This story is part of a partnership between MedPage Today and VICE News.
Doctors Without Borders/Médecins Sans Frontières (MSF) has withdrawn from the Afghan city of Kunduz following an airstrike on its hospital there, leaving patients in and around the war-ravaged province without modern trauma care.
The MSF Kunduz Surgical Hospital was built in 2011 to treat people who sustained injuries from bomb blasts, gunshots, and shrapnel as well as those who experienced various forms of severe physical trauma from traffic accidents and the like. A government provincial hospital was located nearby, but it wasn't functional.
The MSF facility "was the only center in the region that provided care to victims of accidents and attacks in the northeast of Afghanistan," MSF spokesperson Tim Shenk said. "Patients came from surrounding provinces such as Baghlan, Takhar, and Badakhshan."
Even so, it was difficult for them to get to the hospital. An MSF study found that one in five Kunduz patients waited 12 hours before going to the hospital because of security reasons like outbursts of fighting with the Taliban or because it wasn't safe to travel at night, and sometimes because they couldn't find transportation.
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When the hospital opened four years ago, it had 55 beds, an emergency room, two operating rooms, and an intensive care unit as well as X-ray and laboratory facilities, according to MSF. But as the need for trauma medicine grew, so did the number of beds.
Heavy fighting began in Kunduz on September 28, and the hospital had more patients than ever.
"The hospital is inundated with patients," Guilhem Molinie, MSF's country representative in Afghanistan said in a statement the following day. "We have quickly increased the number of beds from 92 to 110 to cope with the unprecedented level of admissions, but people keep arriving. We have 130 patients spread throughout the wards, in the corridors and even in offices. With the hospital reaching its limit and fighting continuing, we are worried about being able to cope with any new influx of wounded."
The hospital staff treated 171 patients over the course of those two days, 50 of whom arrived in critical condition. It was doing some of its most critical work before tragedy struck.
Molinie said that both sides of the conflict had assured MSF that its hospital, ambulances, staff, and patients would be left alone — but a US airstrike hit the hospital on October 3, killing 22 people patients and staff members and injuring at least 37 others.
"We tried to take a look into one of the burning buildings. I cannot describe what was inside. There are no words for how terrible it was," said MSFnurse Lajos Zoltan Jecs, who was in the facility when it was bombed but managed to get to safety. "In the Intensive Care Unit six patients were burning in their beds."
MSF has been forced to abandon Kunduz following the airstrike because its hospital is no longer functional, the organization said. MSF still has staff at facilities in Kabul, Khost, and Helmand, as well as in the Gulan refugee camp.
Related: MSF Says Afghan Hospital Was 'Repeatedly Hit' by Bombs in Prolonged Attack
Afghanistan's health status is one of the worst in the world, according to the World Health Organization. Not only are maternal and infant mortality rates higher than those in neighboring countries, but tuberculosis and malaria, cholera, hemorrhagic fever, measles, pertussis, and meningitis epidemics are common.
In 2014, MSF performed 306,000 outpatient consultations, 7,800 surgeries, and assisted 39,600 births in Afghanistan. Its Kunduz hospital treated 22,193 people and performed 5,962 surgeries that year.
"You have a relatively modest dissemination of contemporary medicine from major centers out into the remote rural areas. People have to come into the major cities in order to get anything close to what we might call more sophisticated medical care," said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University in Nashville, Tennessee. "If that's suddenly gone, then people in the city as well as folks 10, 15, 30 miles away don't have that resource."
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