They have not consented to an independent investigation by the IHFFC. Medical staff aren't being paid. We release our own internal review on the Kunduz attack. In September, another woman suffering from a highly contagious form of tuberculosis was also sent home before she had completed her course of treatment, thus exposing her entire family to the risk of infection. Nearly four years after the destruction of our Kunduz Trauma Centre, the need for life-saving trauma care is extremely high in Kunduz and the availability of free, quality medical care is still very low. We initially announce three people are dead, although many remain unaccounted for. Wages had been unpaid for months before the government collapsed. The midwife said that so far the Taliban were not stopping family planning in that facility. Spiegel said he visited a comprehensive health center outside Kandahar. By the time of the airstrikes in October 2015, the hospital was equipped with 92 beds, an emergency room, two operating theatres, an intensive care unit, an outpatient department, mental health and physiotherapy wards, as well as X-ray and laboratory facilities. Almost immediately, sanctions required that all outside funding stop, including funding for health care, to Afghanistan's de facto authority, the Taliban. Reuters provides business, financial, national and international news to professionals via desktop terminals, the world's media organizations, industry events and directly to consumers. In August 2011, we opened a trauma hospital in the northern Afghan city of Kunduz. Even with five weeks on the ground, the team that Spiegel was part of could not investigate differences in health care in every region and remote rural area. The host of problems that preceded the Talibans rise were exacerbated. ", "The bigger hospitals that provide higher levels of care are not being funded," he says. Only 8% of them are now functioning at all. Patients have to bring their own bedding, their own food," says Spiegel. Ahmadi ordered them to wear a head covering and focus on female patients. This Guide explains the terms, concepts, and rules of humanitarian law in accessible and reader-friendly alphabetical entries. Find important research based on our field experience on our dedicated Field Research website. A health worker at the hospital, who managed to escape, said he heard a large explosion followed by gunfire and a second, larger explosion about 10 minutes later. On Aug. 15, Afghanistan was in the midst of six concurrent epidemicscontinuing polio cases, measles, malaria, dengue, cholera and COVID-19. If a humanitarian organization chose to leave the region in protest at such circumstances would this not, in effect, punish the women, as they would receive even less aid. Worse still, the decision whereby hospitals could treat women in emergencies, taken under Western NGO pressure by the Minister of Health, Mullawi Abbas, has been widely condemned. World Bank allocations funded 2,330 out of Afghanistans 3,800 medical facilities, including the salaries of health workers, said the Talibans Deputy Health Minister Abdulbari Umer. Mdecins Sans Frontires brings medical humanitarian assistance to victims of conflict, natural disasters, epidemics or healthcare exclusion. Our patients burned in their beds, our medical staff were decapitated or lost limbs. Nor could it assess the impact and extent of Taliban policies such as restrictions on where women can travel and work. Health care workers have continued to work without salaries, without medicine for patients and with frequent power cuts. What we are seeing is the total destruction of a health system which until now, in contrast to the education system, has remained relatively unscathed. In the aftermath of the attack, our team tried to move wounded and ill patients out of harms way. It was Ahmadis dream to be a doctor; poverty had kept him from gaining admission to medical school, he said. There is no salary for staff, no food, no fuel for ambulances and other machines. Similarly, in some of the texts used in the case studies, the facts may not always be proven;nevertheless, they have been selected because they highlight interesting IHL issues and are thus published for didactic purposes. They tried to save the lives of wounded colleagues and patients after setting up a makeshift operating theatre in an undamaged room. Learn about how, why, and where MSF teams respond to different diseases around the world, and the challenges we face in providing treatment. Is this the time for a mosque, she asked. Those funds had previously been given to a countrywide organization of clinics and health centers called Sehatmandi, which means healthfulness in Urdu. The main hospital building came under precise and repeated airstrikes, while the surrounding buildings were left mostly untouched. Our hospital was the only facility of its kind in northeastern Afghanistan; beforehand, severely injured people were forced to make long and dangerous journeys to the capital Kabul or Pakistan to receive the care they needed. However, Spiegel says, in some areas immunizations are no longer provided in door-to-door campaigns because of Taliban restrictions on men and unrelated women being alone together within houses. In only a few years, the hospital had become a life-line for people in Kunduz and the surrounding provinces. Additional reporting by Jibran Ahmad in Peshawar, Islamabad newsroom; Writing by James Mackenzie; Editing by Andrew Heavens and Nick Macfie, Ford to buy lithium from ioneer for American EV battery plant, Dinesh Gunawardena to be named Sri Lanka's next premier -sources, World's oldest known male giant panda, An An, dies at 35, Indonesian president to visit China next week, will meet with Xi, Rights group says hundreds remain detained over Uzbekistan unrest, See here for a complete list of exchanges and delays. Access unmatched financial data, news and content in a highly-customised workflow experience on desktop, web and mobile. That same day saw the dismissal of the last 15 female employees of the Karte Se hospital, which may soon cease to function because male workers are not willing to take charge of the laundry. The International Humanitarian Fact-Finding Commission is activated, intending to conduct an independent investigation into the attacks once consent from US and Afghan forces is given. Armed opposition launch a takeover of Kunduz city, putting the hospital in the middle of the frontline; hospital is overwhelmed with wounded. That means letting more money in so medicines and medical supplies get in and health care workers get paid. Ford Motor Co said on Thursday it will buy lithium from ioneer Ltd's Rhyolite Ridge mining project in Nevada and use the metal to build electric vehicle batteries in the United States. Soon after, the Mirbacha Kot district hospital just outside of Kabul became his responsibility. Regional logistic centre for the whole East Africa region. On 28 September 2015, our hospital was suddenly in the middle of a quickly shifting frontline when the armed opposition launched a takeover of Kunduz city. SAMU provides strategic, clinical and implementation support to various MSF projects with medical activities related to HIV and TB. In a recently published document, Mdecins sans frontires (MSF) reported that 12 female patients, some of them with bullet wounds, had been turned out of one of the major hospitals, Wazir Akbar Khan, on October 19, and only two of them were later found at the Polyclinic. Once funded by international donations to the Afghan government, these facilities were just as suddenly cut off. There was no immediate claim of responsibility but the operation was typical of the complex attacks mounted by Islamic State. The pharmacy is stocked only with analgesic and some antibiotics. US military publicly release their own investigation into the attack. When winter comes in earnest, it will get much, much worse.". Ibrahimi said Ahmadi often scrutinizes her prescriptions. NO RESALES. (, Does the requirement to separate health facilities for women and men violate IHL? The renewed funding also means outbreaks of dengue, cholera and malaria can again be addressed. Our medical guidelines are based on scientific data collected from MSFs experiences, the World Health Organization (WHO), other renowned international medical institutions, and medical and scientific journals. The attack from the air lasted for around one hour. This medical unit is based in Rio de Janeiro, Brazil. Hospitals are running out of medicine. The most incredible aspect of the situation is that this policy of apartheid is being financed, initiated even, by the World Health Organization. First, the women of Kabul were forbidden to work. They participate in internal training sessions and assessment missions in the field. Due to shortages, doctors advise patients to find medications elsewhere and return. Woman is woman, man is man, he told us.. This supply and logistics centre in Bordeaux, France, provides warehousing and delivery of medical equipment, logistics and drugs for international purchases for MSF missions. What the military/religious order of the Taliban is endeavouring to establish is a system of health care conforming to the ideal Islamic society which they are advocating, a system in which men and women are kept strictly apart, the women often living a completely cloistered life. On the night of the attack, there were 105 patients in the hospital and 140 of our international and national staff were present, of whom 80 were on duty. His arrival ushered in other sweeping changes. Kunduz hospital is destroyed. The attacks took place despite the fact that we had provided the GPS coordinates of the trauma hospital to the US Department of Defense, Afghan Ministry of Interior and Defense, and US Army in Kabul as recently as Tuesday, 29 September. From now on, until the (hypothetical) opening of a hospital reserved for women, there is only one establishment to treat all the female inhabitants of Kabul. We continue to grieve and mourn the loss of our colleagues and patients. But nobody in Kabul, previously a very Westernized city, would have imagined that the Taliban, who took control of the Afghan capital just over a year ago, would go so far as to prevent women from receiving medical attention. Providing epidemiological expertise to underpin our operations, conducting research and training to support our goal of providing medical aid in areas where people are affected by conflict, epidemics, disasters, or excluded from health care. While both the US and Afghan armies both conducted and released their own investigation and findings, we were not satisfied that an independent, impartial investigation could be carried out by the parties involved. The idea behind the sanctions is to encourage the Taliban, which took over in August, to abandon the kinds of human rights abuses that marked their previous turn in power. It had few medicines and supplies," he says. The power shuts off for hours in the day with generator fuel quickly running out. On the most basic front of health care, that meant money dried up for primary health care, family planning, immunization programs and nutrition services. Find a quick visual guide to our offices around the world. This logistical centre in Amsterdam purchases, tests, and stores equipment including vehicles, communications material, power supplies, water-processing facilities and nutritional supplements. []. Our teams also invested heavily in local recruitment and training of medical staff. If someone with more experience can take this position it would be better, but unfortunately if someone (like that) gets this position, after some time youll see that he might be a thief or corrupt, he said, highlighting a perennial problem of the former government. At least 42 people were killed, including 24 patients, 14 staff and 4 caretakers. Spiegel and other observers say sanctions imposed by the U.N. are the reason. Throughout the airstrikes our teams desperately called military authorities to stop the attack. Dr. Elaha Ibrahimi uses her phone as a flashlight during a power cut inside the hospital in Mirbacha Kot, Afghanistan, in October. Next they were forbidden to study or train for a profession. KABUL, Afghanistan (AP) The Taliban-appointed supervisor of a small district hospital outside the Afghan capital has big plans for the place to the dismay of the doctors who work there. Fighting between government and opposition forces intensifies in Chardara district, 10km from Kunduz city. The Taliban Swore To Kill An Afghan Doctor For Giving Birth Control To A Child Bride. And the emergency room, packed with people, didn't have enough masks to protect everyone from COVID-19 spread, he says. We know there are no full guarantees when working in an active conflict, but we believe that the thorough negotiation process and the commitments we have obtained allow us to move forward and work again in Kunduz, while managing the risks that come with providing trauma care in this context. This is the biggest challenge for us. Are the provisions of the Conventions on grave breaches applicable in non-international armed conflicts? Earlier another spokesman said one of the attackers was captured. Visit this section to get in touch with our offices around the world. And many hospitals couldn't even heat patient rooms. So far, he says, it seems there are vast regional inconsistencies in how many female providers are allowed to deliver care and how female patients are treated. Starting with converting shipping containers, our hospital soon moved into a building in the city centre. The Manson Unit is a London, UK-based team of medical specialists who provide medical and technical support, and conduct research for MSF. We present a petition with more than half a million signatures to the White House, demanding US President Obama consent to an independent investigation. The U.S. froze Afghan assets in American accounts shortly after the takeover, in line with international sanctions, crippling Afghanistans banking sector. In addition, he says, "Some directors of hospitals have little to no hospital administration experience.". Our 14 colleagues who died in the attack are greatly missed and will never be forgotten. 78 Rue de Lausanne CP 1016 1211 Geneva Switzerland We have explicit commitments that our staff, patients and hospitals will not be attacked and that we can treat every person who needs medical care, no matter their ethnicity, political affiliations or which side of the conflict they are on. Just after2 am, a US Military plane repeatedly bombs the main hospital, shooting at anyone fleeing the burning building. That means that immunization programs, aimed at finally eradicating polio in the country, as well as attempting to control the epidemics of measles and COVID-19, can begin again. For example, some female midwives were not allowed to do home visits without a male escort, according to a September article in the medical journal BMJ's opinion blog. Every doctor here is in a deep depression, she said. The United Nations' mission in Afghanistan (UNAMA), along with countries including Pakistan, condemned the attack. "It's just about the biggest concern at the moment for everyone, in the region and in the West," a senior Western diplomat said. Re-starting in Kunduz is a step-by-step process as a first step, in July 2017 we opened an outpatient clinic for people with minor trauma-related wounds and injuries. I think they're hoping that eventually they'll be paid. They have no pain medication for expectant mothers. Based in Brussels, MSF Analysis intends to stimulate reflection and debate on humanitarian topics organised around the themes of migration, refugees, aid access, health policy and the environment in which aid operates. Created in 1991 under the Geneva Conventions that govern the rules of war, the IHFCC is not a UN body. Over the course of the hour, MSF staff in Afghanistan and New York made multiple attempts to stop the strikes via texts and calls to Afghan military, ICRC, UN and US military contacts. Already the emergency departments of two of the four large Kabul hospitals are refusing to admit women. The bigger hospitals that provide higher levels of care at the provincial and regional levels are not being funded.". Female doctors are forbidden to go to the emergency room. Read through our annual financial and activity reports, and find out about where our funds come from and how they are spent. Our Standards: The Thomson Reuters Trust Principles. In more than 70 countries, Mdecins Sans Frontires provides medical humanitarian assistance to save lives and ease the suffering of people in crisis situations. I know the names of the medicines needed for different conditions, he said proudly. The hospital provided high-quality, free surgical care to victims of all types of trauma. As in all our projects, our doctors treat people according to their medical needs and do not make distinctions based on a patients ethnicity, religious beliefs, political affiliation or on which side of a conflict they're from. (GC, Would the situation under IHL be different if the IHL of international armed conflicts were applicable? Given this, and the lack of details and information in the lead up to, and surrounding, the airstrikes, we demanded an independent investigation on the attack. PHOTO OBTAINED BY REUTERS/Handout via REUTERS THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY. Health is acutely affected. Among the dead was Mawlawi Hamdullah Mukhlis, head of the Kabul military corps and one of the first senior Taliban commanders to enter the abandoned presidential palace when the city fell, Taliban officials said. Following the attack, we engaged in discussions with all parties to the conflict over a one and half year period and finalised formal commitments that allow us to gradually start to provide medical care in Kunduz. Health care workers have continued to work without salaries, without medicine for patients and with frequent power cuts. In the days after the attack, the United States military eventually claimed responsibility for the airstrikes, saying that it had been an accident. The main donor for this construction project turns out to be WHO, which has made a contribution of $64,000 for the first six months. Our staff own and manage MSF, making sure that we stay true to our mission and principles, through the MSF Associations. See ICRC News: Afghanistan: Women gradually being re-admitted to Kabul Hospitals, 97/47, November 26, 1997.]. Since opening the hospital in 2011, more than 15,000 surgeries were conducted and more than 68,000 emergency patients were treated. We are Muslims, and we have 32 staff members, and for them, we need a mosque, he said. Reuters, the news and media division of Thomson Reuters, is the worlds largest multimedia news provider, reaching billions of people worldwide every day. The group's attacks have caused mounting worries outside Afghanistan about the potential for the country to become a haven for militant groups as it was when an al Qaeda group attacked the United States in 2001. But, according to the Western doctors who have visited it, the Central Polyclinic has no running water, no electricity above the second floor, no laboratory, no functioning operating theatre and only one microscope. Should they ask Afghan women whether they agree to or wish to have separate treatment? Based in Barcelona, ARHP documents and reflects on the operational challenges and dilemmas faced by the MSF field teams. (, In what circumstances does the treatment of women described in the newspaper article amount to a grave breach of IHL, if the law of international armed conflicts is applicable? What can we do? If we dont want to come here theres no other job for us. Learn about the different contexts and situations in which MSF teams respond to provide care, including war and natural disaster settings, and how and why we adapt our activities to each. Should they always respect the will of those concerned? Is the latter not a cultural judgement? A Taliban security official, speaking on condition of anonymity, said at least 25 people had been killed and more than 50 wounded in the assault but there was no officially confirmed casualty toll. Based in Paris, CRASH conducts and directs studies and analysis of MSF actions. Or does it affirm that the concept of grave breaches applies in non-international armed conflicts? "What's amazing is that most of the staff are still coming in, despite not being paid for many months. Should aid organizations not respect and adapt to the culture and beliefs of the area in which they are working? He could not offer proof that this was the intention of the previous administrator. "When it gets really, really cold and the snow starts falling in winter, I don't think staff will continue to show up. All of them fight with us, Ibrahimi said. N.B. And the few female staff remaining in these hospitals are not allowed to give any treatment at all. First of all, these women are afraid to go out. But Ahmadi is quick to allege deeply entrenched corruption in the hospital under the former hospital administrator, his predecessor from the former government. Or against the policy of separating men and women? We open an outpatient clinic in Kunduz for people with minor trauma-related wounds and injuries, the first return to the area. What's more, new Taliban workers delegated to health care facilities often have no relevant experience. The Luxembourg Operational Research (LuxOR) unit coordinates field research projects and operational research training, and provides support for documentation activities and routine data collection. However, this was what the latest directive issued by the students of Islamic theology on 6 September ordered in very clear terms. He claims that in the past two months he has learned how to administer injections and prescribe basic pharmaceuticals. At the beginning of October a woman in a deep coma was turned away and sent home. Recalling also resolution 52/211 of the General Assembly, Expressing its grave concern at the continued Afghan conflict which has recently sharply escalated due to the Taliban forces offensive in the northern parts of the country, causing a serious and growing threat to regional and international peace and security, as well as extensive human suffering, further destruction, refugee flows and other forcible displacement of large numbers of people, []. The abrupt withdrawal of international support following the Taliban victory has brought Afghanistan's fragile economy to the brink of collapse just as a severe drought has threatened millions with hunger. The second health care front to suffer is the country's larger hospitals. The most comprehensive solution to manage all your complex and ever-expanding tax and compliance needs. Spiegel says that he saw a two-pronged collapse. hide caption. "It all stopped because of sanctions. That money had been provided by USAID, the World Bank and various nongovernmental organizations (NGOs). People should be aware that today women are dying at home in Kabul because the Taliban will not allow them access to treatment. Browse an unrivalled portfolio of real-time and historical market data and insights from worldwide sources and experts. "For example, the U.S. and other donors funded 39 COVID-19 hospitals. A collaborative, patients needs-driven, non-profit drug research and development organisation that is developing new treatments for neglected diseases, founded in 2003 by seven organisations from around the world. Does para. ", "And it's starting to get very cold in Afghanistan," he says. KABUL, Nov 2 (Reuters) - At least 25 people were killed and more than 50 wounded when gunmen attacked Afghanistan's biggest military hospital after two heavy explosionsat the site in central Kabul, officials said. As per thedisclaimer, neither the ICRC nor the authors can be identified with the opinions expressed in the Cases and Documents. In the five days leading up to the attack, our teams in Kunduz had treated 376 patients in the emergency room. MSF International President Dr Joanne Liu condemns the attack in a statement; we report 12 staff and 10 patients have been killed. We mark one year since the attack and continue to mourn the loss of our staff, our patients and their carers. At around 3.10am, airstrikes finally stop. Some cases even come to solutions that clearly violate IHL. Having considered the situation in Afghanistan. Our staff reported no armed combatants or fighting in the compound prior to the airstrike.