BMJ 2007;334:1295 (23 June), doi:10.1136/bmj.39251.642859.DB
Red Cross concerned over deterioration in medical services in Afghanistan
The International Committee of the Red Cross has warned that the deterioration in medical services in remote areas of Afghanistan is making it increasingly difficult for civilians wounded in hostilities to be reached by health workers.
Pierre Krähenbühl, the agency's director of operations, said that the deterioration has been steady and that "important needs are still unmet. The civilians most in need are also the most difficult to reach."
Getting wounded civilians out quickly is often a challenge, he said, adding that Afghanistan's harsh terrain did not help.
He emphasised that the situation in Afghanistan is worse now in humanitarian terms than a year ago, with hostilities now spread in many parts of the country and an increasing number of war wounded people admitted to hospitals.
"Many are unable to access medical care," he told reporters.
The unwillingness of many doctors to be posted in facilities outside cities, mostly because of heightened insecurity, added to the problem, agency officials say.
Mr Krähenbühl said that the agency had increased its support to hospitals to help deal with the large influx of war wounded people and was also providing emergency help to people newly displaced by the escalation in hostilities.
The agency's operation in Afghanistan, its fourth biggest operation worldwide, was reassigned emergency status last year and is far from over in terms of medical and relief needs, he said.
He cited a series of bombing raids and fighting on the ground in Herat last month that resulted in many civilians deaths, more than 2000 displaced people, and 170 houses wholly or partially destroyed.
The agency also supports Afghan Red Crescent Society clinics and volunteers, who go out to "delicate" areas of the country to set up community based first aid teams, he said.
The committee says its goal in Afghanistan "is to provide essential and quality surgical services to victims affected by the conflict or other emergencies."
The agency supports three hospitals—JPHH1 in Jalalabad, Mirwais in Kandahar, and Sheberghan in Jawzjan—with supplies, training, and capacity building support to cope with the influx of wounded people.
An increasing number of people wounded or killed are civilians, the committee says. It has called on all the different parties in the conflict—the international forces, the Afghan army and police, and armed opposition groups—to respect international humanitarian law and not target civilians.
In 2006, 1744 war wounded people were treated in facilities supported by the agency, Mr Krähenbühl said.
According to official Afghan sources 4000 people were killed in hostilities in 2006, which included 670 civilians.
The grim assessment by the agency, which has 62 international staff and 1100 national personnel in the country, is also shared by senior World Health Organization officials.
"Providing primary health services in remote areas of Afghanistan is difficult, and the quality of service is not always good," Shibib Khalid, team leader in WHO's health action in crises unit, told the BMJ.
The implementation of health services is behind target in areas of the country in conflict, Dr Shibib said, pointing out that insecurity, including the killing of health workers, has aggravated the problem.
Decades of war have left the country with a poor health system, and it will take time to improve the quality and delivery of services, said Régis Savioz, the agency's head of operations for central Asia and the subcontinent.
"Everyone is trying, but it's hard," he added.