The Risk of Closure of 33 Hospitals Supported by the International Committee of the Red Cross in Afghanistan

Introduction

Afghanistan, a low-income country divided into 34 provinces and 399 districts, has a history marred by civil and international conflicts. Recent political changes, marked by the Taliban's return to power in 2021, have brought both positive developments and intensified existing challenges. Amid these changes, a looming crisis threatens the healthcare system, especially the closure of 33 hospitals supported by the International Committee of the Red Cross (ICRC) across the country. This urgent concern calls for international attention, including that of the Japanese government.

Healthcare Landscape in Afghanistan and the Looming Crisis 

Afghanistan's healthcare system heavily relies on donor grants, from small community centers to large urban hospitals. Primary health care (basic health services), secondary healthcare facilities (district hospitals and provincial hospitals), and tertiary hospitals (regional hospitals and teaching hospitals), funded mainly by donors like USAID, the European Union, the Foreign Commonwealth and Development Office (FCDO), and Canada, operate under the Humanitarian Emergency Response (HER) program but despite continued efforts, only a quarter of its required funds for 2023 have been secured, leaving a significant gap of $2.2 billion. This presents an uncertain future for these facilities after December 2023.

 Following the change in power in 2021, the ICRC became a lifeline for Afghanistan's hospital sector, sustaining 33 hospitals across the nation; these hospitals, encompassing 6,783 beds and 10,819 personnel, included specialty training centers and medical teaching institutions. With eight hospitals tied to the Ministry of Higher Education and 25 to the Ministry of Public Health (MOPH), this vital support is at risk due to a funding shortage. The ICRC has notified relevant authorities of its impending withdrawal of support, thereby placing these hospitals in jeopardy. List of the hospitals is available in the annex.

 Potential Consequences of Support Withdrawal

 The potential consequences of the withdrawal of support for the 33 hospitals in Afghanistan are profound and far-reaching, with the collapse or reduction in services offered by these hospitals having the potential to significantly worsen the ongoing medical care crises in the country, further deepening the prevailing humanitarian challenges.

The quality of medical education and training programs are at risk of suffering, which could directly impact the development and availability of a skilled healthcare workforce in Afghanistan. Additionally, the loss of support could place an overwhelming strain on hospitals with highly specialized care, potentially causing a decline in their utilization and prompting an increased number of medical referrals to neighboring countries and placing a substantial burden on both citizens and the country's economy. The ramifications extend to emergency preparedness as well, potentially disrupting crucial routine immunization programs, including those for COVID-19, thereby posing a huge risk to public health.

 There is also a concern about the loss of trust in the healthcare system, which could deter medical professionals from remaining in the country and weaken the overall healthcare infrastructure. Collectively, these potential outcomes underscore the urgent need to address the looming crisis surrounding the hospital sector in Afghanistan.

 Suggestions for the Future

 To avert the impending crises in medical care and education, a concerted effort from the international community, including the government of Japan, is essential. It will be extremely difficult for the government of Afghanistan to fully finance the 33 hospitals throughout the country, so the donor community can play a pivotal role by providing medical supplies and humanitarian assistance to preserve the healthcare sector in Afghanistan.

In conclusion, the threat of closing 33 hospitals supported by the ICRC poses a grave risk to medical care and medical education in Afghanistan. The government of Japan, leveraging its humanitarian resources, can step in to help avert this impending medical catastrophe, and by doing so, Japan can contribute significantly to safeguarding the health and well-being of the Afghan people. 

References:

1: BBC Pashto news report. Accessed August 18, 2023. Available at: سره صلیب ویلي، د

بودیجې لږوالي له کبله افغانستان کې د ۲۵ روغتیايي مرکزونو ملاتړ دروي - BBC News پښتو

2: Interview with the National Emergency Operational Center manager for polio

eradication, Ministry of Public Health, Afghanistan

3. Afghanistan Humanitarian Response Plan 2023. Accessed August 18, 2023.

Available at: Afghanistan Humanitarian Response Plan 2023 | Financial Tracking

Service (unocha.org)

Annex: list of ICRC supported hospitals 

DR. WRISHMEEN SABAWOON

Senior Advisor

Dr. Wrishmeen Sabawoon is a global health and public health specialist with extensive experience in Afghanistan. He graduated from Kabul Medical University in 1999, worked as a Primary Health Care (PHC) training officer in the Nangahar Province, and later as the PHC Director with the Ministry of Public Health. Dr. Sabawoon also worked as the Health and Information System and Nutrition Manager and Provincial Coordinator with the International Medical Corps (IMC), a renowned non-governmental organization. He was part of the Global Polio Eradication Initiative (GPEI) in 2013 as an epidemiologist in the Office of the President's Focal Point for Polio Eradication based in the Presidential Office in Kabul city, Afghanistan from 2013-2019, where he concurrently received his doctorate in epidemiology at the University of Tokyo. Dr. Sabawoon is currently a Senior Advisor at LIAISON as well as a visiting researcher at the Decision-Making Laboratory, Center for Decision Making, Waseda University.