9. Dezember 2014

Diese Anfragebeantwortung wurde für die Veröffentlichung auf ecoi.net abgeändert.

 

Die folgenden Ausschnitte aus ausgewählten Quellen enthalten Informationen zum Gesundheitswesen in Afghanistan. Darunter befinden sich auch Informationen, die sich auf die Situation in Kabul beziehen (Zugriff auf alle Quellen am 9. Dezember 2014):

 

·      GHWA - Global Health Workforce Alliance: HRH commitment pathways: Afghanistan, 2013

http://www.who.int/workforcealliance/forum/2013/EMRO_Afghanistan.pdf

„Afghanistan has 3 main health service providers, including:

1- Ministry of public health running 16 major national hospitals in Kabul and 9 provincial hospitals through hospital reform project in the provinces and urban health in Kabul city,

2- BPHS [Basic Package of Health Services] and EPHS [Essential Package of Health Services] in the provinces, which is major health project in the country and running by counteracting out mechanize with national and international HGOs [vermutlich sind hier NGOs gemeint, Anm. ACCORD],

3- Private sector (which is also big and semi regulated.). […]

HRH (Human Resource for Health) is critical challenge in Afghanistan. In 2010 country had 5.4 health service provider (doctor, nurse & midwifes) / 1000 Afghans. With some progress during the last 2,5 years, now it has 7.4 health service providers / 1000 population of the country.

In addition to critical shortage of essential categories of health workforce, there are 3 major HRH issue / problem in Afghanistan:

1. HRH distribution in the country as more than 70% of country population of Afghanistan is living the rural provinces whereas around 60% of health staff HRH is concentrated in the 4 major cities (Kabul, Jalal Abad, Herat and Balkh) provinces.

2. Gender Imbalances, as only 25% of health workforce is female and 75% is male

3. Skill mixed, because some very important categories of health professionals are missing, like biomedical engineer/ technician, educated hospital manager, etc. and likewise 30 areas of specialties are missing in the country.” (GHWA, 2013, S. 1)

·      WHO - World Health Organization: Country Cooperation Strategy at a glance: Afghanistan, Mai 2014

http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_afg_en.pdf

„The coverage of primary health care services has been expanded to districts where 82% of the population resides. Albeit the improvement in the quantity of health service delivery that resulted in an increase of number of functioning health facilities from 496 in 2002 to more than 2000 in 2011 and five-fold increase in the number of outpatient visits, the coverage, quality and accessibility still remains suboptimal. Thirty percent of population has limited access due to lack of security, 40% of population living more than one hour’s travel from nearby health facility and skilled birth attendance is less than 40%.

Afghanistan’s socioeconomic indicators show a mixed picture of progress and challenges, some of which remain a major concern. Life expectancy is low (60 years), despite a significant decline, infant, under-five and maternal mortality, respectively at 77 per 1000 live births, 99 per 1000 live births and 460 per 100 000 live births are still high, and an extremely high prevalence of chronic malnutrition with 39% of all under 5 children and widespread occurrence of micro-nutrient deficiency. There is a high burden of communicable diseases, which account for more than 60% of all outpatient visits and more than half of all deaths.

While Afghanistan remains one of the three polio endemic countries globally steady progress has been made in polio eradication. There is a significant (62%) decline in confirmed polio cases; fourteen polio cases reported in 2013 compared to 37 in 2012. Noncommunicable diseases contribute to more than 35% of all of the mortality. Some of the major challenges and constraints faced by the health sector include: inadequate financing for many of the key programs and heavy reliance on external sources of funding; insufficient and inadequately trained health workers and a lack of qualified female health workers, particularly in the rural areas; lack of access to health care due to dispersed populations and insecurity; quality compromised services; constrained national capacities for health planning and management, especially in the areas of governance, etc. […]

Afghanistan has transformed a conflict-torn health system both in infrastructure and service delivery terms to a relatively functional one through an innovative approach by contracting out Basic Package of Health Services and Essential Package of Health Services (BPHS/EPHS) at primary and tertiary levels to competent NGOs.” (WHO, Mai 2014)

·      IOM - International Organization for Migration: Afghanistan - Country Fact Sheet 2014, Oktober 2014 (veröffentlicht von ZIRF)

https://milo.bamf.de/milop/livelink.exe/fetch/2000/702450/698578/704870/698704/698612/17203115/17376466/Afghanistan_-_Country_Fact_Sheet_2014,_deutsch.pdf?nodeid=17376467&vernum=-2

„1. Allgemeine Informationen

Der Großteil der modernen medizinischen Einrichtungen des Landes befindet sich in Kabul und anderen Großstädten. Der generelle Mangel an Gesundheitszentren besteht vor allem in den ländlichen Gebieten bereits seit längerer Zeit. Die aktuelle Regierung arbeitet an der Wiedereröffnung von Krankenhäusern und der Kapazitätserhöhung auf dem medizinischen Sektor. Darüber hinaus sind Ressourcen zum landesweiten Bau von Kliniken bestimmt worden. Problematisch bleibt jedoch weiterhin die Frage des kompetenten medizinischen Personals.

Der Bedarf an gut ausgebildetem afghanischen Personal, das in der Lage wäre, der Bevölkerung auf nachhaltige Weise medizinische Versorgung zukommen zu lassen, ist groß. Das Land hat eine der höchsten Sterblichkeitsraten der Welt. Mit der Unterstützung von ausländischen Sponsoren und internationalen Hilfsorganisationen wurden in den Krankenhäusern einiger Städte chirurgische Abteilungen wiedereröffnet. Spezielle Behandlungszentren wurden eingerichtet, um Opfer von Landminen zu rehabilitieren.

Trotz dieser Anstrengungen beträgt die durchschnittliche Lebenserwartung nur 44 Jahre. Krieg, wiederkehrende Dürren, schlechte sanitäre Verhältnisse und fehlende Immunisierungsprogramme haben zu weit verbreiteter Unterernährung und dem Ausbruch von Krankheiten wie Cholera (die durch unsauberes Trinkwasser ausgelöst wird), Malaria, TBC, Typhus sowie weiteren Krankheiten, die durch Parasiten ausgelöst werden, geführt. Die Weltgesundheitsorganisation und andere Gesundheitsorganisationen arbeiten zusammen mit dem Ministerium für Gesundheit daran, das betreffende Bewusstsein für diese Krankheiten zu schärfen und insbesondere eine zeitnahe Behandlung solcher Krankheiten zu ermöglichen.

Eine bessere medizinische Versorgung von Frauen und Kindern ist dringend geboten; die Sterblichkeit von Kindern unter 5 Jahren beträgt in Afghanistan 191 pro 1000 Geburten. Eine Behandlung in Krankenhäusern wird von Personen, die sich die entsprechende Anreise leisten können, gewöhnlich in angrenzenden Ländern, insbesondere in Peshawar (Pakistan) durchgeführt. Das Fehlen eines Gesundheitssystems trägt zur Ungleichheit in der Frage des Zugangs zu medizinischen Dienstleistungen bei. Medikamente, überwiegend Importe aus Pakistan und Iran, sind immer besser erhältlich. […]

2. Personal

Eine kleine engagierte Gruppe von medizinischem Fachpersonal mit überwiegend internationalem Hintergrund bietet medizinische Versorgung auf modernem Standard an. Die überwiegende Anzahl dieser medizinischen Dienstleistungen wird in Kabul angeboten. Einige Militärkrankenhäuser wurden in Folge der U.S. Präsenz nach dem Krieg errichtet. Andere Krankenhäuser in verschiedenen Landesteilen werden vom Roten Kreuz unterstützt. In ländlichen Gegenden ist der Nachschub an gut ausgebildetem medizinischem Fachpersonal praktisch nicht existent. Zudem gibt es in 24 der insgesamt 34 Provinzen kein Fachpersonal, das die neu aufgebauten medizinischen Einrichtungen betreuen könnte. Auf 10 000 Menschen kommen in Afghanistan schätzungsweise lediglich 1,8 Ärzte. Da drei Viertel der Ärzte in Kabul tätig sind, verfügen die meisten Provinzen über weniger als einen Arzt für 10 000 Menschen. Der größte Bedarf herrscht an Kinderärzten, Internisten und Geburtshelfern/Gynäkologen. […]

4. Rückkehrer

Physisch und psychisch behinderte Personen und Opfer von Misshandlungen, die erwägen, in ihr Heimatland zurückzukehren, müssen eine starke Unterstützung seitens ihrer Familie und der betreffenden Kommune sicherstellen. Medizinische Versorgung ist für eine Vielzahl von Krankheiten weitestgehend nicht erhältlich. Chirurgische Eingriffe können nur in ausgewählten Einrichtungen durchgeführt werden, denen es generell an adäquater Ausrüstung und Fachpersonal mangelt. Diagnosegeräte wie zum Beispiel Computertomographen, von denen es nur in Kabul einen gibt, oder Magnetresonanzaufnahmen sind ebenfalls nicht erhältlich.“ (IOM, Oktober 2014, S. 16-18)

·      AA - Auswärtiges Amt (Deutschland): Afghanistan: Reisewarnung, Stand: 5. Dezember 2014

http://www.auswaertiges-amt.de/DE/Laenderinformationen/00-SiHi/AfghanistanSicherheit.html

„Die medizinische Versorgung ist in weiten Landesteilen unzureichend, eine Notfallversorgung mit funktionierender Rettungskette meist nicht existent. Auch in Kabul entspricht die medizinische Versorgung nicht immer europäischem Standard. Bei schweren Erkrankungen oder Verletzungen kann in Einzelfällen, soweit lokal vorhanden, ggf. eine erste Versorgung in einer Sanitätseinheit oder einem Feldlazarett der ISAF Truppen erfolgen. Diese Einheiten sind jedoch in erster Linie für die Truppenangehörigen gedacht. Bei beruflichen Aufenthalten empfiehlt sich die vorherige Kontaktaufnahme zur nächsten, erreichbaren Sanitätseinheit bereits vor einer möglichen Inanspruchnahme.

Bei schweren Erkrankungen muss eine medizinische Evakuierung, zum Beispiel nach Indien oder nach Dubai, erwogen werden. Ein ausreichender und gültiger Krankenversicherungsschutz einschließlich einer Reiserückholversicherung ist zwingend notwendig, kann aber die unzureichende medizinische Infrastruktur vor Ort nicht ersetzen. Eine individuelle Beratung durch einen reisemedizinisch erfahrenen Arzt in ausreichendem Abstand vor der Ausreise wird dringend empfohlen […]. Besonders chronisch kranke und behandlungsbedürftige Menschen müssen sich des hohen gesundheitlichen Risikos einer Reise nach Afghanistan bewusst sein.

Die Versorgung mit zuverlässigen Medikamenten und eine ununterbrochene Kühlkette sind häufig nicht gesichert. Es muss damit gerechnet werden, dass insbesondere in kleinen Apotheken auf dem Land auch Fake-Produkte statt richtiger Medikamente verkauft werden. Reisende sollten regelmäßig einzunehmende Medikamente in ausreichender Menge nach Afghanistan mitbringen und sich für die Einreise die Notwendigkeit von ihrem Arzt auf Englisch bescheinigen lassen. Landesweit treten zahlreiche Resistenzen gegen häufig eingesetzte Antibiotika auf.“ (AA, 27. November 2014)

·      USDOS - US Department of State / Bureau of Consular Affairs: Afghanistan, letzte Aktualisierung 5. November 2014

http://travel.state.gov/content/passports/english/country/afghanistan.html

„Well-equipped medical facilities are rare in Afghanistan. Western-manufactured pharmaceuticals are available in limited quantities and may be expensive and difficult to find. There is a shortage of basic medical supplies. Generic medicines manufactured in Iran, Pakistan, China and India are available but may be counterfeit or lack pharmacologic efficacy. There are a number of western-style private clinics in Kabul that offer a variety of basic emergency and routine preventative-type care but are not always open and may not be suitable for the management of complex trauma cases, heart attacks, and strokes.

Public hospitals in Afghanistan should be avoided. Individuals without licenses or medical degrees often operate private clinics, and there is no public agency that monitors their operations. You will generally not be able to find Western-trained medical personnel outside Kabul. For any medical treatment, payment is required in advance.” (USDOS, 5. November 2014, Health)

[Passage aus dem Asylbericht des deutschen Auswärtigen Amtes entfernt]

 

·      NYT - New York Times: Aid Group Sees Daunting Obstacles to Health Care for Afghans, 25. Februar 2014

http://www.nytimes.com/2014/02/26/world/asia/aid-group-in-afghanistan-says-many-still-lack-access-to-health-care.html

„The patients in the four hospitals run by Doctors Without Borders in Afghanistan are the lucky ones, by all accounts, having arrived at well-stocked facilities that maintain international standards with high-quality free care. But when Doctors Without Borders, a French medical aid organization also known as Médecins Sans Frontières, surveyed 800 of those patients last year, the results showed a dismaying picture of unmet health care needs.

Nearly one in five of the Afghan patients, 18.4 percent, had a close relative or friend who died last year because that person was unable to reach medical care – in some areas because of high costs, even though health care is supposed to be free in Afghanistan, and in other areas because the war posed an obstacle to getting to facilities. […]

The report took issue with a widely quoted World Bank statistic that 85 percent of Afghans now have access to health care, compared with only 9 percent in 2001. If the patients at its hospitals reported such difficulties, the report reasoned, ‘Beyond M.S.F.’s reach, large numbers of people continue to suffer illness or injury without recourse to medical care.’

Jessica Barry, a spokeswoman for the International Committee of the Red Cross, which supports two hospitals in Afghanistan as well as 44 Red Crescent Society clinics, said her agency had also seen similar problems. ‘We see and believe there is very difficult access to health care,’ she said. An International Committee of the Red Cross survey issued in 2009 found that 68 percent of Afghans did not feel they had access to adequate health care.

Of the Doctors Without Borders patients interviewed in Khost, in eastern Afghanistan, where the organization runs a maternity hospital, 26 percent said they knew a close relative or friend who had died for lack of access to health care. Even in Kabul, 13 percent of patients said they knew someone who had died, and in Helmand Province 16 percent said they did. In the past year, a third of those in Helmand, in the south, said that fighting had prevented people they knew from receiving medical treatment. In Kunduz, in northern Afghanistan, the percentage was 19. […]

The report also stated that many patients said they discovered that health care facilities they wanted to visit were unstaffed, unsupplied or, in some cases, closed or even nonexistent. In other cases, although public facilities were meant to be free, patients could not afford prices demanded of them for food and medicine. […]

Ahmad Zia Naiem, the deputy minister of health for Afghanistan, complained about the aid group’s report, saying it had not received permission from the ministry’s ethical review board before preparing the report. He also said a survey of 800 patients ‘cannot represent the entire sector in the country.’” (NYT, 25. Februar 2014)

Der vollständige, im obigen NYT-Zitat erwähnte Bericht von Médecins Sans Frontières (MSF) findet sich unter folgendem Link:

·      MSF - Médecins Sans Frontières: Between Rhetoric And Reality: The Ongoing Struggle To Access Healthcare In Afghanistan, Februar 2014

http://www.msf.org/sites/msf.org/files/msf_afghanistan_report_final.pdf

 

·      IRIN - Integrated Regional Information Network: Stark choice for many Afghans: sickness or debt, 2. Juli 2014 (verfügbar auf ecoi.net)

http://www.ecoi.net/local_link/279521/409250_de.html

„In line with Afghanistan’s constitution, primary health services, including medication, at public facilities is free. But stocks often run out, and patients are then forced to buy the medication in private pharmacies or at the bazaar. […]

According to the World Bank, 85 percent of the Afghan population lives in districts with facilities able to deliver a basic package of health services; and around 60 percent live within one hour’s walking distance of a public health facility.” (IRIN, 2. Juli 2014)

·      USDOS - US Department of State: Country Report on Human Rights Practices 2013 - Afghanistan, 27. Februar 2014 (verfügbar auf ecoi.net)

http://www.ecoi.net/local_link/270628/399487_de.html

„The overall health situation of women and children remained poor, however, particularly among nomadic and rural populations and those in insecure areas. Similar to males, female life expectancy was 64 years of age. Rural women continued to suffer disproportionately from insufficient numbers of skilled health personnel, particularly female health workers.

Compared to men, women and children were disproportionately victims of preventable deaths due to communicable diseases. Although free health services were provided in public facilities, many households could not afford certain costs related to medicines or transportation to health care facilities, and many women were not permitted to travel to health care facilities on their own.” (USDOS, 27. Februar 2014, Section 6)

·      UNICEF - UN Children’s Fund: Health care for children and women in remotest Afghanistan, 27. Mai 2014

http://www.unicef.org/infobycountry/afghanistan_72846.html

„Afghanistan remains one of the world’s most dangerous places for women to have children. Per every 100,000 live births, 460 women will die in childbirth or during pregnancy. At least 1 in 10 children will die before their fifth birthday.

According to Dr. Nasreen Khan, Health Specialist with UNICEF in Afghanistan, there are health services available, but the majority of them are clustered in urban centres. Rural areas like Jaghatai village are therefore almost deprived of health services. ‘Health surveys in Afghanistan have revealed that more than 30 to 40 per cent of the population does not have access to health care,’ says Dr. Khan.

‘Another important thing is that, even if we provide the health services, there is inequity within the provision of these services,’ she adds. ‘Even if the services are available, these are not accessible to women in rural areas, and those women who are poor.’” (UNICEF, 27. Mai 2014)

·      AP - Associated Press: Report: Sub-standard medicine floods Afghan market, 19. November 2014

http://bigstory.ap.org/article/266128eaefbf4909be329ecbfc6156bd/report-smuggled-medicine-floods-afghan-market

„Half of all medicine available on the Afghan market has either been smuggled into the country or made under sub-standard conditions in neighboring Pakistan, according to a report released on Wednesday. Up to 300 companies in Pakistan produce poor quality drugs exclusively for Afghanistan because their products do not meet Pakistani government standards, said the report by the Independent Joint Anti-Corruption Monitoring and Evaluation Committee, a joint body set up by the Afghan government and international community. Since there is no Afghan government regulation of pharmaceuticals, the medicine can be sold freely in Afghanistan, it said. […] This flood of poor quality drugs causes wider health problems for the Afghan people; in addition to ineffective treatment of illnesses, the substandard drugs often cause dangerous side-effects. The poor standard of local drugs and healthcare forces many Afghans who can afford it to travel abroad for medical treatment.” (AP, 19. November 2014)

Der vollständige, im obigen AP-Zitat angeführte Bericht des Independent Joint Anti-Corruption Monitoring and Evaluation Committee ist unter folgendem Link verfügbar:

·      Independent Joint Anti-Corruption Monitoring and Evaluation Committee: VCA Report on Pharmaceuticals importation process (Translated from Dari), Oktober 2014

http://www.mec.af/files/2014_11_19_Pharmaceutical_VCA_ENGLISH.pdf

 

·      IWPR - Institute for War and Peace Reporting: Afghans Complain of Substandard Medicines, 11. Juli 2014

https://iwpr.net/global-voices/afghans-complain-substandard-medicines

„Out-of-date or counterfeit medicines, often administered by under-trained doctors, are a serious risk to public health across Afghanistan. The problem is especially acute in provinces like Khost, where a common border with Pakistan provides rich opportunities for smuggling, including substandard pharmaceuticals.” (IWPR, 11. Juli 2014)