Afghanistan's ailing health service

Afghan health indicators are among the world's worst

By Marcus George BBC News Online
Tuesday, 4 February, 2003, 15:47 GMT

Not a week goes by without a serious warning about the health or humanitarian situation in Afghanistan appearing in aid agency reports.
But few of these make the headlines.
Polio, scurvy, a high maternal mortality rate, malnutrition, anaemia, tuberculosis, whooping cough - to name just a few - are health problems that we in the developed world associate with a bygone era.

In some areas, there is absolutely no basic health careDr Yon Fleerackers WHO

For Afghanistan they are a reality - and one which the West is tired of hearing about.
Despite the establishment of aid agency projects, Afghanistan's health care services barely exist.
An estimated 70% of medical programmes in the country have been implemented by aid organisations. The state health infrastructure, such as it is, could no longer function without it.
Even the country's largest hospitals lack the most basic equipment needed for simple treatment.
Hi-tech medical equipment is not available and cleanliness is a luxury that few medical centres can offer.

Maternal mortality
Even the most basic treatment is out of reach for Afghans living outside urban centres. Their closest clinic may be at least a day's journey away, and that often by foot.
Afghan women are at high risk
When it is accessible, it comes at a price only a minority of Afghans can afford.
Arguably, it is pregnant women and infants who bare the brunt of the country's health crisis.
A recent report by the United Nations Assistance Mission in Afghanistan describes the countr's maternal mortality as "one of the highest in the world, with two to three women dying every hour".
More than half of all Afghan children grow up stunted and suffering from iodine deficiency, it adds.
Maternal mortality rates vary widely across the country.
Whilst statistics of successful births are improving in Kabul, the mortality rate remains an extreme danger to would-be mothers in rural areas.

Life expectancy
Recent figures from the remote north-eastern province of Badakhshan show nearly 7% of mothers die while giving birth.
The figure has consolidated Afghanistan as having some of the worst health indicators in the world.
Disease control won't have any success without education to go along with itDr Yon Fleerackers WHO
"In some areas, there is absolutely no basic health care available for the population and no medical supplies to serve the people," said Dr Yon Fleerackers, an epidemiologist with the UN's World Health Organisation.
"And the rate of infant mortality is also extremely high."
Of every 100 babies born in Afghanistan, 14 are likely to die before reaching the age of five.
Those more fortunate can look forward to a life lasting an average of 46 years. Life expectancy in the UK is estimated at 75-80.

Training
But services are slowly getting better.
Kabul's largest maternity ward, at Malalai hospital, has been refurbished and staff have been trained in emergency obstetrics.
An Afghan girl receives a tetanus vaccination
Several other regional hospitals are receiving aid and advanced training.
Small medical teams are reaching the country's largely inaccessible rural areas, equipping clinics with drugs.
"There have been a lot of improvements," says Dr Fleerackers.
He gave as an example the immunisation of 10 million Afghan children in a joint campaign between the WHO and the Ministry of Health last year.
"We saw that mortality caused by measles had seriously declined through the campaign.
"And tuberculosis control has improved," he said.

Changing behaviour
But educating Afghans is critical to creating a healthier population.

"Disease control won't have any success without education to go along with it," Dr Fleerackers says.

"The key to success is community involvement in changing behaviour that has helped to cause mortality."
Poverty forces many children to work on the streets
Aid agencies are now in the process of drawing up a plan with the transitional government to provide basic health services throughout the country.
But restructuring health care is just one short step on the long path to Afghanistan's renovation.
No amount of medical treatment can cure the economic misery faced by hundreds of thousands of Afghans.
Without a healthy diet, Afghan men, women and children will continue to fall victim to common illnesses.
If the UN's indicators are to show improvements, their social circumstances will have to change.
In this sense, reforming health care in Afghanistan is yet another piece of Afghanistan's reconstruction puzzle.
And only one thing's for certain: it will be a long, arduous task.