Mothers and babies, such as this girl on the malnutrition ward in Ghor, are at particular risk
“There’s no space inside,” shouts a beleaguered hospital worker as he tries to push back a frantic crowd of mothers and babies hoping to receive nutrition packs.
“It’s like this every day,” he yells out to us over their heads, “it’s been like this for the last four or five months… It was bad last year too, but not like this.”
The war in Afghanistan is over, but its economy is collapsing and at this hospital, in the remote, central province of Ghor, they’re struggling to cope with the fallout.
International support, which propped up the previous government, was withdrawn after the Taliban takeover in August, whilst the country’s foreign reserves, totalling around $10bn, have been frozen – chiefly by the United States.
Afghanistan has seen unemployment and food prices soar, whilst the value of its currency is plummeting and banks have set limits on cash withdrawals.
Local people, seen here queuing, rely on nutrition packs because money and food are in such short supply
For the women outside the malnutrition triage centre in Ghor, life has always been difficult, but now it’s getting even harder.
“We have nothing, no food. My children are sick and we don’t have medicine,” pleads one mother. “Why aren’t we getting any help?”
There are twice as many cases now compared with this time last year, one senior doctor tells us.
Inside a small room, a nurse wraps a measure around the stick-like arm of a young baby. It indicates “red” – the child is severely malnourished.
They’re witnessing a sharp rise in cases of malnutrition here and across the country, with both mothers and young infants in particular unable to get enough food. The UN has warned that one million children are at risk of dying due to starvation over the coming months.
At the malnutrition ward, they’re running out of space. “Right now, we have two babies and their mothers in a single bed,” Dama, a nurse tells me. “At times we have three.”
Temperatures can drop well below -10C at night, but there’s only enough wood in the heater to last for a couple of hours each day.
Under the previous government, the hospital was also badly under-resourced, but at least the Ministry of Health was able to provide them with enough fuel. Now, with funds cut off, the Taliban’s government simply doesn’t have the money.
Space is so short that two women and their children share one bed
Even the small pile of wood in the ward’s heater has been donated by an international charity.
Someone has shoved an empty medicine box and a crisp wrapper inside the stove too, to try and provide a few extra minutes of warmth.
Chaghcharan, the capital of Ghor province, is around 10 hours drive from the capital Kabul, much of it along a dirt road. The mountains along the way are picturesque, but there’s less snow on them than usual – a sign of the continuing drought that’s adding to the humanitarian crisis.
As we arrive at the province’s only hospital, staff are receiving their salaries for the first time in five months, thanks to the International Committee of the Red Cross.
Medicine supplies, for now are still dangerously low, however. They have only about a week’s worth left, so most patients are told to buy their own from nearby pharmacies.
“We don’t have anything… no medicines,” says Dr Safar, his voice cracking with emotion as he holds up a prescription he’s writing, “we are suffering, sometimes we are crying.”
The hospital has so little cash it can’t pay salaries or afford enough power and heating
Many struggle to cover the costs of treatment. Gulfiroz, 20, is recovering from a Caesarean section. Her baby, Benyahim, is doing well, but the procedure has driven her family into debt.
“We didn’t even have 10 Afghani (9c; 6p) for a taxi here,” her mother-in-law tells the BBC. “We couldn’t afford to buy her meat, just milk… We had to buy lots of medicines. We asked everyone we know to lend us the money.”
At times hospital staff hold their own collections on behalf of patients, despite not having received pay checks for months themselves. Dr Parsa, the head of the hospital, has been paying out of his own pocket for six extra nurses, just to keep essential services running.
Western governments are anxious about resuming funding, concerned they will be strengthening the new Taliban government. But Dr Parsa says his hospital needs support.
Hospital chief Dr Parsa says he fears the hospital will close if help doesn’t arrive
“My message to the international community is: this is the worst situation we have ever faced… please send us humanitarian aid. Negotiate with the Islamic emirate [the Taliban government] and unfreeze their foreign reserves.”
It’s not just a rise in malnutrition that hospital staff are witnessing, but also of cases of severe pneumonia as winter sets in.
“We don’t have fuel, shawls or warm clothes,” says one elderly woman accompanying her baby granddaughter in the emergency ward. “We don’t have a real life… we’re displaced refugees.”
It’s in the measles ward we come across the starkest example of the consequences of the lack of hospital resources.
The hospital is struggling to cope with the number of cases of the infectious disease – vaccination campaigns were recently disrupted by both Covid and, until the Taliban takeover, armed clashes.
The night before we arrived a baby boy died, because doctors couldn’t provide him with enough oxygen.
“We needed pure oxygen in cylinders… they’re expensive,” says another doctor, Dr Musa.
A cylinder would have cost them around $50. That can be the difference between life and death in Afghanistan.
Babies on the measles ward in Ghor rely on scarce supplies of oxygen
In fact, there are a few dozen empty cylinders just outside the measles ward. The hospital has a machine to produce its own oxygen, but there’s no electricity to power it.
At the moment, there’s no electricity across the whole city, apart from private solar power in some residents’ homes. The city used to be powered by a fuel-run power plant, but there’s no money to turn it on. The hospital has its own generators, but they’re not enough.
Dr Khatera heads the maternity unit, and is the wife of Dr Parsa, who is in charge of the whole hospital. Despite the billions of dollars of international support over the past two decades, she reels off a list of equipment and resources they have long been in need of.
Now, the situation is even worse. The International Committee of the Red Cross is committed to providing emergency support for the next six months.
Dr Parsa is grateful, but also deeply worried about the future.
“If we don’t get international help, and this situation continues, my fear is the hospital will shut down. That would be the end of the health service in this province,” he warns.