“It is one of the largest and most important women’s hospitals in Afghanistan,” she explained. The patients were women, of course, but almost all the medical staff were too. As we walked through the hallways, which smelled of disinfectant, she pointed out that they were clean and freshly painted — a drastic change from a year ago, when they were fetid with bodily fluids and litter. The hospital, too, had suffered from corruption and dysfunction endemic to the republic. Much of the civil service stopped receiving salaries as early as April or May. The former government had attempted to switch to a new payroll system, while simultaneously burning through its cash reserves in a last-ditch attempt to fund anti-Taliban militias. At the hospital, staff continued to work for months without pay and begged for donations of food and other supplies from local businesses. “It was heartbreaking to think it was about to fall apart,” Stocker said.
In the recovery room, nurses transferred a young patient from a stretcher to her bed, her back bent in pain. Aged 24, she suffered from eclampsia, a complication of pregnancy that caused convulsions so intense that she lacerated her tongue and broke her teeth; doctors had performed an emergency abortion to save her life. His gray-haired mother sat by his bedside, relief apparent on her face. “She would be dead,” she told me.
Now that the fighting had stopped in the countryside, more patients could travel to the capital from remote areas, where the reproductive health of women in particular was often dire. Suddenly, the staff was dealing with very serious cases: women who, like this young patient with eclampsia, would simply have died at home. The economic crisis had gutted the private sector and ended overseas medical tourism, so public hospitals like Malalai, where care was free, had seen an increase in admissions – in some cases outpatient visits had increased tenfold. . The pressure on medical workers was evident, but at least, unlike much of the Afghan public sector, they could expect regular salaries. But for how long ?
Along with its appeal for emergency aid, the UN was seeking to fund a $3.42 billion plan to deliver basic services directly to the Afghan people, bypassing the Taliban government, what some call “humanitarian plus”. But as Stocker pointed out, the intervention of groups like the ICRC entrenched the very addiction that was the problem. “Our feeling was that a national health care system needs a ministry to sustain it,” Stocker said. “You need a state.”
As a teaching hospital, Malalai has also helped train the next generation of Afghan maternity specialists, nurses and midwives, women like Dr. Rana Afzali, whom I met in the neonatology ward , where a young mother sat in the corner, holding her newborn baby. Dressed in a white blouse and a colorful scarf, Afzali had just left her residence. It was a daunting time to enter her profession, but she told me she was happy to work, unlike many of her classmates who had fled overseas. “They’re sitting inside depressed – I stayed,” Afzali said with a shrug. “I am a hopeful person.”