Medical support despite difficult security situation

Since the gradual withdrawal of international troops from Afghanistan, the media interest in the country’s situation has also declined. Being left alone with the Taliban, the IS and other militias, the country’s situation appears to be fatal. For the political influence of the official government usually does not go far beyond the border of the city of Kabul, the political and religious spokesmen of the tribal affiliations are fighting for regional predominance in the 34 provinces. The attacks and fights continuously demand civilian victims and an end of violence is not in sight.

The United Nations have been trying to gather victims of these conflicts on a systematic basis since 2007. Apparently, the number of people killed or wounded in the country’s ongoing conflicts has reached a sad climax in 2015. According to the “Global Terrorism Index 2015“, Afghanistan is ranked second after Iraq on the list of most severely affected countries by terrorist activities. Throughout the country, the Taliban and other insurgent groups are gaining ground.

The security situation is under increasing strain and has also singularly complicated our work: kidnappings and armed robbery is the order of the day. Militant groups are sabotaging construction projects and supply capabilities urgently needed to improve the standard of living of the civilian population. Unfortunately, a change in this development is not in sight. Given the current situation in the country, our work appears to be even more important.

High infant mortality

After almost 4 decades of war, Afghanistan is ranked no. 16 (of 193 states in total) in the latest UNICEF statistics on infant mortality worldwide: one in every 7 children dies before its fifth birthday. Quite often, children die in the first months of their lives. Rural regions that lack well-equipped hospitals and therefore have to rely on home births appear to be particularly affected by this. The infant mortality rate of children under 5 years is at least 91 of 1.000. These figures refer solely to the registered cases. Given the difficulty to cover remote areas in the statistics, the estimated number might be far higher. For comparison: the infant mortality rate in Germany is 4 of 1.000.

Education as a fundamental milestone

The training of midwives and nurses is essential in a country like Afghanistan, which is strongly marked by patriarchal structures and does not expect women to pursue paid employment. But it’s exactly here where those are missed – amongst others in health care professions and particularly in such sensitive sectors as gynecology and obstetrics. If for cultural or religious reasons, male doctors are not allowed to attend birth, the domestic birth with the help of female non-professionals is the only remaining possibility for pregnant women. Accompanied by all the deadly risks that can come with a birth far from the assistance of midwives and hygiene, 85% of Afghan mothers give birth at home.

With regard to the alignment of our projects, special importance is attached to the considerably high impact education has on the development of a population. Our training schedule is coordinated with the local Ministry of Health. Thus, the exam is officially recognized and state-certified. Our local teaching personnel undergo frequent advanced training in order to keep their knowledge up to date at any time.

All expenses, that is approximately 3.200 € for the whole 2-year training course of a midwife or a nurse respectively are covered by Cap Anamur. Apart from the instructors’ salaries, this also includes working material, electricity and heating costs as well as the accommodation of trainees and the care for their children. After the conclusion of the training course, the students return to their home town as certified midwives or so-called Community Health Nurses and create awareness for what they have learned within their respective local environment. They operate pre- and post natal care as well as obstetrics and are available to answer questions regarding vaccinations, hygiene and prevention.

The last 7 years of work are clearly showing signs of success: only two month ago, on 5th May 2016, another 81 graduates were celebrated in Herat. As part of this festivity, 41 midwives and 40 nurses received their certificates. Since the beginning of the project in 2009, a total of 130 midwives and 76 nurses have been trained.

Construction and maintenance of hospitals

Besides the training of midwives and nurses, Cap Anamur builds and operates hospitals in rural regions of Afghanistan. Five of these hospitals could already be passed over to the state system. As planned, all facilities remain in operation and are able to reach population groups which were previously excluded from adequate medical care.

Construction work on the sixth clinic has been concluded in mid 2015. Following the compulsory 3-year period, the clinic will be handed over into state responsibility as well.