Afghan's Health Care System Ailing

By Kathy Gannon, Associated Press,
Monday 28 September 1998 3:41 AM EDT

KABUL, Afghanistan (AP) - Even a minor illness can be fatal in today's Afghanistan.

Most humanitarian aid groups have pulled out of the beleaguered capital of Kabul rather than heed an order from the ruling Taliban religious army to move into abandoned university dormitories.

The few foreigners left behind by the International Red Cross and the World Health Organization race around trying to help local health workers keep dozens of clinics and 14 hospitals running with few medical supplies.

After two decades of war, Afghanistan is an all too easy place to get sick or wounded. Apart from causing injuries, artillery, rocket and mortar fire have wrecked the city's water, sewage and sanitation systems, inviting epidemics like the current cholera outbreak in Kabul.

Dr. Mohammed Daim Kakar, a director for WHO, the United Nations health agency, said medical supplies are critically needed by the infectious diseases control center.

But even treating minor maladies is a daunting job in overflowing civilian hospitals that often have to turn away the sick.

We are short of everything - medicines, equipment, doctors, said Dr. Maruf Aram, deputy head of the medical department at Aliabad Hospital, once one of Kabul's finest.

Outside Aliabad, a teaching hospital that used to attract the country's best doctors, patients in unwashed clothes carry their own intravenous drips as they shuffle around the compound. A white and red ambulance, though much needed, sits in the parking lot, sagging on a flat tire, its headlights smashed.

Beneath the trees, patients lie on the grass and chat with visiting kin. An old man, barely able to hold his head up, gets a haircut from his son.

Not even the original Aliabad survives. Four years of warfare between rival Islamic factions left the building in ruins, forcing relocation to a shabby maternity hospital, where the steel beds are barely covered with tattered sheets.

Most of the hospital's windows are broken, and the building's last coat of paint is little more than a memory.

The hospital is so short of drugs that patients have to buy their own at local markets. If they can't afford them, that's their problem, Aram said. y Not even doctors have money because few have seen their roughly $10-a-month wage in four or five months.

We have no economy, but we do what we can, said Sher Mohammed Stanikzai, deputy public health minister for the Taliban government. We provide some essential medicines and equipment, but there is very little money.

The Red Cross says it cannot fill the gap left by the departure of humanitarian groups.

Even before the aid groups pulled out, health care was a sensitive issue because the Taliban ordered the segregation of male and female patients and dismissed female health care workers.

Since seizing Kabul in 1996, Taliban militiamen have imposed a restrictive brand of Islam that bans women from working and prevents girls from going to school.

Out of necessity, Taliban leaders relented and allowed many female nurses and doctors to return to work, but they insisted the women wear all-enveloping robes and treat only women. Then the Taliban ordered all women to work and be treated at one hospital - the Rabia Balkhi Hospital.

But while some hospitals remain off limits, except in emergencies, WHO says beds are beginning to open up for female patients at the two hospitals supplied by the Red Cross. According to a WHO survey, there are 1,157 hospital and clinic beds available for women and 1,531 beds for men.

At the women-only Rabia Balkhi Hospital, its director and the only woman among the Taliban's hierarchy, Dr. Seliana Nabizada, says she is aware of Western criticism of the Taliban's treatment of women.

She watched as the Taliban last year threw out European Union Commissioner Emma Bonino, the trade bloc's top humanitarian aid official, for taking pictures of female patients, a serious offense under Taliban rules. After Bonino's visit, all foreign aid to Rabia Balkhi was stopped, which Nabizada said hurt female patients without fazing the Taliban leadership.

She said the Taliban needs to do more for the health and rights of women. But she is clearly proud of her hospital.

It's a hospital for women, run by women, she said.

She took broken equipment, such as an X-ray machine that hadn't worked for eight years, and hovered over male technicians until they fixed it. She badgered Taliban leaders into allowing male specialists to treat women, and she now has 40 male doctors at her hospital.

I say to the Taliban leaders: `You have to accept our rights. We have our rights,' she said.