take her somewhere else to deliver her babies.

“My husband took me to the Emergency Hospital of Parwan. There, they treated me in a very kind manner and I bore my children very easily.”

Patients and relatives claim that staff misconduct extended to selling equipment and medicines to patients that they should receive for free.

Naida, 23, said that she had taken her sister-in-law to the public hospital two months ago to deliver her baby.

“Nurses and caregivers not only take 50 US dollars from patients as bribe, but they also make patients buy medicines and other things they need – that they should get for free - from outside the hospital. Once the patients buy all this paraphernalia, nurses and caregivers can sell medicines and tools to other patients. “

She added, “Doctors only serve a patient when they know they are powerful, have money or connections in the hospital.”

Article 52 of the Afghan constitution states that the government must provide all citizens with free healthcare facilities.

According to the World Health Organisation’s constitution, access to healthcare is a human right and should be provided free of any racial, religious, social or economic discrimination.

But Wali Aziz, head of communications at the provincial department of public health, said that mistreatment was rife in hospitals across the province.

“We have investigated many cases in which doctors misbehave towards patients and also cases in which doctors demand bribes from patients. After the investigations, the accused officials were referred to the investigation team of the ministry of public health and their enquiries are ongoing.

He also added, “I absolutely can confirm that in many hospitals patients are mistreated and abused. Doctors don’t respect the oaths they took when they graduated.”

Hospital officials reject all such accusations of abuse.

Parwan hospital head Mohammad Qasim Sangeen said there was no truth to claims that patients were beaten, asked for money and insulted.

“I totally reject such allegations,” he told IWPR. “I think it’s the patients who should be blamed as they don’t consider the rules and regulations of the hospital. We have installed cameras in different parts of the hospital to watch and control the movements and activities of our staff and by installing such cameras we have solved almost 98 per cent of the patients’ complaints.”

Sangeen did acknowledge that the hospital suffered from severe shortages.

“We accept that we face the limitations regarding medicines, beds and rooms; therefore, one bed is used for two patients or one patient should be discharged so that another patient should replace him or her. We also have a lack of rooms for the relatives who accompany the patients. The construction of the new building is underway and when that is complete all the problems should be solved.”

However, an official at Parwan hospital who asked to remain anonymous told IWPR, “All the officials lie. The statements made by the patients are true especially regarding the taking of money, which is blatant and undeniable.”

Parwan provincial council member Hosai Bayani agreed that the government hospital had severe problems.

 “Patients have met me many times to complain about their problems,” she said. “Patients are not only mistreated, but also doctors extort money from them in various ways. I personally talked to the head of government hospital of Parwan regarding the issue and he accepted all the accusations.”

Bayani confirmed that Sangeen was taking action to combat wrongdoing.

“The head of the hospital told me that he had installed cameras in different parts of the hospital and has caught many officials red handed,” she said. “He has cut salaries of some officials and some of them have been formally warned for mistreating patients.”

Yet nothing was being done to address a wider culture of abuse, she continued, although the problem had been raised numerous times during provincial council sessions.

 “I have also discussed this issue with the Parwan governor and he promised to share the issue to the minister of public health; however, nothing has so far been done to solve these problems,” Bayani said.

Back in Parwan’s government hospital, Hamid waited for his wife to give birth. He said that he was prepared for a familiar process of bribery and mistreatment.

“This is the third time that I’ve taken my wife to the hospital to give birth,” Hamid explained. “Whenever I come here, the doctors and nurses ask for money in the form of a gift. All three times, when I gave them 20 dollars as a gift, they refused to accept this amount, so I had to pay more to keep them happy and satisfied.

“Every time I’ve come here, I bought all the medicines I needed outside the hospital, and the hospital didn’t provide anything. I don’t know if the government provides medicines and equipment to the hospital for free or not.”

This report was produced under IWPR’s Promoting Human Rights and Good Governance in Afghanistan initiative, funded by the European Union Delegation to Afghanistan.