Afghans turn to Pakistan for health care

By Ashfaq Yusufzai

The Taliban's insurgency in Afghanistan has caused Afghans to travel to Pakistan for proper medical treatment.

At the Rehman Medical Institute (RMI) in Peshawar, 51-year-old Afghan national Hashimzada explained how he had travelled 84km from Jalalabad to undergo a medical examination for his unrelenting kidney pain. "We regularly come to Peshawar to seek treatment because the Taliban destroyed the health facilities back home," Hashimzada told Central Asia Online. RMI, a private hospital, treated more than 80,000 Afghan patients in 2013, most of whom were forced to go there because of Taliban destruction of Afghan facilities. North West General Hospital (NWGH) Peshawar last year received 88,000 patients, according to hospital data. About 50% of patients at free medical camps in the Federally Administered Tribal Areas (FATA) came from Afghanistan, Dr. Muhammad Kamran, the head of mobile hospitals in FATA, said. "Last week [the camps] received 543 patients from Kunar and Jalalabad in Bajaur and Khyber agencies," he said. "As in FATA, the Taliban have destroyed health facilities in Afghanistan, causing Afghans to visit our camps." Afghans comprised 10% of outpatients and occupied 15% of the beds in KP hospitals last year, Dr. Mukhtiar Ali at the Khyber Pakhtunkhwa Health Directorate said.

Taliban tactics cause flight of doctors

The Taliban's campaign against quality health care has led to the destruction of 654 facilities and driven countless doctors out of their profession. Hashimzada recounted the story of how the Jalalabad surgeon general left after the Taliban beat him because he did not have a beard. His departure left a population of 300,000 without a surgeon. Akbar Nawaz, a Kandahar-based journalist, remembered a story about how the Taliban caught a surgeon operating on a woman, so they blackened his face and paraded him through the streets. That surgeon subsequently fled to Germany, Nawaz said.

Shortage of doctors, facilities

The country is dealing with chronic shortages of both medical personnel and facilities, experts say. "There are only 8,000 doctors for a population of 30m in Afghanistan," Raees Shinwari, a Kabul-based World Health Organisation (WHO) official, said. "The country should have at least 50,000 doctors." Meanwhile, more than 30,000 Afghan doctors have been working abroad, he said. "Local doctors have been leaving the country since 1996 when the Taliban seized power and placed restrictions on female doctors, nurses and technicians," he added.

Cost to Afghans

Being forced to travel abroad for treatment has saddled many Afghans with a heavy financial burden. "The majority of the patients can't afford treatment and transportation to Peshawar, but they have no other option," said Zargai, a Kabul-based grocery vendor who brought his wife to NWGH. "She has improved a lot, but we ran out of money," he said. "Now I am taking out loans to complete her treatment." "We pay for accommodations, medical procedures and medication, all because of the Taliban's follies," he said. "The situation is ... pathetic." Not only are Afghans facing the financial burden, but some are paying with their lives. The female population is the hardest hit, Dr. Mukhtiar Ali said. One indicator of his assertion is Afghanistan's high maternal mortality rate – 330 deaths per 100,000 deliveries, according to UNICEF, part of which is undoubtedly linked to the lack of care.

Slowly rebuilding

Afghanistan has not stood idly by while its healthcare infrastructure suffered. "We have been trying to restore the health system with the help of donor agencies, but it will take time," Saleem Samadi, an official at the Afghan Public Health Ministry, said. Meanwhile, Afghanistan is working with Pakistan. "We signed an agreement with Pakistan under which it is imparting training to 50 doctors, nurses and paramedics in diagnosis, management and treatment of HIV/AIDS," Samadi said. “We have also been sending medics to Pakistan for training in treatment of TB and malaria patients," he said. "We have trained more than 500 medics who are working ... across Afghanistan."