By Christine Monaghan
An Afghan father recently described how his 15-year-old son lost both feet after stepping on a mine. He couldn’t get proper care in Kunduz City – the only trauma centre there had been destroyed – so he took a taxi more than 200 miles to Kabul. By the time his son received treatment, it was too late.
“Both of his legs had to be cut off from just below the waist, because the bones were ruined and he had a serious infection,” the boy’s father said. "For one week, he was ok, but then, from the infection, he went into a coma. Ten days later, he died in the hospital."
This is one of the many brutal stories I heard during a trip to Afghanistan, where I travelled in November to research the impact that targeted attacks on medical facilities have on children’s health. Children and their parents, health workers and humanitarian staff repeatedly told my colleagues and I how these attacks have compromised access to critical healthcare and devastated children’s lives. In a country already among the world’s most dangerous for aid workers, clinics have become battlegrounds and medical professionals are on the front lines of the conflict.
Over the last two years, the Taliban, Afghan government forces and other groups have committed more than 240 attacks on medical facilities. These violate humanitarian laws and erode an already extremely fragile health system. In a report released today, we show how these unlawful attacks have damaged or destroyed clinics and hospitals, and killed or injured many health professionals. Others have been forced to leave their jobs or flee, and many patients have been afraid to seek care. Children have suffered greatly: casualties have increased, along with rates of malnutrition, diarrhoeal disease and vaccine-preventable diseases such as measles and polio.
Injured Afghan children are attended to by medical personel as they are taken to hospital from the scene of a bomb blast which killed at least 15 people, mostly children, in the southern Afghan city of Kandahar, 06 January 2004. A large bomb ripped through a crowd of onlookers, mostly children, who had gathered after a smaller device exploded 20 minutes earlier some 100 metres away without causing casualties. (Photo: Maqsood Ghayal/AFP)
Instead of places of healing, clinics and hospitals have become targets in Afghanistan’s escalating conflict. Attacks have been so frequent that one health director told us that many go unreported. Attacks have taken place in at least 20 of the country’s 34 provinces, making it difficult, if not impossible, to access healthcare in many areas. In one case, a 15-year-old girl suffering from meningitis took a week to reach a hospital. She died shortly after getting treatment.
Warring parties have also closed medical facilities, and stolen medical supplies and ambulances. They have threatened, detained and killed medical personnel. A health vaccinator told us that when the Taliban caught him administering polio vaccines, they warned him they would kill him if he continued. He felt threatened again when fighters with the so-called Islamic State entered the area, and he later left his job.
“I have seen with my own eyes, in an area of 100 metres there are three kinds of leaders: Taliban, IS and government,” he said. “Our clinic was in the middle of the conflict, so even though it is my job, I had to stop, otherwise I thought either the IS or Taliban would kill me.”
Such cases of threats and extortions are far from unique. In February 2015, a group of unidentified men shot and killed a social mobiliser for a polio programme run by UNICEF. In August 2016, Taliban fighters abducted a staffer of a NGO overseeing a polio vaccination programme.
The impact of these systematic assaults on the healthcare system and health professionals has been profound. The World Health Organization reported 169 measles outbreaks in 2015 – a staggering 141 percent increase from 2014. More than one million of Afghanistan’s children now suffer from acute malnutrition, an increase of more than 40 percent since January 2015, according to WHO.
In Afghanistan, clinics and hospitals are the only places where children can be treated for malnutrition (unlike in Yemen, for example, where there are standalone nutrition centres). When medical facilities are occupied or forced to close, children lose access to treatment for malnutrition as well as other preventable illnesses, such as acute respiratory infections and diarrhoeal disease. These diseases are easily treated if there's access to healthcare, but become deadly without access. When vaccinators cannot immunise children, disease rates also go up.
In 2016, armed opposition groups carried out 95 attacks on healthcare, while Afghan forces were responsible for 23 attacks, according to the United Nations Assistance Mission in Afghanistan. At Watchlist on Children and Armed Conflict, we are calling on all parties to immediately stop these attacks. We’re asking the UN secretary-general to name, for the first time, the Afghan forces among those responsible for the attacks (only Taliban forces have been cited for attacks on hospitals until now). Parties listed in the secretary-general's annual report must enter into an action plan with the UN to be de-listed. Action plans include concrete steps regarding preventing attacks, responding to attacks when they occur, as well as showing that attacks have decreased or stopped altogether.
The Afghan government must establish a permanent and dedicated body to investigate these incidents. The government can help stop these attacks by training troops, investigating any incidents and holding government troops accountable. Even during wartime, basic elements of humanity must prevail, and few are more important than ensuring sick and injured children can get medical care.