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Kabul Health Care System in Ruins - 2001-12-08

In the Afghan capitol, Kabul, the World Health Organization has just concluded a citywide survey that shows a health care system in ruins. Qualified doctors are just as scarce as medicine in many clinics and hospitals.

Sixty-year-old Mahboba is having trouble breathing as she waits for a doctor to examine her. It is her first visit to the Pahwanse Clinic on the outskirts of Kabul.

Mahboba says she walked 15 kilometers from her home to get here because she had heard that the clinic may have someone who can diagnose her illness. She says she has seen a doctor at a clinic closer to her home but after two visits she did not get better and she still does not know what is causing the pain in her lungs.

The lone nurse at the clinic, Rangina Lodin, assures Mahboba that the staff will do all they can for her. But the staff is clearly overwhelmed. Only three doctors are available to examine some 120 people, mostly women and children, crammed inside the waiting room.

Ms. Lodin says that on average, that's how many people the clinic treats during a five hour day. "Right now we have three doctors but before we had five. What happened to the two? Where did they go? They went...did migrate to the neighboring countries because of the bad situation here," she says.

Years of civil war and more recently the war on terrorism in Afghanistan, have caused hundreds of thousands of trained professionals to flee the country. Many of those who fled are doctors and surgeons, leaving a huge hole in the medical system.

One of the hardest hit by the loss of medical professionals is Ali Ahbad Hospital near the center of Kabul. Before the Taleban took power in Kabul five years ago, it had a staff of 100 doctors and was considered one of the better hospitals in the city.

Now 14 doctors struggle to attend to some 200 patients, many of whom need more advanced care than the doctors can provide.

The head of the hospital's internal medicine ward Habibullah Mahbob, consults with two of his colleagues about the condition of a patient suffering from leukemia. The patient, a thin 19 year old boy, is tossing feverishly on his bed. Dr. Mahbob says the boy needs an immediate bone marrow transplant to survive.

But his says such surgery can not be performed in Kabul anymore. There are no functioning X-ray machines in any of the hospitals, let alone sophisticated equipment to perform delicate surgeries. "We had the means to provide good medical care some years ago when this city was relatively peaceful. But war has left us with nothing now," Dr. Mahbob says. "What is more sobering is that the health care available in Kabul is still the best in all of Afghanistan."

The World Health Organization estimates that outside of the capitol, 85 percent of the cities in this country of 24 million have only rudimentary health care facilities. The rest have none.

Seventeen hundred of every 100,000 women in Afghanistan die during childbirth. The second highest infant mortality rate in the world, behind Sierra Leone.

The United Nations says the health care situation in Bamiyan province in central Afghanistan is typical of the situation in rural areas. U.N. spokesman Khaled Mansour says "in Kabul there's one doctor for every 1,700 people. In Bamiyan province there are only two doctors in the whole province that has about 440,000 people."

Now that a foundation for a broad-based government has been laid and efforts are being made to secure peace in Kabul and elsewhere, Afghans are hoping that many professionals living abroad, especially doctors, will soon return to their homeland. Many people fear that without their help in their reconstruction process, Afghanistan could remain on the critical list for years to come.