Hospital closure could leave Paktika without health care

Sitting in the waiting room at the provincial hospital, Bibi Bakhtewazir told IRIN she had travelled several hours by car to reach the facility in Shiran, the principal city of the southeastern province of Paktika, to get medical care for her malnourished child. "The doctor told me to take him to Ghazni [a neighbouring province around 250 km from Shiran] as the province's only hospital is closing down due to lack of funding," the mother-of-12 said. Bakhtewazir said she was from Barmal, a border district of Paktika, where there was no health facility or medical doctors. Bakhtewazir is one of thousands in the border province who will soon have to go to neighbouring provinces via unpaved roads to reach the nearest health facility as the province's only hospital in Shiran is due to close soon. "We don't have a car nor can we afford to take a special taxi to Ghazni," she stressed. According to local doctors, the hospital in Shiran - run by a Kuwait-based NGO - was one of the best in the southeastern region, but they said the hospital started losing staff when the agency's funds were frozen by the United Nations Security Council (UNSC) for suspected links with Al-Qaeda earlier this year. "We have already run out of funds, we have to close, as no other agency has taken this responsibility," Hasibullah Nikzad, one of the three remaining doctors at the hospital, told IRIN. The chair of the UNSC Al-Qaeda and Taliban Sanctions Committee, Ambassador Heraldo Munoz, told IRIN in Kabul that he was not aware of the specific case of the Kuwaiti NGO's involvement with Shiran hospital, but he emphasised that the committe was able to de-list NGOs where sufficient evidence existed that they were not linked with the two terrorist organisations. "We will look into it. We will have to get information and perhaps a judgement will be made by the committee to revise it but I cannot anticipate that right now." Resolution 1267 of October 1999 imposed sanctions on Osama bin Laden and Al-Qaeda for their alleged roles in terrorist acts, including the bombing of US embassies in East Africa, and on the Taliban for harbouring Al-Qaeda. Countries are supposed to enforce a travel ban, a freeze on financial assets and an arms embargo against individuals and groups on a council list of suspected members of the two groups. Munoz chairs the council's committee that monitors compliance with 1267 and Resolution 1455, adopted in January 2003, which tightened the sanctions on the two groups. Nikzad said the very modern, well-equipped hospital had no money left to cover any further daily expenses, but that he and his colleagues were still visiting patients. "We cannot undertake operations and hospitalise patients as before, because we are losing our doctors and professional support staff," he said. The 70-bed Shiran hospital began operating at the start of 2003. "Since June we have been trying to find another donor to support operating costs, Nikzad said, adding that the hospital needed a minimum of US $6,000 per month to run. Government officials in the province told IRIN that they could not run the hospital unless an aid agency covered running costs. "The Ministry of Public Health has said it is too weak to meet all the operational costs of the hospital," Dr Abdul Kabir, the head of the Paktika public health department, told IRIN. Abdul Kabir complained that the government was ignoring the isolated province, and that aid agencies had largely written it off as a security risk. The ministry acknowledged that getting qualified doctors to work in places like Paktika was difficult. "The most serious challenge with regard to provinces is paying incentives for doctors. Without that we cannot force them to go to provinces, and also security is another impediment which prevents access to many places like Paktika," Dr Mir Azam Mehraban, the Afghan deputy health minister, told IRIN adding that his ministry's budget could not stretch to pay anything more than normal salaries. Mehraban expressed the hope that the Saudi government would support the operational costs of the hospital. "We are discussing it with the Saudi embassy in Kabul," he said. According to the deputy minister, Kabul was working on a strategy to pay incentives for doctors throughout the country. "We are pledged by USAID, the World Bank and European Commission to provide incentives for doctors and health workers throughout the country next year," he said adding that the ministry had allocated $4.5 per individual in the provinces for health care, assuming donor support was forthcoming.