Making it Work: Providing Medical Care in Kunduz, Afghanistan

·6 min read

Fighting in the city of Kunduz in north-eastern Afghanistan ended on August 8, 2021. During the clashes, Médecins Sans Frontières (MSF) transformed its office space into a temporary trauma unit to treat the wounded. That unit is now closed, and on August 16, all patients were transferred to the nearly-finished Kunduz Trauma Centre that MSF had been building since 2018. The local community still requires trauma care. A medic in MSF’s Kunduz team describes their experience during the fighting and the work that is going on today.

It is busy but calm; we’re recruiting new staff, and the final parts of finishing the hospital construction are happening all around us. But first things first – starting with the day when clashes began in Kunduz city.

That first evening there was continuous bombardment and shooting, so, we had to rush to the bunker, where we stayed all night, without any sleep. Patients were unable to reach the trauma unit due to the non-stop fighting in the streets.

The following morning, we received news of multiple victims arriving at the unit. We were unable to get there because of continuous clashes on the streets. My colleagues were desperate – we had a patient with a gunshot wound in his chest and stomach, who needed immediate surgery.

Finally, once the gunshots grew quieter, the three of us ran to the operating theatre. The patient had no pulse, so we started chest compression while the anaesthetist searched for an airway. I cut two holes in the chest - to make sure blood could drain out and to allow the lungs to expand; meanwhile my colleague was trying to stop the bleeding below the sternum. We could tell pretty quickly that the bullet had probably hit part of the heart, and that there was no way that we could save him.

<div class="paragraphs"><p>Dr Bart Scharuwen, nursing activity manager Jane Hancock and nurse Marzia perform cardiopulmonary resuscitation on a malnourished baby with asthma, who sadly passed away, in the operating room of Herat regional hospital. (Afghanistan, December 2020.)</p></div>

Dr Bart Scharuwen, nursing activity manager Jane Hancock and nurse Marzia perform cardiopulmonary resuscitation on a malnourished baby with asthma, who sadly passed away, in the operating room of Herat regional hospital. (Afghanistan, December 2020.)

Hard days

This was only the beginning, as we soon realized. Several victims needed surgery, many had gunshot wounds, others were injured by bomb blasts; and a lot were caught in the crossfire.

Most of our staff could not reach the trauma unit. Colleagues on night shift worked through the day. Some would sleep while others worked so we could keep going from morning and into the night.

At about 6:30 am the next morning, an ER doctor called on the radio, saying “I need your help now”. The fighting had receded for a bit, so I ran across the road with the surgeon. When we reached the unit, it was crammed.

Four patients needed emergency surgery at the same time. In the end one could not survive, but we managed to save three of them, all of whom had very severe gunshot wounds and bomb blast injuries. In between all this, we still needed to assist other patients who needed care.

<div class="paragraphs"><p>Zakia has just given birth to twins, Abbas and Qasim, born 20 minutes apart. Abbas, who came first, is also the smallest; he was hypoglycemic at birth and was placed in the incubator for a few hours. (Afghanistan, Dec 2019)</p></div>

Zakia has just given birth to twins, Abbas and Qasim, born 20 minutes apart. Abbas, who came first, is also the smallest; he was hypoglycemic at birth and was placed in the incubator for a few hours. (Afghanistan, Dec 2019)

An unexpected case

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

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

We packed up the wound again and tried to stabilise the hand. The only thing remaining in his arm was the artery going all the way to the 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 debride [clean] the wound and keep the tissue alive, attached an external fixator (a metal bracket to hold the bones in place while mending) to let it heal for as long as possible.

As of today, the boy still has his arm. It will never be as functional, but we didn’t expect that we would be able to make it work. The boy was obviously quite scared of doctors – he expected a lot of pain when he saw any of us. We never really saw him smiling, though he did smile at his father.

After the fighting receded, more patients began coming in. We also saw an increase in patients who were referred to us from provincial hospitals. Many a time, we go into surgery only to realise that we didn’t have too many options left.

Moving to the new hospital

In Kunduz, the rebuilding of our hospital has been going on for quite a while. Two weeks prior to this, we transferred patients from our temporary clinic to the hospital. It was a huge step for us.

Initially, we saw patients with active gunshot and bomb blast injuries. Soon, we began to receive patients with war wounds who need follow-up treatment. We also saw traffic accident victims, as society opened up again. Everyone here drives on their motorcycles without a helmet; when they fall, they suffer head traumas. Since we don’t have neurosurgeons, sometimes there is little we can do.

Making it work

In the Kunduz Trauma Centre, we continue our medical work even as the construction goes on. There is a lot of innovation and speed despite the setbacks. For instance, a bearer had problems passing a stretcher over the uneven ground because there was too much rubble. In no time, there were people putting concrete over the rubble. It’s quite incredible how the construction team always steps in to fix the problems the medical staff encounter.

We have the same support from the team responsible for the hospital compound. One of them is always on a bicycle, cycling from one department to the other, fixing things rapidly. Similarly, we would see medical items and supplies suddenly appearing at the front step of the departments, followed by more packages sent for us to treat patients.

There’s also the recruitment aspect: We have exams for staff going on, as well as hoping to start recruiting mental health officers – something we urgently need.

In a nutshell, this is our lives at the moment: every individual and team doing their best to help each other, trying to just make it work.

MSF has been working in Afghanistan since 1980, with a short absence in 2004 following a critical incident. After the change in regime, since August 15, 2021, MSF has continued activities in 5 project locations: Herat, Kandahar, Khost, Kunduz and Lashkar Gah. Now that fighting has mostly ceased in the provinces people can move more easily, and we have seen a subsequent increase in patient intake in some projects, particularly Herat and Lashkar Gah. Health structures are under great pressure with staff and equipment shortages which means patients sometimes 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. In the last few decades, their work in South Asian countries has become relevant more than ever before. Four years after the Rohingyas fled Myanmar, MSF continues to provide healthcare in the largest refugee camps in the world. In India, they provide comprehensive treatment for drug-resistant tuberculosis, advanced HIV, mental health illnesses, while in Pakistan, they provide pediatric, maternity and trauma services and treat cutaneous leishmaniasis. As long as people on the margins 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, creed or political affiliation, and that the needs of these people are essential. In December 2021, they mark 50 years, but their commitment remains just as firm as it was on day one. For more details about MSF’s work please click here.

You can make a contribution to MSF’s life-saving activities by working with us, please click on this link to know more.

To see a timeline of key events and photographs from the history of 50 years of MSF, please click here.

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