Fever, malnutrition, child deaths: The Irish medics fighting to save Afghan patients

Dr James Lee: 'I remember seeing four women and children regularly die before the day shift ended, from preventable causes.' Picture: MSF

“No weapons past this point” warns a sign on the wall of a hospital emergency department accessed through two narrow doors — one for women and one for men from a dusty road.

On a typical day, 1,000 people will pour into this unit at Boost Hospital in Helmand Province, Afghanistan, among them 700 women and children.

Among those who have staffed the unit are Ciara Flood, a nurse and Dr James Lee, an emergency medicine physician, from Ireland, working with MSF (Medicines Sans Frontières) which supports the hospital.

Dr Lee worked there for nine months. He said it was “rapidly becoming the only reliable centre, with its lights on". 

Despite the large numbers, some patients haunt his memories.

“I remember seeing four women and children regularly die before the day shift ended, from preventable causes,” he said.

Watching a mother silently mourn for the loss of her eighth child, or having six young women independently present to you following suicide attempts from ingesting pesticide. These are things which hit home. 

All six survived, receiving emergency care followed by mental health support.  

The corridor in the paediatraic department of the MSF-supported Boost hospital in Lashkar Gah, Helmand province.

The hospital offers “a phenomenal range” of care to Helmand Province — slightly smaller than the Republic of Ireland — and nearby regions.

“In the emergency department there are 1,000 presentations per day — [including myself] two consultants in the department, and then we have anywhere from four to six emergency doctors working under us per shift.” 

Some health conditions were familiar from home, while others were "very different” such as haemorrhagic fever, which can cause severe bleeding and malaria.

Vaccination programmes are not widespread due to the decades of conflict. 

Polio and measles

“Afghanistan is one of the only places in the world remaining with wild polio. And we see enough measles that we have an entire section of the emergency department set up to manage them," Dr Lee said. 

Patients can travel over 10 hours to reach help, with the numbers of women surging mornings and evenings — before or after working hours. 

Women must be accompanied by a male relative on long journeys, and increasingly in public, according to the governing Taliban — the Islamic Emirate of Afghanistan.

America and coalition partners evacuated Afghanistan in 2021, accompanied by frightening scenes at Kabul airport, as thousands attempted to flee.

“I feel since the evacuation Afghanistan has largely fallen out of attention for much of the world, especially with respect to the humanitarian crisis in healthcare they are facing at the moment,” Dr Lee said.

MSF has been co-managing Boost Hospital since 2009 in close partnership with the Ministry of Public Health in Helmand Province.

Ciara Flood and Dr Lee were among a small group of international staff working alongside 1,000 Afghan staff last year.

Ciara Flood: 'When I was in Afghanistan, between both my departments, about 10 children per day died. That is some of the highest mortality rates in most of the MSF projects.'

A nurse trained in paediatrics and adult care, Ms Flood worked in the  neo-natal intensive care unit (Nicu) and paediatric intensive care unit for six months.

“When I was in Afghanistan, between both my departments, about 10 children per day died. That is some of the highest mortality rates in most of the MSF projects,” she said.

Just because a country is not in active conflict, it doesn’t mean the population isn’t in massive need of humanitarian assistance.

These tragedies stand out among many successes.

“We have 2,000 deliveries a month in the hospital, which is just a huge number,” she said. “That is about 60 babies a day.” 

During 2022, the 19 Irish maternity units saw 57,540 births.

“In our Nicu, we had sepsis, prematurity, very small babies which would be called low birth weight, and birth asphyxia as well,” Ms Flood said.

“You would see these issues in Ireland but a very, very small percentage of deliveries would have those issues, because we have antenatal care and healthy women giving birth.” 

The Nicu also treats babies with tetanus. This can occur when the umbilical cord is cut with unsterile instruments during home births with skilled help unavailable, she explained.

“No one would have a scan pretty much, it’s very rare,” she said. “No one would know they are having multiple babies, unless the mother is experienced and could feel the babies moving around.”

Severe malnutrition

Among children, severe malnutrition is most often seen. Measles, tuberculosis and accidental ingestion of poison are also common.

Ms Flood found malnutrition the most challenging, as recovered children would have to be discharged back to “a home without food”.

Due to high numbers of patients needing treatment there are two children sharing a bed at the paediatric intensive care unit at the MSF-supported Boost hospital in Lashkar Gah, Helmand province

Overcrowding was constantly an issue, with the Nicu regularly caring for 70 or more babies in overflow cots in a unit funded for 53.

“In the Picu, we were budgeted for 30 beds, but we usually put two patients per bed, so we would have about 58 patients on average,” she said.

However she is at pains to stress how much each birth is celebrated.

“What’s lovely is how Afghan people love babies, they really adore babies as a society,” she said.

“A baby is a very happy event to be celebrated. I found it really heart-warming and interesting.” 

Ms Flood also worked with nurses, supporting them in an online course from London through MSF and other education projects.

Both Irish workers repeatedly emphasise the skills and dedication of Afghan staff, while describing their time in the city of Lashkar Gah.

Some 50% of Boost hospital staff are female, Ms Flood said, including obstetricians and nurses.

“The work the local staff do is just phenomenal," she recalled. 

“Children’s death are really, really hard for the staff, and the community. They do their absolute best. The staff are so dedicated."

Dr Lee recalled pregnant women arriving at the door in crisis and said: “Many survive with healthy babies due to the emergency service that is provided, with a level of efficiency that would be impressive in an Irish ED.” 

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Feb 6, 2024: MSF has contacted the Irish Examienr to say that while as many as 10 chilren may have died in a given day in Boost hospital, this was not an average figure overall. It adds that it is difficult to draw comparisons between MSF projects in different hospitals and countries due to the wholly different circumstances that may apply in each.