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Afghanistan: Health-Care System A Microcosm Of Nation's Troubles

More than 200,000 civil servants in Afghanistan were finally paid this week as they began to receive six months' worth of back wages owed to them. The paychecks, amounting to some $8 million, are being financed by the United Nations Development Program. Both the Afghan government and the UN have stressed the importance of paying workers so they can continue to perform crucial duties as the impoverished country gets back on its feet. RFE/RL's correspondent in Kabul, Bruce Pannier, visited Afghanistan's Health Ministry to see how employees in this critical sector of Afghan society are faring.

Kabul, 23 January 2002 (RFE/RL) -- Officials from both the interim government in Afghanistan and the United Nations have stressed how important it is to pay the country's civil servants so they can continue to work in vital sectors of society, such as law enforcement, education, and health services.

At a press conference in Kabul on 21 January, the UN representative for Afghan aid agencies, Jordan Day, offered his assessment of health care in the country at present: "Six million Afghans have no, or very little, access to medical care. Every day, 45 women die of pregnancy-related causes, which leads to about 16,000 deaths a year. And one-fourth of all Afghan children do not live to celebrate even their fifth birthdays, and half have stunted growth due to chronic malnutrition."

RFE/RL visited Afghanistan's Health Ministry in Kabul and asked workers there to assess the situation in the country following more than two decades of war, and one month into the interim administration of Hamid Karzai.

Gulam Usman of the Afghan Health Ministry is responsible for working with international aid agencies. Officials in the Health Ministry are better paid than most in Afghanistan, making about $40 a month. Usman confirmed what the UN has been saying about back wages for civil servants: "[For] about six months, we haven't received our salary here."

Six months without pay, but still Usman, like hundreds of other civil servants, continued to come to work. The situation is especially frustrating for Health Ministry employees. Not only have they not been paid, but the health care sector received so little attention that there are shortages of practically everything.

Abdullah Aydiwydi is responsible for implementing UN health-care programs in Afghanistan. He hangs his head and stares at the floor when he lists some of the things needed to restore the effectiveness of the Afghan health care system: "We need X-ray machines, office materials, [and] computers to run our health facilities all over Afghanistan."

The building that houses the Health Ministry is itself evidence of how bad the situation is. There is no glass in the windows at the entrance to the building, allowing the cool winter air to flow inside. The building has no heat, so a small army of workers spends time feeding wood to the stoves placed in the offices of senior staff. Lower-level staff simply wear coats while they work.

Wazil Nizani is the assistant director for the international relations department at the Health Ministry. He says the government is basically starting from scratch. "Now, you know that the interim government and even the ministries, [like the] Health Ministry, has started from zero."

Despite the less-than-ideal conditions, no one at the ministry talked about repairing the building. Nizani, speaking for many, preferred to focus on what the ministry's staff considers the first priority.

"For the time being, and it's very important for us to have it -- the medicine, the medical equipment. You know, our hospitals, many of them do not have the necessary medicines to give the people, to give to the sick patients."

Much of rural Afghanistan is without any health care at all, and many of the hospitals in the big cities were destroyed. Aid agencies are speeding medicines and equipment into Afghanistan to correct the situation. Some countries have sent their own medical personnel to provide immediate care to the country's 20 million people.

And then there are the Afghans who themselves are interested in practicing medicine, but whose schooling was delayed by fighting or discouraged by the arcane rules of the Islamic fundamentalist Taliban.

Haiber Taubish is a doctor who trained in Afghanistan. He said the country's health-care system was in fairly good shape when he first started studying medicine during the time of President Najibullah, the last communist ruler of Afghanistan, who was overthrown by the mujahedin in 1992.

"After the fall of Dr. Najibullah's regime in Afghanistan, the medical system [and] all other systems in Afghanistan were badly destroyed."

After the fall of Najibullah, the Hezbi Wahdat group seized control of the area where Kabul University is located. Bitter fighting ensued, which kept the university's medical school closed for more than three years.

Eventually, the Jamiat Islami group took control of Kabul, and the medical faculty resumed teaching, only to be interrupted yet again when the Taliban took control of the city in 1996.

While the Taliban allowed medical studies at the university to continue, there were complications. First, medicine took second priority to Islamic studies, which, Taubish said, became increasingly part of the required curriculum. While Islamic courses occupied only an hour or two at first, these lessons gradually came to take up most of the day.

The Health Ministry's Nizani said the influence of the Taliban was particularly devastating for Afghanistan's health-care system: "I have to say that during the war, this last war, and during the last five years of the Taliban government, we lost everything. Even the buildings were destroyed. When the Taliban came to power, they terminated the [medical] staff. They just terminated the expert staff -- doctors, even administrative staff."

Far more frustrating for medical students was the Taliban's prohibition against depictions of the human form. Diagrams of the human body in medical textbooks were forbidden. Models of the human body were removed. There was no question of working on cadavers, a practice common to medical schools in most countries.

These prohibitions led to professors urging their students to continue their studies secretly, using grim methods. Taubish explained the lengths to which some students went to continue their training.

"When the Taliban came, there wasn't anything for studying, to learn better and improve the knowledge. So students could find bones very secretly. Maybe they dug up graves, and they could find some bones and study that. Maybe sometimes students used the organs of animals -- especially the heart and kidney. I myself used the kidneys of sheep."

The tragedy is that there are many in Afghanistan like Taubish -- trained medical workers who have been working as taxi drivers or, as in Taubish's case, in flower shops. They are eager to practice their chosen profession again, but for now they must wait until the nation's health-care system has been repaired and jobs become available again.