image sourceBBC/Imogen Anderson
- author, Yogita Lamaye
- position, BBC News, Jalalabad
Warning: Some details at the beginning of this article may be disturbing to readers
‘This is no less than an apocalypse for me. I feel a lot of pain. Can you imagine what it must have been like for me to see my children die in front of my eyes?’
These are the words of Amina, a mother from Afghanistan. She has lost six of her children so far. None of them lived past the age of three and now their other child is fighting for his life.
Amina’s seven-month-old daughter, Bibi Hajra, is severely malnourished and lies on a bed in a ward of the Jalalabad Regional Hospital in Afghanistan’s eastern Nangarhar province. She looks younger than her age due to malnutrition.
‘My children are dying of poverty,’ Amina screams. I can only give them dry bread and water, which I heat outside in the sun.’
What’s even more painful is that it’s not just a story.
Bibi Hajra is one of the 3.2 million children in Afghanistan who are severely malnourished. This situation has troubled Afghanistan for decades. There are many factors behind this, including 40 years of war, extreme poverty and other factors.
But three years after the Taliban took power, the situation has increased dramatically.
It is hard for anyone to imagine how 3.2 million children could be severely malnourished but stories from just one small hospital ward can illustrate the devastation.
image sourceBBC/Imogen Anderson
There are 18 small children in the seven beds of the hospital ward and not all of them are admitted here due to some seasonal illness but this is a normal thing here.
In this hospital ward, there is no sound of crying, no squirming of a baby, just an unnerving silence, broken only by the shrill sound of pulse rate monitors.
Most of the children there are neither unconscious nor on oxygen. They are awake but too weak to move or make a sound.
Along with Bibi Hajra, another three-year-old girl, Sana, is with her in the hospital bed.
Wearing a purple dress, Sana’s small arm covers her face. Sana’s mother died giving birth to her a few months ago, so Sana’s aunt Laila is taking care of her. Layla touches my arm and tells me with a hand gesture that she has lost seven children.
The two girls have a three-year-old inspiration in their adjacent bed. Due to malnutrition, he could not grow properly for his age and looks much younger than his age. Due to malnutrition, the skin on his arms, legs and face is dry. Three years ago, his two-year-old sister also died.
Even looking at a one-year-old asthma is very painful. She has beautiful eyes and thick eyelashes. But they are torn from malnutrition and they barely blink due to weakness. She is wearing an oxygen mask that she is breathing through and it covers her face.
Dr. Sikandar Ghani, standing by her head, shakes his head and says, ‘I don’t think she will survive.’ Asma’s little body has gone into septic shock.
image sourceBBC/Imogen Anderson
Despite these conditions, there was a kind of indifference or indifference in the room by this time, the nurses and mothers were engaged in their work, feeding the children, comforting them. But after listening to the doctor, everything stops and many faces show signs of despair.
Asma’s mother Naseeba is crying. She lifts her hijab and leans over to kiss her daughter. ‘It feels like a part of my body is falling off,’ she cries. I can’t see her in this pain.’
Naseeba has already lost three children. She says, ‘My husband is a labourer. We eat when they get work.’
Dr. Sikander Ghani told us that Asma could have a heart attack at any moment. About an hour after we left the ward, we were informed that she was dead.
The Taliban health department in Nangarhar told us that seven hundred children have died in the hospital in the past six months. According to this calculation, there were more than three deaths per day.
This is a shockingly high number, but if the hospital had not been funded by the World Bank and UNICEF, there would have been even more deaths.
International funds given directly to the previous government financed almost all public health care in Afghanistan until August 2021.
But when the Taliban took over, funding was halted due to international sanctions against them. It affected health care so badly that it began to collapse. In such a situation, the aid agencies had demanded to continue them.
image sourceBBC/Imogen Anderson
In a world where so much is already going on, funding for Afghanistan has been cut further. Similarly, the policies of the Taliban government, particularly restrictions on women, mean that donors are reluctant to provide funds.
“We inherited the problem of poverty and malnutrition, which has been worsened by natural disasters such as floods and climate change,” Hamdullah Fitr, deputy spokesman for the Taliban government, told us. The international community should increase humanitarian aid, they should not link it to political and internal problems.
In the last three years, we have visited more than a dozen health facilities in the country and have seen the situation deteriorate rapidly. During each of our last few visits to hospitals we have seen children die.
But what we’ve seen is that the right treatment can save children. Dr. Ghani told us over the phone that Bibi Hajra is much better now and has been discharged. But when we visited the hospital, his condition was critical.
“If we had more medicines, facilities and staff, we could have saved more children,” he said. Our staff is very committed. We work tirelessly and are ready to go the extra mile. I also have children. When a child dies, we also suffer. I know what goes through the hearts of parents in such a situation.’
image sourceBBC/Imogen Anderson
Malnutrition is not the only cause of increased mortality. Preventable and curable diseases are also killing children.
A six-month-old girl is suffering from severe pneumonia in the intensive care ward adjacent to the nutrition ward. She cries loudly when a nurse puts her on a drip. Umra’s mother Nasreen is sitting next to her and crying.
‘I wish I had died in his place,’ she says. I’m so scared.’
Umra died two days after we returned from the hospital. These are the stories of people who have been brought to the hospital. There are countless others who could not reach the hospital.
If five children require hospital treatment, only one of them gets a place in Jalalabad Hospital. The pressure on the hospital is so intense that almost immediately after Asma’s death, a three-month-old baby girl, Alia, was moved to the half-bed vacated by Asma.
No one in the room had time to see what happened because there was another seriously ill child in need of care.
image sourceBBC/Imogen Anderson
Jalalabad Hospital is carrying the burden of the population of five provinces. According to the estimates of the Taliban government, there are about five million people living in these provinces. And now the pressure has increased.
Most of the more than 700,000 Afghan refugees forcibly deported by Pakistan since late last year live in Nangarhar.
According to the data released by the United Nations this year, 45 percent of children under the age of five in the population around the hospital are stunted.
Rubina’s two-year-old son Muhammad cannot stand yet and is much shorter than his age.
“The doctor has told me that if he is treated for the next three to six months, he will be cured,” Rubina said. But when we can’t even eat two meals, how can we afford the medical expenses?’
Rubina and her family had to leave Pakistan last year and now live in Sheikh Misri area. This township is located at a short distance from Jalalabad.
image sourceBBC/Imogen Anderson
“I’m afraid he will be crippled and will never be able to walk,” says Rubina. Our life in Pakistan was also difficult but there was work. Here my husband also rarely gets work. If we were still in Pakistan, we could have got him treated.
Stunting can cause severe irreversible physical and mental damage, the effects of which can last a lifetime and affect the next generation, says the United Nations agency UNICEF.
Dr. Ghani asks, ‘How can our society help Afghanistan, which is already suffering from economic difficulties, if a large part of our future generation is physically or mentally disabled?’
If treatment is not too late, Muhammad can be saved from permanent damage. But community nutrition programs run by aid agencies in Afghanistan have seen dramatic cuts, and in many cases only a quarter of what is needed.
image sourceBBC/Imogen Anderson
In the streets of Sheikh Masri, we met families with malnourished or stunted children.
Sardar Gul has two children who are malnourished. One of them is three years old while the other is eight months old. Sardar Gul is holding the young son Mujeeb with shining eyes on his lap.
Sardar Gul says that ‘A month ago, Mujeeb’s weight was less than three kilos. When we managed to register him with an aid agency, we started receiving food bags. These people have really helped him.’
Mujeeb now weighs six kilos, still two kilos underweight for his age, but has improved significantly.
This is evidence that early intervention can help protect children from death and disability.
Imogen Anderson and Sanjay Ganguly provided additional reporting for this article.
