Healthcare in Afghanistan: ‘Doctors are threatened at gunpoint, even by civilians’

It’s dangerous to be a doctor in Afghanistan.

This is what the staff deal with most days at a hospital in the country’s north-west: physical attacks by patients’ relatives; gun-wielding soldiers inside the wards; and verbal assaults and threats of bodily harm against doctors and nurses who are only trying to help.

An Afghan surgeon I’ve met keeps a gun at home for protection, and I understand why.

Assailants recently attacked two female nurses, causing cervical spine injuries. Another nurse responding to a mass casualty event arrived at the hospital to be assaulted and choked by relatives of a wounded patient who were demanding immediate service.

Why does this kind of violence happen in hospitals in conflict zones? There is no easy answer to that question. A patient, relative or combatant could be in pain, confused and stressed, in a life or death situation and an unfamiliar environment. They may well be angry, armed or suspicious about our neutrality. They’re living in a community consumed by conflict. But that does not mean violence, of any kind, against medical professionals is acceptable.

Doctors and nurses, ambulance drivers and paramedics, hospitals and health centres have all come under attack in Afghanistan. This disrupts the delivery of medical care when people need it most. Patients – both civilians and combatants – die because they are prevented from receiving needed care. The disruption can be so severe that the entire system collapses.

“No weapons” signs are routinely ignored at the hospital entrance in Maimana, capital of Faryab province. Recently I watched two soldiers, M16 rifles dangling over their shoulders, standing guard over a wounded comrade. When I asked the staff why we didn’t disarm them, I was told they were protecting their fellow soldier.

Staff don’t dare tell the soldiers to leave their arms outside and you can understand why. When a military commander was shot dead inside the hospital by opposition fighters two years ago, the doctor on duty was the one arrested, although he was later released. Arms carriers have since become even more reluctant to yield their guns before entering the hospital.

The hospital security guards once tried to disarm men entering the grounds with guns and were beaten. When a hospital administrator tried to take away weapons from a security official, the official threatened to kill the administrator. He later apologised but the deed was done.

I have witnessed these violations while working on an International Committee of the Red Cross surgical team. We are carrying out short missions to some of Afghanistan’s most important hospitals to assist the medical teams and help them learn more advanced techniques.

The Maimana hospital is fairly well equipped, and has four skilled surgeons and good hygiene standards. That’s better than many Afghan hospitals. But police officers, soldiers and even civilians there routinely threaten doctors and nurses to compel them to provide priority care at the point of a gun.

Even health workers’ families are not safe. A surgeon’s child was briefly kidnapped just a month ago. Another doctor’s child was kidnapped a few months earlier, forcing the doctor to sell his home to pay the ransom. One surgeon and his family were so afraid of the recurrent threats that they simply packed their bags and left.

This all leads down a dangerous, deadly path.

My message to community leaders, fighters and even average citizens is clear. It is the same message that my colleagues are using in conflict zones across the world: if you don’t respect and protect the healthcare workers, you will soon find no one left to care for you.

Wars must have limits, so respect the laws of war. Respect hospitals and the staff working in them. Let them do their jobs.

Neill Kling is a surgeon with the International Committee of the Red Cross’s mobile surgical team in Afghanistan

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