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TRAPPED

TRAPPED. Between Rhetoric And Reality. AFGHANISTAN. war. poverty. mortality rates. politicised aid. CONFLICT. 35 years of war. 2001 US led intervention 2014 violence continues. Surge in civilian deaths. Humanitarian needs grow. POVERTY and HEALTH. 1/3 below poverty line.

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TRAPPED

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  1. TRAPPED Between Rhetoric And Reality

  2. AFGHANISTAN war poverty mortality rates politicised aid

  3. CONFLICT 35 years of war 2001 US led intervention 2014 violence continues Surge in civilian deaths Humanitarian needs grow

  4. POVERTY and HEALTH 1/3 below poverty line Women: x 100 more likely to die giving birth Children: 1/10 die before five years Underestimations

  5. AID as AMMUNITION Win ‘hearts and minds’ Threat based, not needs based Blurred Boundaries Selective Storytelling Fails the most vulnerable

  6. “Best Performing” Reconstruction Area “Best thing the US did in Afghanistan” Exuberant claims

  7. Veil Spin

  8. OBJECTIVES Clearer picture: access to healthcare Understand barriers: Types Extent Impact

  9. METHODS Study period: Jun – Oct ‘13 Cross-sectional survey: 800+ patients, caretakers

  10. LOCATIONS

  11. DATA COLLECTION Questionnaires, 763 : structured, pre-tested Individual interviews, 35: semi-structured Focus groups,12: semi-structured Additional information: - MSF medical reports - Key interlocutor interviews

  12. ETHICS ✓ MoPH permission for survey ✓ Informed oral consent ✓ Confidentiality ✓No identifiers Formal review not sought

  13. RESULTS Deadly combination of barriers Delay Prevent

  14. 1 in 4 people experienced violence VIOLENCE

  15. 7 in 10 barrier to reach MSF n=763 4 in 10 conflict as a barrier

  16. DISTANCE Perilous Journeys 1 in 3 Taking wounded to Kunduz  distance a major difficulty

  17. COSTS 2 in 3 Poor, extremely poor $1 day

  18. 1 illness episode  costs more than 1 month of income

  19. 2 in 5 44% forced to borrow money or sell goods to obtain healthcare during a recent illness.

  20. HEALTH SYSTEM GAPS Rise in Numbers Too Few

  21. Proximity ≠ Access 4 in 5 Bypass

  22. ✗quality Staff Services Treatments ✗availability “empty, lacking medicines, qualified staff, and electricity, closed, long queues, corruption, malpractice, high prices, no referral“

  23. PARTIES TO THE CONFLICT Active fighting Occupying facilities Deliberate delays Harrassment Sharp increase in military intrusion Attacks, medical vehicles, personnel 450 health facilities close - insecurity

  24. “I can’t go to the government doctor in my area because of the insurgents and other problems. They don’t like us to go to clinics supported by the government. If I go there, maybe the insurgents will arrest me, ask me why I was there, what I was doing there.” - Male, 22 years, farmer, Nawzad district, Helmand

  25. EFFECT 1 in 5 Death LACK OF ACCESS to medical care

  26. DEATHREASONS FOR LACK OF ACCESS TO CARE JOURNEY 36% COST 32% CONFLICT 18%

  27. “In the last years violence has blocked us coming to health centres and hospitals more than 100 times. The fighting doesn’t stop when there are injured people. So we wait, and then they die, and the fighting continues.” - Male, 25 years, school principal, from Baghlan province

  28. LIMITATIONS Health facility survey Underestimate barriers Urban v rural bias Responder bias

  29. CONCLUSION Far from a simple success story Remarkable gap – paper and practice Meaningful medical care not available Neutral, needs based Serious, often deadly, risks Pragmatic, principled Reality, not rhetoric

  30. Uphill struggle

  31. THANKS Ilham Kamal Shahab Benoit deGryse, Renzo Fricke, Catherine Van Overloop, Mit Philips, Tom DeCroo, Silvia Pineda Corinne Baker, JehanBseiso, Jonathan Whittall

  32. Thankyou

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