Location and size of the Afghanistan
Afghanistan is a mountainous landlocked country at the interface of Central and South Asia and covers an area of 652,225 km². In comparison, the Federal Republic of Germany is content with approx. 357,386 km². The largest extension is around 1,550 km in a south-west-north-east direction, and around 750 km from north to south. Afghanistan lies between the 29th and 38th parallel north and the 60th and 75th longitude east.
It borders Pakistan (2,430 km) to the east and south, Iran (936 km) to the west and Turkmenistan (744 km), Uzbekistan (137 km) and Tajikistan (1,206 km) to the north. Finally, in the far north-east, Afghanistan has a narrow strip of land Wakhan corridor still has a border (76 km) with China.
Midwife doing a health check on a patient, hospital in Parwan Province
The Afghan health system was on the verge of the end of the Taliban’s rule. At that time only about a third of the population had access to basic medical care.
A lot has happened since then and numerous hospitals and clinics have been repaired and rebuilt, so that every province in Afghanistan now has basic medical care facilities. But especially in rural areas, which are sometimes difficult to access, these facilities are difficult to reach and the level of care is below average.
The World Health Organization (WHO) estimates the proportion of the population who can access a basic health service within an hour’s walk at 57 percent. In this context, the Afghan statistics agency speaks of a population of 93 percent who can reach a public clinic within two hours.
The poor security situation also affects free and safe access to medical facilities.
That being said, the Afghan health system suffers from a shortage of medical personnel, both in numbers and in terms of education and gender. In purely statistical terms, there is a national average of 0.3 doctors for every 1,000 residents. Above all, there is a lack of female medical staff, be they doctors, midwives or pediatric nurses. Given the cultural background that women can only be treated by women, this is serious and has implications for maternal and newborn health.
Maternal mortality is high, with 638 deaths per 100,000 live births, Afghanistan ranks 11th out of 184 countries in the world. The child mortality rate for children under 5 is 62 deaths for every 1,000 live births. In terms of infant mortality, i.e. deaths related to children under one year of age, the country ranks first out of 224 countries included with 108.5 deaths per 1,000 live births worldwide. Only 53% of all births are accompanied by trained medical staff and only 16% of all pregnant women receive four antenatal examinations, as recommended by the WHO for normal pregnancies. In addition, around 55% of all children under the age of five suffer from malnutrition.
A lack of sanitary facilities and access to clean drinking water represent another serious health problem in Afghanistan, a country located in southern Asia according to animalerts.
The public water supply system, to which only less than a quarter of the population is connected, is often defective. The rural population gets its supplies from wells, rivers or water tankers. A lack of or inadequate garbage and wastewater disposal leads to pollution of ground and surface water in many places. The consequences are water-induced diseases such as cholera, diarrhea, hepatitis A and typhoid, as many people are dependent on the use of the harmful water.
Furthermore, sustainable strategies for combating tuberculosis, malaria and HIV / AIDS need to be successfully developed. Afghanistan is one of the 22 countries in the world hardest hit by tuberculosis. Malaria is particularly endemic in 14 of the 34 provinces, putting over 13 million people at risk. The exact extent of HIV / AIDS infections is uncertain as there are no reliable figures, but there is a high risk of spreading it. The risk factors are numerous, poverty, the sharp rise in drug addiction, a lack of education and a lack of social awareness are certainly the most important.
More than 30 years of armed conflict have also left emotional marks on people. The WHO estimates that over 60% of the population suffer from mental illnesses and stress disorders, but the number is still underestimated. In contrast, there is a lack of sufficient psychosocial facilities and specialists in the country. The Afghan Ministry of Health (MoPH) launched the National Mental Health Strategy in order to establish efficient psychiatric care in the health system and thus gives weight to the topic of ” Mental Health “.
Viewed in isolation, the issues addressed present the Afghan health system with at least an ambitious task. All in all, however, it is a massive challenge that Afghanistan cannot rise to on its own. In this respect, the Afghan health sector will probably remain dependent on international aid for years to come.