Providing medical care in Kunduz, Afghanistan



Difficult days

This was just the start, as we quickly understood. Several victims had to be operated, many were wounded by gunshot, others were wounded by bomb explosions; and many have been caught in the crossfire.

Most of our staff were unable to make it to the trauma unit. Night colleagues worked all day. Some slept while others worked so that we could continue from morning till night.

At around 6:30 am the next morning, an emergency doctor called on the radio saying “I need your help now”. The fighting having subsided a little, I ran across the road with the surgeon. When we reached the unit it was packed.

Four patients had to be operated urgently at the same time. In the end, one of them couldn’t survive, but we managed to save three, all of whom were suffering from very serious gunshot wounds and bomb explosions. In between, we still needed to help other patients who needed care.

An unexpected case

One of our patients was a young boy, brought in by his father, already with a bandage on his arm. He was not crying and the matter did not immediately seem so urgent to me. The fingers sticking out of the bandage seemed well circulated and warm, so I took my time demonstrating proper investigation for the nerve damage. The boy seemed to feel nothing in his hand, suggesting that three different nerves were severed.

I gently unwrapped the bandage from his arm. To our shock, there was only a gaping hole in his forearm. The father explained that a stray bullet hit him while the kid was playing.

We repaired the wound and tried to stabilize the hand. The only thing left in his arm was the artery that went to his fingers; but the nerves were all damaged.

Medically, we agreed that amputation was the best option. The father, however, wanted to save the arm. We did our best to unleash [clean] wound and to keep the tissue alive, attached an external fixator (a metal support to hold the bones in place during repair) to let it heal as long as possible.

To this day, the boy still has his arm. It will never be this functional, but we never expected to be able to make it work. The boy was obviously very afraid of the doctors – he expected a lot of pain when he saw us. We never really saw him smile, even though he smiled at his dad.

After the fighting ended, more patients began to arrive. We have also seen an increase in the number of patients referred to us by provincial hospitals. Often times we go to surgery only to realize that we don’t have too many options.

Move to the new hospital

In Kunduz, the reconstruction of our hospital has been underway for some time. Two weeks ago, we transferred the patients from our temporary clinic to the hospital. It was a big step for us.

Initially, we saw patients with active gunshot wounds and bomb detonation wounds. Soon we began to receive patients with war wounds who needed follow-up treatment. We also saw victims of traffic accidents, as the company reopened. Everyone here rides their motorbike without a helmet; when they fall, they suffer from head trauma. Because we don’t have neurosurgeons, sometimes there isn’t much we can do.

Make it work

At the Kunduz Trauma Center, we continue our medical work even during construction. There is a lot of innovation and speed despite the setbacks. For example, a porter had problems passing a stretcher over uneven ground because there was too much rubble. In no time at all, there were people putting concrete on the rubble. It’s pretty amazing how the construction team always steps in to resolve issues faced by medical staff.

We have the same support from the team responsible for the hospital grounds. One of them is still on a bicycle, going from one department to another, fixing things quickly. Likewise, we would suddenly see items and medical supplies appear in front of the wards, followed by other packages sent for us to treat patients.

There’s also the recruiting aspect: we have staff exams going on, and we’re hoping to start recruiting mental health workers – something we urgently need.

In a nutshell, this is our life right now: every individual and every team is doing their best to help each other out, just trying to make it work.

MSF has worked in Afghanistan since 1980, with a short absence in 2004 following a critical incident. After the regime change, since August 15, 2021, MSF has continued its activities at 5 project sites: Herat, Kandahar, Khost, Kunduz and Lashkar Gah. Now that most of the fighting has ended in the provinces, people can move around more easily, and we have seen a subsequent increase in the number of patients in some projects, especially in Herat and Lashkar Gah. Health structures are under great pressure with staff and equipment shortages that sometimes mean that patients cannot access the care they need.

MSF has been providing life-saving medical care and humanitarian assistance in crises like these since its inception in 1971. Over the past decades, their work in South Asian countries has become more relevant than ever. Four years after the Rohingya fled from Myanmar, MSF continues to provide care in the world’s largest refugee camps. In India, they provide comprehensive treatment for drug resistant tuberculosis, advanced HIV, mental illnesses, while in Pakistan, they provide pediatric, maternity and trauma services and treat skin leishmaniasis. As long as marginalized people are excluded from health services, MSF’s humanitarian work will continue to be relevant.

MSF was created with the belief that all people have the right to quality medical care, regardless of gender, race, religion, beliefs or political affiliation, and that the needs of these people are essential. In December 2021, they celebrate their 50 years, but their commitment remains as firm as the first day. For more details on MSF’s work, please click here.

You can contribute to the vital activities of MSF by working with us, please click on this link to find out more.

To view a timeline of key events and photographs of MSF’s 50-year history, please click here.



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