Refugee Relief International | Helping Victims of Armed Conflict

RRI Volunteer: personal retrospective

Summary of Refugee Relief International Exploratory Mission in Afghanistan

October 2001

In October 20, 2001, Refugee Relief International (RRI) sent a team of four operatives to northern Afghanistan and, from its unique perspective, surveyed the medical situation in the civilian and military sectors.

RRI visited the surgical hospital and the Iranian Hospital at Khoja Bauhuddin (military headquarters of the Northern Alliance at Khoja) and also visited front-line combat areas in and around the small village of Dash-E-Qala. Although RRI witnessed considerable strategic bombing and some tactical ground support by the US Air Force at the time of the visit, the ground fighting had not begun in earnest and no practical evaluation of the medical system in action was possible.

The Khoja Bauhuddin Surgical Hospital (KBSH) is a small hospital with meager resources and is not designated as military or civilian, but simply treats people as appropriate. KBSH was however the chief - indeed, the only, - evacuation hospital in the area, so any combat-related injuries would have been treated there.

The Iranian hospital, a much larger, more modern facility, had then just been completed and was not yet in operation. KBSH numbered ten to fifteen surgical cases, almost all of whom were victims of either land mines or indirect-fire attacks (mortar, artillery, etc). Women were not treated at the hospital except on an emergency basis. The hospital had some fifteen beds in the main wood-frame building with about thirty additional beds in the outlying wards, which were nothing but three tents of the US "GP Small" variety.

The surgical staff of the hospital is headed by a physician who is also the Afghan Minister of Public Health. There are six other surgical physicians on staff, at least one of whom also moonlights as a tobacco vendor in the bazaar due to the low compensation he is able to earn for his professional services.

The hospital lacks, well, everything. There are few if any of the modern machines on which most hospitals depend. There is no capability for general anesthesia, only local and regional. There are no regular supply channels, and the facility depends only on the chance shipments of whatever medicines or supplies an outside humanitarian-aid agency is moved to ship or bring. At the time of RRI visit, antibiotics were especially plentiful due to a recent large shipment from Italy but bandages were at a premium, a situation which might have been reversed unexpectedly. There is no shortage of labor however, although the technical qualifications of that pool are lacking. In addition to the needed medical supplies, the physicians asked repeatedly for medical textbooks

There is nothing in the Afghanistan medical system that corresponds to the familiar US medical model: Immediate first-aid, followed by rapid and efficient evacuation for triage and stabilization, through necessary transfer into a system of ever more highly specialized treatment centers. The mission of American military medicine, i.e. to conserve the fighting strength has no apparent counterpart in Afghan military doctrine, if indeed there is such a thing.

At the frontline combat area in Dash-E-Qala, with the Taliban trenchline only 500 meters away, RRI recently observed that the Mujahidin had no designated medics, no forward medical facility, no designated medical evacuation capability -- air or ground --and when directly asked, even the Afghan Minister of Public Health (the Chief Surgeon at KBSH) displayed curiously little interest in the development of such a system.

Under present reality, the wounded Mujahid can expect aid only after the fighting is over, when he might possibly be taken to a rear area hospital (assuming transportation assets are not committed elsewhere as they often are) and not always under military necessity. Even if he is fortunate enough to survive the evacuation process (a two-hour ride in a pickup truck unattended by medical personnel and over roads not worthy of the name) to arrive at a hospital, he can expect only marginal care, largely due to lack of supplies, instruments and medicines. (It is a not-so-funny combat joke in Afghanistan that if you survived the evacuation, you didn't need it.)

Air evacuation of wounded, except for highly-placed commanders, is unknown. Afghan physicians and nurses themselves are as dedicated as any in the world, but outside of these excellent people, Afghan military medicine needs everything. The clear intent of the Afghan physicians after the fighting, was to reoccupy the larger medical facilities in the cities such as --Mazar-E-Sharif, Kunduz, Jalalabad, Kandahar, etc--from which they had been driven by the Taliban military advances in the mid-Nineties.

In the likely event of the return of some semblance of law and order -- if only that imposed by the US and international pressure--Afghanistan will probably revert to its former state of having a more or less sophisticated medical system in the larger population centers, but little in the rural and remote areas.

The ability of RRI, indeed all NGOs, to contribute to Afghan medicine is limited only by resources and will. From basic nutrition and sanitation in the public health area, all the way up through medical evacuation and specialty care, the most appalling deficiencies and the most pressing needs are in evidence - any help is welcome.

As one of the poorest countries on earth, Afghanistan counts medical care however as only one on a long wish list of social improvements. Smaller medically-oriented NGOs such as RRI will be able to make their greatest contributions in these smaller, rural areas, where need will be great, and conventional relief agencies will be last to penetrate.

Respectfully submitted,

Forrest Smith, MD
Mission Commander, A 2001-1
Secretary/Treasurer
Member, Board of Directors

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