Kabul's Health Apartheid
On September 6, Afghanistan's Taliban extremists ordered all hospitals in the capital city of Kabul to partly or completely suspend medical services to women. The directive--issued by the Ministry of Public Health and intended to further restrict contact between the sexes--had an immediate, and by all accounts gruesome, effect on the city's female patients. One woman with burns over 80 percent of her body was refused care because the male doctor on duty was prohibited from removing her clothing; two women were forcibly removed from a maternity ward while in labor; a young woman with highly infectious TB was sent home to her family before completing treatment; a comatose girl was refused entry to an emergency room.
These accounts, reported by the Paris-based Médecins Sans Frontières (M.S.F.), one of several humanitarian organizations operating in Kabul, signal an alarming turn of events. With the restoration of a women's hospital as much as a year away from completion, remarkably poor health indicators among the female population to begin with, and a miscoordinated effort on the part of the international humanitarian community to cope with the new Taliban directive, a bad situation just got considerably worse. According to Pierre Salignon, M.S.F.'s officer overseeing operations in Kabul, "the situation is deteriorating every day."
To accommodate the sick and injured, Kabul maintains twenty-two semi-functioning hospitals, with about 2,700 beds. Since the September directive, five of those hospitals--including the largest in the city--have imposed either complete or partial suspensions of primary (e.g., immunization, checkups) and secondary (e.g., surgery, emergency treatment) health care for women. At the current rate of hospitals closing their doors to women, there could be no secondary health services available to them by mid-March. That leaves primary care to twenty-six clinics in all of Kabul, where 70 percent of the TB patients are women and the maternal mortality rate is more than 140 times that of the United States. Hospitals outside the city, explains Salignon, are hardly an option. "Transportation is a problem because of the cost of taxis, and some women are afraid of being stopped at a checkpoint. The women in Kabul seek health care in Kabul. That's it."
Kabul's deteriorating Rabia Balkhi hospital is to be renovated and used exclusively by the city's women, but it is not expected to open for six months, possibly a year. In the interim, female patients in need of secondary care are being referred to the Central Polyclinic, a dilapidated facility with only forty-five beds, no working surgical equipment, no oxygen, limited running water, no electricity in the surgical unit, no specialized services like lab testing or X-rays.
The humanitarian organizations now operating in Kabul--M.S.F. and the World Health Organization in particular--are at odds on how to combat the Taliban decree. M.S.F. criticizes the W. H.O. for partially funding the restoration of the Rabia Balkhi hospital, for example, feeling that the $64,000 in W.H.O. aid may have appeared to the Taliban to be a quiet nod to the policy of gender segregation. W.H.O., in turn, announced on November 4 that it would send its own fact-finding mission to Kabul.
Salignon and Joelle Tanguy, executive director of M.S.F.'s New York office, suggest that any further humanitarian aid given the Taliban be contingent on the lifting of its directive. But it's unclear whether that sort of approach would help. The fact that the U. N. called for the suspension of humanitarian aid to Afghanistan just after the Taliban seized power; that the United States (itself complicit in the region's instability) has now refused to acknowledge the government officially; that Iran has characterized the Taliban's interpretation of Islamic law as "violent" and "narrow-minded"; and that two major humanitarian groups, UNICEF and Terre des Hommes, have curtailed their programs in Kabul seems to have had little effect on the Taliban, which continues to issue even more extreme directives. As Terre des Hommes director Nicolas Gyger explained to the Swiss newsweekly L'Hebdo, "The main impression is that the pressure or indignation of the international community doesn't have much weight."
The W.H.O.'s strategy of directly funding the renovation of Rabia Balkhi might well turn out to be the most effective approach. The more money allotted to the project, the sooner women in Kabul will have access to emergency and surgical care. In the meantime, they will have to wait until the humanitarian organizations untangle a situation that one W.H.O. official admitted has "gotten kind of political."