Anita, 14 years old, is worriedly cradling her first daughter, Azita, a premature baby who was born 53 days ago and weighs 2,115 kilos. It is barely half of the usual, but better than the 1,860 kilos with which eight days ago he arrived at the therapeutic feeding clinic of Doctors Without Borders (MSF) in Herat, the third largest city in Afghanistan. Like her, several hundred Afghans have found in the center a lifeline for their babies, amid the economic and health emergency that the Central Asian country is experiencing. Here not only are newborns nourished, but mothers are also cared for and trained in the importance of breastfeeding and basic hygiene measures. A drop in the ocean.
The global approach is a necessity given the extreme poverty of families. Ghaderman, 29, is confident that he has only eaten tomatoes, bread and tea for a long time. She barely has milk to give her three-month-old baby, Mustafa, who in the two days he has been in the center has gained 600 grams and already weighs 4.6 kilos. Many mothers cannot even read or write. Abagul, 15 years old and with her second daughter, Raziyeh (5 months), never went to school. “Of course I would have liked it, but the people here do not approve of us girls educating ourselves,” she responds.
Christophe Garnier, the MSF coordinator in Herat, explains that “when a child is malnourished there is a 90% chance that families will be food insecure”. That is why the organization has launched a voucher system that provides them with flour, rice and oil to help them get ahead. While the babies are in the hospital, the mothers also receive three meals a day, in addition to diapers, cleaning supplies and laundry products.
Located within the Herat Regional Hospital, the clinic that MSF has managed for two years has now been overwhelmed by the hardships of the population it serves. “In intensive care we are at 150% capacity,” reports Gaia Giletta, the head of nursing. This means that some babies have to share a bed and, as they are all accompanied by their mothers, the rooms are overcrowded. Three months ago they reached 200% occupancy, despite the fact that in the summer they had expanded their 40 places to 74 to face the seasonal increase in malnutrition.
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Contrary to the usual, hospital pressure has not decreased since then, which has led the organization to replace the temporarily installed tents with heated containers that allow them to continue caring for babies and mothers during the winter . “We get between 75 and 90 patients a day,” says Giletta, and many of them require treatment for several weeks. But the needs are much greater in Herat and the rest of Afghanistan.
MSF attributes this increase to the collapse of health services, the economic recession, the high cost of living due to inflation and the persistent drought that affects the area. Access to health care was already a major problem in Afghanistan long before the Taliban took power last August. Since then the situation has further deteriorated with the suspension of most international aid, including World Bank funding for World Health Organization basic care programs. Foreign assistance accounted for 43% of gross domestic product (GDP) and financed 75% of public spending.
Last October, Unicef, the United Nations Children’s Fund, already warned that half of the six million Afghan children under the age of five were at risk of acute malnutrition. Even before the current crisis, Afghanistan had one of the highest stunting rates for that age group (41%), mortgaging its future.
Many of the patients MSF receives in Herat come from other provinces such as Badghis, Ghor or Farah, after traveling distances of more than 100 kilometers, which gives an idea of the deficiencies in those regions. Only 17% of health centers are fully operational nationwide and two-thirds lack staff and basic medicines, according to the UN. Public Health workers have been five months without receiving their salary, until earlier this month that international organization began to pay them directly.
“We have been able to continue operating thanks to the fact that we are financed with private donations and our independence,” explains Tom Casey, MSF’s press officer in Afghanistan, who recalls that during the past two decades the organization has maintained contacts with both the Government and with the Taliban. “When they took power, we already had a previous relationship; Furthermore, even during the fighting we kept the Helmand hospital open ”, he points out.
The growing needs of a health system that was already weak before external assistance was interrupted, has also led MSF to extend its support to the pediatric unit of the Herat Regional Hospital. The project, which started just ten days ago, offers outpatient consultations and has 17 beds for the most serious cases, with mixed staff from the NGO and the public system.
If medical care is generally precarious, that received by internally displaced persons is bordering on non-existent. A total of 5.5 million Afghans remain outside their places of residence, of whom 677,000 have been displaced this year by both war and drought. 20 kilometers east of Herat, another MSF project has been assisting since 2018 those who have settled in the informal settlement of Shaidayee, around 10,000 families today.
The clinic focuses on pre and postnatal consultations, but also offers treatment for non-communicable diseases, detection and treatment of malnutrition, childhood vaccination and health promotion. The three doctors, two women and one man, see an average of 50 patients a day each. The head of nursing, Jasper Adoto, considers that his work “is a drop of water in the ocean” given the enormous needs of the country. Still, for many displaced people it has become a place to go for help.
Maryam, 24, falls exhausted into a chair with her 6-year-old daughter Zarmineh in her arms. The girl cannot walk since she was born. With tears in her eyes, the woman asks for help to eat because she can’t take it anymore. Her husband, a man who is 20 years older than her, is a drug addict and what little he earns he spends on drugs. They left their village in Badghis after neighbors, to whom the man owed money for it, snatched two younger daughters to pay off the debt. They tried to cross into Iran, but were rejected. Now he doesn’t know where he is. “He often leaves me alone,” he says.
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