Afghanistan: Providing emergency medical care to severely malnourished children in Herat | Doctors Without Borders

Every month, Médecins Sans Frontières (MSF) sees hundreds of sick children admitted to the intensive care unit (ICU) of the MSF-supported pediatric ward at the Herat regional hospital and the inpatient therapeutic feeding center (ITFC) managed by MSF. the next door. Many are severely malnourished and fighting for their lives.

Eight-month-old Nyayesh has been in a coma for three days. Her mother sits with her and caresses her, softly humming a song. “Nyayesh has pneumonia that overwhelms his weakened body,” says pediatrician Solveig Köbe, who has worked for MSF in Herat for six months. “She was in shock and was unconscious when she was brought to us. She was suffering from severe shortness of breath, and her circulation and heart were extremely weak.”

The MSF team in the intensive care unit gave Nyayesh an adrenaline infusion for shock, oxygen, fluids and antibiotics to fight the infection. But she remains unconscious. “We are very worried for her, she could suffer brain damage,” Köebe said.

Köbe and his team treat many very sick children. Like Nyayesh, most suffer from severe malnutrition. They have complications such as respiratory infections, pneumonia or measles. A congenital heart defect makes it even harder for Nyayesh’s body to cope with malnutrition and inflammation.

A food crisis

Access to food was precarious in Afghanistan long before the political upheavals of August 2021. Harvests were reduced due to persistent drought and people fleeing their homes to escape conflict. After the conflict ended and the Taliban took power, international donors withdrew funds that had supported the Afghan economy. Sanctions and other measures against the new government led to an economic crisis. Banks were paralyzed and people could no longer access their savings. Thousands of people lost their jobs and food prices soared. “We have no wheat or anything else to eat,” said a woman whose granddaughter is being treated by the team in Herat. “There is no work for us. My granddaughter is so sick from hunger and poverty.”

The health system threatened to collapse after the change of power. “It was already underfunded and dependent on international aid,” Köbe said. [minimal] help was suddenly no longer there. Although international financial aid has been restored to the health system, it is less than before, does not finance all health establishments and has only been promised until June. Many state institutions can no longer pay staff salaries or cover operating costs. “People also have to pay for medicines and materials such as infusion needles and compresses themselves. Most of them are not able to,” Köbe said.

Two patients per bed

In September 2021, when the health system was at its lowest, MSF hired more doctors for its outpatient clinic for pregnant women, children and people with non-communicable diseases in Kahdestan, a suburb of Herat. More and more people came, and the team sometimes treated up to 200 patients a day.

In October, MSF installed containers to provide additional beds for its ITFC. In December, MSF also started supporting emergency and intensive care in the pediatric ward of the Herat regional hospital. During the first weeks, the number of patients increased fivefold compared to the previous year. “At the moment we have 50 children in 20 beds,” Köbe said. “There are two children in most cribs, and sometimes three. Their mothers stay with them 24 hours a day and sleep next to their children on folding chairs at night.

The team does everything to help patients. Doctors stabilize the children, treat their infections and provide them with high-calorie therapeutic milk to boost their strength. “It’s incredibly stressful, but it also feels good that together, as a team, we’re giving these kids a chance.”

Treatment Brings Hope

Nyayesh finally wakes up after four days in a coma. She is recovering, no longer needs oxygen via a tube, and is breastfeeding again. His progress gives hope to the team, although concerns about his future remain. “Nyayesh can live with his heart defect. But her chances of staying healthy would be even better if she could [receive surgery]Kobe said. But in Afghanistan it is difficult to get treatment for her condition. Nevertheless, Köbe remains confident in Nyayesh’s recovery. “The therapeutic food strengthens Nyayesh and his immune system. His body can deal with infections better now. When I [visited] her in the morning, she sat on her mother’s lap and laughed at me. That’s when I knew she had overcome the worst.”