An article by Doctor Éric Cheysson, President of La Chaîne de l’Espoir

Since 2001, I’ve been going to Afghanistan three or four times a year to take part in the Board of Directors of the French Hospital in Kabul[1]. Since the return of the Taliban on August 15, 2021, I’ve made no exception. The frequency and regularity of these trips give me a clear picture of developments at the hospital, of course, but also of the general situation in the country, thanks to the many exchanges I have with my Afghan colleagues.

These days, when I walk through the doors of the hospital, I’m always amazed at the frenetic activity in the wards. Due to an ever-increasing influx of patients from all over the country, all sectors are running at full speed: paediatric surgery, nutrition department, laboratory, radiology, scanner, intensive care unit, etc. This influx is the result of several factors.

This influx is the result of several concomitant factors: the explosion of needs linked to the humanitarian crisis; the restoration of security, which facilitates travel; the failure of many health centers due to unpaid salaries and a lack of consumables and medicines; and finally, the impossibility for a large part of the population to access care from private health infrastructures due to the high level of poverty.

The hospital and the Women’s and Children’s Pavilions are now operating at maximum capacity. Between January and September 2023 alone, we counted over 10,000 admissions to the hospital, including 4,000 surgical operations and 442 open-heart cardiac surgeries. Never before has this volume been achieved. The density in the hospital is such that it makes the repeated demands of Ministry of “vice prevention and virtue promotion” officials for the separation of men and women totally impractical and illusory. When 30 people are waiting for a scan or a laboratory sample, how can you respect a watertight separation between men and women: welcome to “Absurdistan”!

In an extremely difficult environment, keeping the hospital running on a day-to-day basis is no mean feat. We face basic problems, such as maintaining sufficient, uninterrupted electrical power for all key areas such as the operating theatre, adult and neonatal intensive care, and radiology. Technical teams need to be able to call on generators quickly during daily power cuts. To alleviate this problem, we have continued to develop solar energy on the land still available and on the roofs. This solution now enables us to provide 12% of the electricity consumed by all our buildings. We are also facing a water supply problem caused by the severe droughts of recent years, forcing us to dig a new well up to 220 metres deep in an attempt to reach the water table.

In terms of human resources, we remain deeply concerned about maintaining the right of women to work at the hospital, which has 280 of its 960 employees. We have set up a bus service to take them home to avoid the usual hassle. We are also concerned about the major brain drain that has taken place since the Taliban returned to power, and which threatens the hospital’s survival. 160 of the hospital’s doctors and nurses have already left the country, driven by the political situation and the perpetual threat to women and girls. Any doctor or nurse with a little girl at home cannot bear the total lack of future offered to them by this regime. We have the appalling impression of witnessing a veritable social feminicide, unique in the world, so much so that it seems that the authorities’ priority is to make women disappear from the public arena, and take away their most basic rights.

Since the spring of 2022, a series of decrees have been issued to curtail women’s rights, with women losing their right to secondary and higher education, to travel unaccompanied by a male relative, to access public social spaces and to work for international and non-governmental organizations.

These measures target half the Afghan population, but affect the whole of society, including the hospital. The oppression of women goes hand in hand with a general hardening of the Taliban regime since its seizure of power. The regime’s violence is reflected in the number of extra-judicial executions and the return of public corporal punishment. As a result, the population is emigrating en masse to escape this straitjacket.

This general context is compounded by a major economic crisis. Before the Taliban came to power, the Afghan state budget stood at around $9 billion, 75% of which was based on international aid, the vast majority of which was American. With the end of international aid, this budget has been drastically reduced. In addition, the Taliban regime is facing a liquidity crisis linked to US financial sanctions, and in particular the freezing of around $10 billion from the Afghan Central Bank[2]. The Taliban government is trying to compensate for these losses by increasing exports, notably of coal, and above all by multiplying border taxes and customs duties. NGOs are not exempt. They are subject to financial controls and suffer a series of incomprehensible fines and penalties. We ourselves are currently the subject of a financial audit that is mobilizing the entire team, both at the Pavillon des Femmes et des Enfants and at the hospital, to try and plead our case. This contributes to a climate of difficult relations with the authorities, who seem to target NGOs in their mode of operation and financing. NGOs are divided between those who refuse to compromise with the Taliban government, and those who call for aid to be provided to the population despite the regime. Often keen to be as close as possible to our Afghan beneficiaries and colleagues, but subject to increasingly heavy-handed obstacles and diktats from the authorities, an NGO like ours moves from one state of mind to another, and regularly wonders where the red line is. It’s difficult to work serenely in this context.

If that weren’t enough, the country is also regularly confronted with major natural disasters (earthquakes, floods, droughts), the consequences of which are amplified by the generalized crisis. At the same time, while the eradication of poppies was brandished by the regime as a success to be put to its advantage, the Afghan population is suffering from the scourge of methamphetamines. The latter, commonly known as “crystal meth”, has replaced heroin following the strict ban on poppy cultivation decreed by the Taliban’s supreme leader in April 2022. Its production is facilitated by the abundance of the Ephedra plant, which grows wild in Afghanistan and is the source of Ephedrine, the key ingredient in methamphetamine. The massive influx of this devastating synthetic drug has further increased the scourge of drug addiction, affecting ten percent of the population.

The combination of all these factors has led to an increase in poverty and food insecurity. More than half of Afghanistan’s population, some 18 million people, are currently food insecure, and nearly 3 million children suffer from acute malnutrition. The general poverty of the population is further exacerbated by the large number of internally displaced persons, and by the latest measures taken by neighboring Pakistan to return 1.7 million refugees to Afghanistan, many of whom had been living there for over 30 years.

All these critical circumstances are affecting all aspects of hospital operations. This is naturally accelerating the flight of the doctors we have trained since 2006, who have only one thing in mind: to emigrate to Europe, the United States or Tajikistan. For example, 8 of the 9 doctors we trained in intensive care have already left, causing major dysfunction in this key department for day-to-day surgery, particularly cardiac surgery. Given that this is the only intensive care unit in Afghanistan, we are obliged to compensate for these departures by sending out resuscitation anaesthetists to ensure patient safety. The same phenomenon can be seen in other specialties. And yet, at the same time, we have great difficulty in finding and recruiting medical volunteers willing to go to Afghanistan, given the fear that the country under this regime can arouse.

Finally, in addition to the considerable influx of patients to the hospital and all the difficulties I’ve mentioned, I’ve also observed over the course of my latest missions a gradual, obvious decline in the morale of our Afghan colleagues. In the course of our many discussions, I came to sense the pervasive sadness and fear that contrasted with the welcoming and hospitable atmosphere I had always known in this country: a real blanket of gloom now covers the country. This sadness and despondency cannot be measured by the usual parameters and indexes used by the major international organizations to audit the countries of our planet, and that’s a shame.

The current international situation has overshadowed the Afghanistan issue and put it under the pile of international concerns.

Despite all these negative and worrying developments, we remain fully mobilized.

We will not abandon Afghanistan.

 

[1] The French Medical Institute for Mother and Children (FMIC), built and equipped by La Chaîne de l’Espoir. Inaugurated in 2006 by Mme B Chirac.

[2] Pierre Ramond, “le Grand Continent” 2023/08/15

 

Opinion column published in L’OBS on December 15, 2023

 

Doctor Eric Cheysson

Eric Cheysson is a cardiovascular surgeon and President of La Chaîne de l’Espoir. Alongside his career in the hospital sector, he has been involved in humanitarian action since 1979, when he went to the rescue of the Vietnamese boat people in the China Sea. He was one of the founders of Médecins du Monde, and in 1994, together with Pr Alain Deloche, he created La Chaîne de l’Espoir, whose mission is to improve access to healthcare for vulnerable populations and strengthen healthcare systems in countries with inadequate healthcare structures in Asia, Africa and the Middle East. Deeply committed to Afghanistan, he fought with determination for the creation of the Mother and Child Hospital in Kabul, which opened in 2006, and continues to do so despite the challenges and obstacles of today’s world.

He is the author of “Au cœur de l’espoir” ( Ed Rober Laffont), “l’arrogance du bistouri” ( Ed Hugo &Cie) and “Afghanistan, la spirale infernale” Ed Robert Laffont.

 

Discover Doctor Eric Cheysson’s latest book:

“Afghanistan, la spirale infernale”

Co-written with Michel Faure, journalist and former senior reporter at L’Express.

Published in March 2023 by Robert Laffont.