HIGHLIGHTS
Armed groups force clinics to close and deny civilians access to health care to pressure NGOs to provide more trauma care for their combat-wounded.
Doctors and medical professionals are under threat across the country by armed groups and criminal gangs.
Cash assistance exceeded US$9.5 million in the first four months of the year.
Displaced families in Taloqan face a difficult life as solidarity in the host community wears thin.
CHF-Afghanistan funded with less than half of its target for the year.
In this issue
Armed groups force clinics to close P.1
Medical staff threatened and at risk P.2
Cash programming grows further P.3
New insights from the IOM DTM P.4
500,000 people denied access to health care
For several weeks in June and July, nearly half a million people in Laghman Province were unable to see a doctor or seek medical care and an estimated 70,000 girls and boys were missed by the national polio immunization campaign. Members of Non-State Armed Groups (NSAGs) had forced the NGO Swedish Committee for Afghanistan (SCA) to close down 40 of their 54 in the whole province.
Following weeklong mediation efforts from local communities, 20 clinics reopened, while as many remained closed in three districts. However, after receiving new and increasingly direct threats to staff members, SCA also decided to close their health management office in Mehtarlam.
NSAGs in need of war surgery pressure NGOs via denying people health services This incident may be unique to date in its magnitude, but is not an isolated occurrence with similar intimidation and interference by members of NSAGs reported in Farah and Badghis provinces. In all cases, NSAGs have attempted to coerce the NGOs running the clinics to either move them into areas firmly under their control or to change the scope of health services.
This interference comes at a time when casualties on both sides of the conflict have become unsustainably high. In 2016, the Afghan National Defense and Security Forces (ANDSF) recorded more than 18,500 casualties and NSAGs 30,500.
Heightened NSAG casualties combined with limited opportunities for in-country and external patient transfer have increased pressure on the district-level hospitals for stabilisation and casualty management services to be provided, and suggest that these tactics are part of wider NSAG efforts to extract enhanced emergency treatment for their combatants. Trauma care, already a rarity in a country where casualties are on the rise, usually is only available in hospitals, not the smaller clinics and health posts.
National policies, not NGOs decide which services are to be provided where The affected NGOs to date were all contracted by the Ministry for Public Health to provide the Basic Package of Health Services (BPHS). These services are guided by national health policies and the number of people living in a catchment area and can’t therefore be altered based on individual requests for improved healthcare delivery in a context where the demands of the conflict are constantly shifting (see Bulletin 65, June 2017).
In a further twist, NSAGs threatened health workers at the end of July to close five health facilities in government-controlled areas along Highway 1 in Zabul. NSAGs were possibly trying to compromise the ability of ANDSF personnel to access treatment. More than 80,000 people were deprived of access to health care as a result. After one week of negotiations, the facilities were able to re-open.
SCA also was able to re-open their remaining 20 clinics and the management office on 1 August, after extensive dialogue with communities and by reassuring all stakeholders in words and actions that SCA provides quality healthcare services to all, irrespective of whether civilians or combatants. The NGO also was presented with a letter by local com-munity elders committing to safeguard SCA’s workers and facilities.