Fawzia, who was a midwife at the hospital at the time, was already in the ward when the shooting started. “There were seven mothers in the ward and I helped them all escape, and then I ran to the safe room, but it was already locked, so I ran outside and I saw a group of men jumping over the wall into the courtyard of the guest house next door. I tried, but I couldn’t climb over the wall. So I hid behind a rubbish bin,” she said. “I had one newborn baby with me, and we just hid there behind the bags of rubbish.”
“I had one newborn baby with me, and we just hid there behind the bags of rubbish.”
A week after the attack, Aquila and the other midwives were summoned to the hospital. They were told that MSF was leaving. The organization had operated the maternity ward since 2014, providing care to over 1,200 women a month, but the attack made them decide to cease operations and completely withdraw from the 100-bed hospital – leaving women in the area without vital emergency obstetric care, and the midwives with an uncertain future.An MSF representative said they "made the difficult decision to leave Dasht-e-Barchi in the aftermath of the attack because while we still don’t know who was responsible, we know enough to realise that the maternity [ward] was targeted.”
Many rural Afghan women have no access to basic health clinics, and two-thirds of births in the country happen at home. For decades, Afghanistan battled one of the highest infant and maternal mortality rates in the world, particularly in rural areas, where as few as 3 percent of deliveries are attended by a skilled professional. Postpartum hemorrhaging remains the leading cause of maternal death.
Those who could afford to stay were given subcontracts with MOPH until November last year and had their salaries cut by more than half. Understaffed, the hospital had to shut down the operating theatre and blood laboratory for several months, and the neonatal unit remains closed.
“The other day, a woman gave birth and asked for a diaper, and I couldn’t even give her that. She couldn't even afford a diaper, and there was nothing I could do.”
At warp speed, the Taliban took over the country, officially overthrowing the U.S.-backed government on August 15. Amid the U.S. military drawdown, donors began pulling more support out of Afghanistan. One of the first hospitals to lose its international funding was Dasht-e-Barchi. Today, just over two months since the takeover, the situation is dire.The United Nations Office for the Coordination of Humanitarian Affairs reported this month that as of the middle of the year, nearly half of the population, or 18.4 million people, were already in need of humanitarian and protection assistance. The country is heavily donor-dependent, with 75% of the total public health expenditure coming from external aid. But after the Taliban seized power, the World Bank and other international donors froze $600 million in healthcare aid. This month U.N. spokesman Stéphane Dujarric appealed to donors for $606 million to pay for humanitarian programs through the end of the year. So far, that appeal is only 22 percent funded.
Despite progress made since 2001, when the first Taliban regime ended, childbirth remains the most serious problem Afghan women face, and maternal mortality is still the leading cause of death in the country. According to the most recent U.N. data, one out of 52 women die from pregnancy-related causes. Before starting work with MSF nine years ago, Laila was living in Iran and working as a teacher. “I remember hearing about mothers and children in very poor health conditions and I thought, ‘Afghanistan is my country; I should go back.’ And so, I studied a midwifery course in Iran, and then I came to Afghanistan with the promise to myself to help the women and decrease the maternal mortality in the country,” she said.Laila earned 29,000 Afghanis ($329) a month while working for MSF, of which 20,000 came from MSF and 9,000 came from the MOPH, she said.“Now, under the Taliban, none of us are receiving our salaries.” She said it has been more than three months since the hospital staff in Dasht-e-Barchi received their salary, and no one knows who controls the MOPH now or who would fund it.
Meanwhile, the World Health Organization warned that two-thirds of the roughly 2,300 healthcare facilities it supports have run out of essential medicines. Only about 400 are now functioning, and according to the MSF representative some medical professionals have been working without pay for up to five months.
“But we cannot stop our work. If we stop, how can our families survive, and how will our community survive?”The Taliban have moved into the hospital, to keep watch. “Two representatives on behalf of the new government have come and reserved a room here. So the Taliban are here, all the time, at the hospital, to control things, and they are checking everything and monitoring us,” said one healthcare worker who chose to be anonymous for her protection.Some of the midwives have now left the country, and Aquila and Masooma stopped working at the Dasht-e-Barchi hospital.
“Now, the Taliban have taken our country and we don’t feel safe here anymore. Of course, if you are at home, you also don’t feel safe. If I’m at home and my children are in school and my husband is going somewhere, I’m worried about them,” Laila said. “My husband thinks the same about me, especially when I am coming [to the hospital] for work.”
“I am jobless now. I am not able to find any work, and I don’t feel like myself anymore. I don’t feel secure because everyone in the community knows us and [knows] that we work with women in the hospital. Everything has changed,” Masooma said. “Now, when I go out, I wear long clothes. I’m really struggling to manage. I have lots of stress.”For those still at Dasht-e-Barchi, the future is uncertain. For now, the Taliban have allowed them to continue their work. “But any day, they could come and tell us all to leave,” said Laila. “I’m most scared about security. And because we are not secure, psychologically we are struggling. Every day, we are working at the hospital and we are scared.”Unpaid and burdened with uncertainty, Laila and the others still at the hospital soldier on. “We will not stay at home in fear. We will continue our work.”Outside the maternity ward, no security guards stand at the gate to the hospital. The courtyard is deserted and the hallways are silent except for the gentle swish of a mop as a cleaner dips it into a bucket. And then a cry – the only birth this morning. The first child for a mother who had travelled from neighbouring Laghman province.The midwives are still here, still working, for now. Follow Lynzy Billing on Twitter and Instagram.
Unpaid and burdened with uncertainty, Laila and the others still at the hospital soldier on. “We will not stay at home in fear. We will continue our work.”