Inside Story – The ill state of Afghanistan’s healthcare

Inside Story – The ill state of Afghanistan’s healthcare


an aid organization draws a bleak
picture of the health care system in Afghanistan Doctors Without Borders says access to
health care fails to meet people’s means and is only influenced by political and
military considerations so what have years of international
aimed at investment achieved in Afghanistan this insightful and welcome to the program I’m she ever
chancery Afghanistan has one of the most inadequate health care systems in the
world something that contributes to a life expectancy of just 44 years all this despite the hundreds of
millions of dollars that have been pumped into that health care system over the past 12 years a new report by
the aid agency meant sells all forms here or Doctors Without Borders says one in
five people had a family member who died because they couldn’t get access to health facility bud Smith has more
from Kabul livid if you were born in Afghanistan the odds
of making it past your first birthday still the worst in the world met south on from Tia has found that
patients in the most volatile parts of the country have seen little improvement in their
access to health care despite more than a decade foreign military intervention most of
the women the community come from far away from the mountains text about two hours
to get here and some others that working farm 6
o’clock 6 a.m. MSS report is critical of what became a
cornerstone of the International Security Assistance Force counterinsurgency strategy the
provincial reconstruction teams P arties made up of civilians and
military were tasked to win over local
populations after the area has been secured by I some forces but MSF says there was little long-term
thinking involved a lot of Health structures that have
been nicely built but RMT we have a lot of basements for love
donated equipment arm but then we have no maintenance we
have no fuel so I think having this niskanen initiatives that we’re just
getting out of the blue and we’re serving political ames mother
are not sustainable and I’m even wondering if they ever worked MSF says that although the number of
health facilities has increased in Afghanistan people
either can’t afford to use them but don’t rush the service provide Afghan still bearing the brunt of the
cost of health care here according to MSF Afghan spend about
forty dollars if they need treatment for an illness that an enormous burden
in a country where most people are learning about dollar-a-day and mSF is worried that as
foreign forces pull out international interest in Afghanistan
will go with them before there’s been any significant improvements in health
care Bernard Smith Al Jazeera couple well the talk more about the
difficulties facing Afghans accessing healthcare were joined by all three guests in Kabul
doctor Alan John Naim he’s the Afghan Deputy Minister of
Public Health in Brussels Christopher stakes general director of doctors
without borders and in london have a bar senior
researcher at Human Rights Watch welcome to you or Christopher Stokes then
improvements in the Afghan health system are
presented as one of the few tangible benefits if invasion and occupation at the best thing the US
ever did according to one headline I remember are you saying that’s not true well what
we’re saying is that term perhaps that picture isn’t as positive flows arm was perhaps arm some political and military entities wish to
present it arm we’ve seen a doubling in the number of
patients come into our hospitals are over the course of the last year and so
what we did is we actually did a survey and asked the Afghan patients themselves what they
thought on what had happened to them on the last year and the picture they described is
actually are not want to be a huge success from their perspective
especially in terms of access in security cost and quality services
yeah it’s interesting you mention access catheter we often hear improved access
but we would you reports as well we have to be careful with that word
because that can be confused with geographical proximity block actually the ability of a health care provider to
provide health care yeah and of it’s often portrayed as a bit
this part is often portrayed as a big success with the number often given is that eighty-five
percent of Afghans now have access to health can compare to 9 percent in 2001 and actually in the survey that we
should we did with our patients one of the things that came out as many of them I many people actually didn’t come I to health services because I’m insecure
it actually one in five of the patients we interviewed had I member of their family or a friend in the previous you who died who lack of
access to health care misses jhoo to in security checkpoints arm the cost as well love traveling arm and also sometimes the fact that the
clinics that is supposed to exist that exist on paper are actually buildings without any drugs
or without any qualified medical staff so the they have to go quite far away
into the main towns to seek a access to health care so basically they
the really facing a a very grim conflict reality in
Afghanistan today and this is in the context a so much
money having been spent as a sec remind ourselves that the US has been
pumping billions NZ Afghanistan to more than a decade
according to the Special Inspector General for Afghanistan reconstruction the US to spend over $100 billion
dollars now on reconstruction since 2002 of bats more than one billion dollars
went on health gap almost a third wheel health some things
in Afghanistan are supported by the United States with these just the US figures as far as
total international aid goes there’s no reliable figures because so much if the money is bypassed the Afghan
government itself before bring the rest the panel in though Christopher states I wonder whether when
you look at all at the last twelve years is health care being used primarily to
help the Afghan people or as a to counterinsurgency or as a
tool to show progress in counter insurgency would you
say now it’s very good to have her a good point on actually of course some for the Ministry of
Health in Afghanistan and for a lot of people working on the ground healthcare
is a core issue and health system should be provide
based on need however unfortunately what we’ve seen
over the last decade is that health care has been part of the hearts and minds
campaign arm areas have been supported not only
based on needs billion base based on the kind military strategies
that were to be deployed in our area arm so we could say that health care has
somehow been integrated into part of the conflict in
part of the strategies and this of course hasn’t helped the
health centers in turn to that perception is being neutral and safe
places for Afghans to come to this is probably compounded the problem
for Afghans have a bother what’s interesting is that according to the report there’s quite a
bit awareness how useless love these projects do turn
out to be even though they cost a fortune able have their nicknames is
humanitarian projects quick impact quick collapse what is
what’s going so wrong here well i i think they’re it’s a
complicated picture in and and Chris’s touched on some of the issues certainly
this this kind of merging of development
assistance with military strategies has been deeply unhelpful and and as is something
that I think will look back on Afghanistan as having been in a way that death have this separation between a den and military strategy and and that
having been a terrible mistake I think there’s been an overall problem
and accountability for aid I’m I think that the international
community has not dealt well with issues about corruption both within
their own programs and within the Afghan government I’m and I think that erm what’s really
concerning is is the the city-state that Chris I did
about how the that number of people seeking services
has doubled in the last year I think this is an indication of
something really a disturbing which is happening now which
is that having having made some progress having and you know learned some good lessons and some bad
lessons along the way rather than to building on that in
looking at why have things not work that well how can we improve it how can we sustain the progress that has
happened is much more by a desire to just walk away and say well we did what we could and
it’s up to the Afghans now and I think that would really be a tragedy yeah but I’m because my first and this
was never about the Afghan people this was about geopolitics and and it is just that’s how it’s gonna be
no more my grades no more aid well that shouldn’t be the case I mean unfortunately it feels like
you’re right it feels like the message now is he signed the PSA or we’re finished with
you and you can have anything you can do about it was not right at all doctor name though it’s great having you
on because you’re you you what you know you had a long a long history both in with whoo hoo
NGOs and now you’re in the Afghan government a festival with your whoo how to on your the world
health organization had on to what extent they have have NGOs in
aid agencies contributed them to the waste of time and money by being part of this counterinsurgency
strategy in being an instrument of power instead of helping the Afghans
themselves and thank thank you very much for the
question in good evening to everybody a in my
opinion the first of all you know that I would like
to thank a.m. a sec enough for the services they have been providing
during the years of contract and following the conflict and in secure areas and de los some people lined 2004 and 10 the provinces of Afghanistan and the
return and 2009 basically their mandate is a
humanitarian mandate and by mandate probably and research was not
you know one of their heels of specialities and secondly at the any studies you know that our conducted which
involves human subjects I believe you know it should gold those research proposal should go to and critical review board I get your new
ministerial and then we’re going to get around the world health organization
clearly gross mistakes what about up a point and
you don’t do research you you help people in a humanitarian I in humanitarian way but when it comes
to researchers asked you to solve a good about hmm prove costly the aim we also do in epidemiological investigations
when we when we face with her epidemics and what we did in this case
was interviewing the patience because one of the problems we face in
Afghanistan is there’s love with this cool some are around a Afghan need sunday and the
successes have from have two different interventions health interventions for example but we
considered that the I’m what we were seeing on the ground
convicted in with a good news story so that’s why we decided to interview the
800 also patience and I think they give a pretty arm fair
accurate description of their day-to-day realities the difficulties they face in their regions the distances they have
to travel the in security and the fact that some love the health
centers that they would wish to go to really on functioning properly
especially outside of the major towns and I think for for MSS for and for other aid
organizations we have to recognize that we also haven’t been arm we haven’t
provided part of the solution there because we’re treating more more people
in the towns but is very hard to go outsider the main
towns because we’re dealing with the same kind of in security and difficulty to the Afghans in dealing
with checkpoints the land mines et cetera home from our pet hoffa the the patients
who after the people who reported not being
able to come cited over half for them cited violence and
conflict is being the main reason the delayed or weren’t able to access
health services and this is really the day-to-day reality the Afghans be on the
statistics or well beyond the the public discourse a
few so doctor name you don’t accept you can accept that those findings I to I I i believe the some of the the call to know that there
there there eighty-five percent I access to health services that one is
not you know what the ministry has been saying but I agree
you know that insecurity poverty the culture they are they’re all the
barriers in order to access health services in specially in a traditional a
community like Afghanistan where we have the mobility of women especially in rural
areas is limited and at the same time the they the
information you know that the about him as also an issue because the a literacy date in Afghanistan has been very low
especially for women so so those are all major barriers to
access health services but some have I E also the not this in the report that
the the public facilities are not used well FB compare you know the some of the
reports and that that is verified by a third party at the coming into the
Ministry of Public Health every year you know the number of
consultation has been on the increase from a from the 2007 till date and the be a have had you know about the over $42 million consultations the and the health facilities that does
there are about 2100 a health facilities around the
country the so I E I am not very sure you know
if that was the true because they’re that
some of the interviews that are done deal those are
the opinion of the people coming from those remote
villages which I the spektr very much but at the same time it could be a
little bit exaggerated as well because so that they get more assistance and the that that has been you know what i been
noticing I work for non-governmental organizations as well so I have as an Afghan you know I know
you know the culture better and that usually happens alright and how are
you also a few doctor name there’s another point Ben I
am and we know this is this is already the
response actually have some a Western countries it’s like it’s not our fault
it’s because the Afghan government is so corrupt that went on Sat making much headway in
Afghanistan all this money disappears and Afghan government hands well I near sorry I didn’t get the
question well as planned about you know what it’s about Afghan
corruption and the corruption of politicians in your own government
that’s going to be the reason why the US and others say they’ve made such
little progress all these of the progress they’ve made
it things are limited over the last 12 years I luckily you know that least you know
I’m working for the Ministry of Public and we have the taken for the measure you know to
avoid corruption or lead you said the for that
purpose BR the mmm contracting that service delivery to
non-governmental organizations me or not this spending the money
ourselves so basically and 31 out of 34 provinces we have contracted out health service delivery to
non-governmental organizations so that may you know we are making sure
that the money that is allocated for help they spent in a transparent manner where
we can accountable for all the donor money and the taxpayer money
that’s coming up from the the donor countries okay we’ll have
a bar then if we look at accountability and and oversight what’s so weird is
there is oversight on almost on a weekly basis to other we’ll get emails from the its
Special Inspector General Afghanistan say hi on this money is going nowhere as
being in minutes is being spent it’s a complete waste of time just
recently we already got this email about the a hospital in Gardez a mmm overpayments
a five hundred and seven thousand dollars paying five hundred dollars per
gallon for diesel fuel will be more it should have
been more than five dollars a gallon I am and indeed it was a hospital that
once it’s completed as operations and maintenance costs a five times the cost the hospital it’s
replacing its probably gonna go bust am I’m the government gets those reports
the US government what why don’t they seem to do anything about it or change
their ways am it’s interesting I mean that the
cigar reporter very damning indeed and damn I mean I i think thats cigar
has been playing a much more active role in the last couple years than previously
so and two innocent summer this feedback
wasn’t coming in earlier but but certainly this report
while they’re damming about the Afghan government they’re they’re almost more
damning about the US government and the US government sort of desire to
to cover their ears and say I can’t hear anything you’re saying I
think there’s a there’s a great desire right now to declare victory and go home in Afghanistan on but no experience our
way and that narrative from tyre aspirants how can you spend
six hundred thousand dollars on your on a new hospital and I don’t have clean water and don’t
have electricity and other furniture not have equipment well I’m never built a hospital I
couldn’t explain but my own experience how that’s possible US problem on
corruption in Afghanistan yes I used to run a an anti-corruption
project for for the united nations and one of the things that I found incredibly frustrating about that job
with I felt that we were tackling a problem it was really a political
problem through technical assistance what needed to happen wasn’t for us to do training programs
for Afghan officials on how to not be corrupt what needed to happen with President
Karzai needed to say to the government to his government that corruption wouldn’t be tolerated
and his international partners and donors needed to convey that message to him and
that wasn’t happening at either of those levels but krista is it actually corruption or
incompetence often when it comes into USA ID there’s another story about them so we must do something about
Afghan youth they approve fifty million dollars over
three years go somewhere three years later they said I was not
actually achieve anything other than that the countless examples like this
not to mention buildings being built which have no use now well first two I’d like to grew
doctor name that we do not want to substitute a narrative that says that
everything is a great success with another
simplistic narrative that says everything is a failure was there have been some successes in
the city’s access to care is probably improved in some hospitals as well I think there really is a key issue
around the the rule conflict afflicted areas and I also find it a little bit strange
the way we’re portraying it as being just an Afghan problem the corruption
issue the fact that I don’t order about USA idea you’re talking about
military-industrial complex where this money’s going up but in effect that are not sure the to
end some of these projects were actually
designed to deliver health care in the first place some of them were designed
to provide health care services close to a
front-line arena village or in a room there was conflict in at
the same time investigate interrogate patience some these projects were done as kind of
a high-visibility projects I went myself into the hospital in Nash County AHA abused hospital and if you go in the
basement it’s full of expensive donations a from western governments are who are
keen to but these products across and and have a
good image in the community but they were necessary what was needed in the hospital so have
very expensive x-ray machines can as acceptor that have been donated so your sis have to look at the kind of
assistance that’s been flowing in so we have a combination of cut sometime
cynical healthcare projects conducted by arm Western forces which had military
objectives a combination of that with a a high
level of conflict in many the rural areas in around host for example north of Kunduz and in around how much we we’re
reporting for and and there it’s true that the day-to-day reality over have an Afghan in the villages outside
of the the main towns really hasn’t changed progressed
significantly over the last decade and we could even say the conflict in
many of these areas has intensified over the last couple of years doctor Naim the it does seem that a lot
of this aid has been flowing in which some oven has been use all summer
but has been a complete waste is is going to dry up slowly over the
next few years what effect as I gonna have a I believe the I agree what the some of the issues that were raised the
regarding you know the construction of a health facilities in their health services some of them are the funds are flowing through their
treasury of the government of Afghanistan and some of the fans are not flying
through the tragedy of the government of Afghanistan
which the government of Afghanistan does not have much cunt control on so therefore I think you know
we could’ve done better together but the anyway I the the sources for him the what reports he is that in the and short to medium term via have the commitments of our donors a
and it though in spite of you know the
support from the UC ideas it was announced the over media we heard add it is did you saying have ever you know
in the health sector the we will a not be a affected very badly up hopefully because
that that’s what we have been discussing in
similarly at our other major donors they are committed to
to to till 2018 n at thinking in the support the to be on 2010 process takes there
are any lessons being learnt similar to its not as Afghanistan frankly my normal %ah to post-conflict areas
we’re seeing this kind of wasted shouldn’t be so too cynical tactics
being used and week is doomed to repeat this every
time there is another conflict will not necessarily in one of the
problems is to consider Afghanistan is being a post-conflict environment because if you living in now
Helmand to Renault hoster and other provinces I think most Afghans if you could could
call their environment post-conflict when you see the stories the described in our report
the interviews given and the people really holding death
watch Ines over wounded family members waiting for
the fighting to stop it a the checkpoint this whole notion that
his post conflict and we should be developing a common long-term I health care system sustainable in summer
these provinces I think was probably misguided and probably driven by a political William David Cameron said
decision accomplish very much love mission the mission was accomplished here
exactly that’s exactly what and and and Cameron said it himself in Helmand trashy we’ve actually seen an
increase in the number of people coming in as a result to violence and so there
is this willingness to portray this is a success story on one lessons has to be to look at the
reality on the ground and under the hard facts maybe get a
balance between the humanitarian in the development assistance right and
to not provide medical assistance based on military or political objectives because
ultimately it boomerangs and actually has a negative
impact on on the health providers themselves in
terms that perception towards the population Christmas company myself as
well belligerence Christmas exactly so much
have about thank you doctor I’m a Jan 19 thank you as well and thank you for watching if you want
to send your feedback by email to Inside Story al Jazeera top that things to do thanks
again she represented

Daniel Yohans

3 thoughts on “Inside Story – The ill state of Afghanistan’s healthcare

  1. Aryan King says:

    Poop skins are incapable of running a proper health care system.

  2. Aryan King says:

    Even in the richest Arab countries like Qatar, all the doctors and surgeons are either white or Asian because Arabs are way too stupid for that kind of thing.

  3. Seraphine Demonspawn says:

    The other comments on this video terrify me.
    Shihab, if you're reading this page…I'm sorry.

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