Afghan Health Minister: Health Care Is ‘On The Verge Of Collapse’ But ‘I’m Optimistic’

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A newly-opened COVID-19 hospital in Kabul. Dr. Wahid Majrooh, the acting minister of public health in Afghanistan, must address the pandemic’s toll at a time when the Taliban takeover has triggered a freeze in hundreds of millions of dollars in health-care aid from outside groups.

Sayed Mominzadah/Xinhua News Agency via Getty Ima

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Sayed Mominzadah/Xinhua News Agency via Getty Ima

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Most health-care facilities across the country are now running out of emergency medication, medical oxygen and other essential supplies. The freeze in funding has affected over 80% of our health-care facilities. There is no money to run operations. Staff salaries haven’t been paid even several months prior to the takeover as a result of violence escalating in provinces, creating more health-care issues, and we’ve dealt with three waves of COVID with a fourth wave coming.

What are the consequences of a health-care system that is choked by growing demand, lack of funding and staff shortages? What kinds of procedures might not be available?

Every day 150 mothers require Caesarean sections, half of these emergency cases. Both mother and child are at risk of death if complications arise. We perform 500 surgical procedures every day, half of which are emergencies. Those interventions will suffer, leading to more deaths.

How will it affect children?

With increased conflict, 20,000 children are at immediate risk of malnutrition, deprived of nutrition from aid programs and lacking basic health care.

What are the health-care priorities right now, given the constraints you’re under?

The situation is very stressful at the moment. We’re in an unprecedented time where there are many priorities. Our main concern is to ensure the availability of health-care staff and of supplies and financial resources. And then we need to be able to ensure the safety of our staff members from violence and attacks as a result of the ongoing unrest. We need the disrupted services to resume as soon as possible.

How about government-run hospitals?

Government-run hospitals are in bad condition too — even worse than aid funded facilities — as a result of the conflict and lack of funds.

What are the steps that you’re taking in this situation?

We’re coordinating with [international] NGOs and donors, describing the challenges that our health-care workers are facing and trying to suggest ways in which funding can be resumed. We’re conveying our sense of emergency to the Taliban to prepare for the transition to a new ministry. I hope it will happen smoothly and swiftly.

How has the Taliban treated you and your staff so far?

I am coordinating with the Taliban Health Commission [made up of public health officials they have appointed to oversee health care]. Overall, the communication has been good. It will take time to rebuild the trust among health-care workers and to remove the fear that has set in, especially since health-care personnel appointed by the previous government believe that they will be soon replaced [by Taliban-appointed staff].

Are you optimistic about the transition, especially for female health-care staff?

How do you define optimism at this point in time? Well, sometimes in life, you’re left with just one option and I’m in that phase right now. As long as we can ensure that our (female) staff can continue to work and that women and children [who are at the bottom rung of the societal ladder] are being cared for, I’m optimistic. If I am hesitant and doubtful now, it won’t help anyone, and people in need of care will be the first to be affected.

How are international aid agencies faring in Afghanistan now? What is their situation moving ahead?

The ICRC has assured me they will continue their mission [in Afghanistan] and their focus is on emergency care. The Bill and Melinda Gates Foundation have assured me that they will continue funding some of our health-care facilities. I wrote to [international] donors two days ago, thanking them for two decades of support and proposing certain solutions on how we can overcome this [funding] freeze. I understand the limitations, but there are solutions that we can implement to make this possible. Otherwise any gains we have seen, especially in maternal and child health, will be lost. Afghanistan’s health-care system still needs investment and support for at least one or two more years to strengthen its capacity before the government can take over.

What kind of solutions have you proposed in the wake of the funding freeze?

International aid organizations can be paid through different channels – either directly (by governments and aid donors) or through U.N. agencies.

Are you concerned for your safety or worried about retaliation by the Taliban as you speak out on the current health-care crisis?

I’m aware of the risks, but my focus right now is not on the political situation. I have no intention to stay on as health minister, and I haven’t sought to challenge anything. My focus is ensuring a smooth transition so that life-threatening disruptions in health care and threats to personal safety [for health- care workers] are minimal. It is taking longer than I expected, however, and I don’t know when a new ministry will be appointed.

How does all this make you feel?

It is very stressful and exhausting; we’ve lost a lot of sleep. We are really tired.

Kamala Thiagarajan is a freelance journalist based in Madurai, India, who has written for The International New York Times, BBC Travel and Forbes India. You can follow her @kamal_t.