As It Happens·Q & A

Afghanistan's health-care system is 'close to collapse' says acting health minister

The Taliban's takeover of Afghanistan a month ago has plunged the country's health-care system into a crisis. Dr. Wahid Majrooh, Afghanistan's acting health care minister, says the system is "close to collapse."

Dr. Wahid Majrooh says staff haven't been paid, and hospitals lack food and medicine for patients

Dr. Wahid Majrooh was the Afghanistan minister of health under the former government. He has stayed on in the role since the Taliban have taken control of the country. (Wahid Majrooh/Facebook)

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The Taliban's takeover of Afghanistan a month ago has plunged the country's health-care system into crisis.

Hospitals are running out of medical supplies, including COVID-19 test kits, as well as food and fuel, while some health-care staff haven't been paid for months, says Dr. Wahid Majrooh. He was Afghanistan's health minister under its previous government and has stayed on the job as the acting public health minister now that the Taliban have taken over.

Western governments and the World Bank have suspended $600 million US in funding that has kept the Afghan health-care system operating. They want to put economic pressure on the Taliban regime, according to the Associated Press. But that is having dire consequences for people living there who need food, health care and vaccines. 

"The system [is] close to collapse," Majrooh told As It Happens host Carol Off from Kabul. Here is part of their conversation.

Female nurses take care of patients at Wazir Akbar Khan hospital in Kabul in early September 2021. Some health-care workers haven't been paid for months, according to the country's acting health minister. (Aamir Qureshi/AFP/Getty Images)

Dr. Majrooh, can you give us a picture of what it's like in the health-care system right now in Afghanistan?

Health facilities are running out of medicine, essential medicine, fuel, consumables. Our staff are not paid for their salaries for [the] last three to five months. And we have those donors and international agencies who contributed generously during [the] last 20 years and are facing their internal limitations based in which they cannot continue their contribution to the health system.

It is both an administrative failure and challenge as well as an emotional trauma.- Dr. Wahid Majrooh

These are the donors and the NGOs [non-governmental organizations] that have conducted so many of the programs for women's health, for childhood health. So what has happened with all that? Can you give us a sense of ... the impact on women and children to see that donor money disappear?

Mothers and children are the first group to be affected, unfortunately. We normally conduct about 150 caesarean sections every day in health facilities, and freezing the funds means 150 mothers whom are in need of caesarean section services will be deprived, with a high number of them prone to death, and the infants as well.

And when it comes to general services, we conduct about 500 major surgeries every day, in our health facilities funded by the World Bank. And about 50 per cent of them are emergency cases, which are prone to death.

And when it comes to child health, about 5,000 children will be deprived of immunization services a day. About 19 to 20,000 children will be deprived of nutrition services and the morale of the staff is badly affected.

Now, our staff has not been paid, and it is not only about their salary. We haven't been able to provide them food for themselves and their patients and their health facilities and the means to help them heal the pains of the patients. So it is both an administrative failure and challenge as well as an emotional trauma.

A patient suffering from COVID-19 receives treatment at the Afghan-Japan Hospital, in Kabul in June. Since the Taliban takeover in August, hospital supplies are running out. (Reuters)

And we know that a number of doctors and nurses, Afghan medical professionals, are leaving the country. Many of them, because they are associated with the foreign NGOs and they fear for their security. How much loss have you had to just the staffing in your clinics and hospitals?

Unfortunately, brain drain has badly affected our system, especially in major cities like Kabul and Herat. And to be honest, our HQ in Kabul is also not an exception. At the same time unavailability of resources has made the staff not show up in the health facilities.... The major part of the issue is disruption of the system and the morale of staff members.

We know the World Bank and other organizations, they have frozen more than a half a billion dollars in health-care aid that is supposed to go to Afghanistan. And the international donors are saying they will not support the government, they won't give aid because the Taliban has people they have on their terrorism lists and so they won't supply money to a Taliban government. What do you say to that?

We have our donors who contributed generously and now they have their limitations. And I have no other option but to respect and to be flexible and work with them. I have sent an official letter to all donors expressing the extent of the dilemma as well as options available.

The health service delivery in Afghanistan is done by nongovernmental organizations. And these non-governmental organizations could be paid directly, could be paid through the U.N. agencies, could be paid through third-party consortiums, which could be [not-for-profit] or private sector.

We're flexible to work with them. But the Ministry of Public Health is a technical institution which has proven its neutrality and impartiality. It's completely left out of the communication and coordination mechanisms. And that is very painful. And I expect and I call on our donors to work with the ministry, at least as the coordination body.

Patients at Wazir Akbar Khan hospital in Kabul. The country's health-care system has been hit hard by the withdrawal of international aid since the Taliban's takeover in August. (Aamir Qureshi/AFP/Getty Images)

But sir, you are still the minister of health within this government. You stayed on with the Taliban in power. Do you have any sense the Taliban regards public health, the health of these women, of these children? Is it a priority for them? Do they care about the health of Afghan women and children?

I am the only minister who has stayed on. They haven't introduced their official new minister in the cabinet... Members and deputies are working with me in the office. I'm waiting for a smooth transfer for the new leadership. I've been trying to communicate the sense of urgency and the extent of the challenge, the level of understanding and the approach is different.

But at the end of the day, they're the owner now and I have to adapt [to] the way they want to work. I don't expect and I'm not intending to continue for longer. I just stayed in office to ensure a smooth transfer, hopefully. I'm praying that that will happen soon.

It's not just that there are immediate health-care needs of people in Afghanistan, but for the past 20 years of building better health care, of having family planning and women's health and the ... vaccine programs for children. All of this, you believe you're going to lose all of the momentum you have built in the past 20 years, is that right?

Unfortunately, that's right. The great improvements we have in indicators, 40 to 60 per cent decline in maternal mortality rates and people's access. We had four or 500 health facilities in 2001. We have 3,800 now. And it is very difficult to see this ... demolished. I respect the decision of donors, I understand them, but I call on them to work with the ministry to find an alternative, pragmatic solution before it is too late, before the system collapses.


Written by Andrea Bellemare. Interview with Wahid Majrooh produced by Chloe Shantz-Hilkes. This Q&A has been edited for length and clarity.


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