International aid donors must find a way to fund Afghanistan’s crumbling health system, or risk an even greater humanitarian catastrophe.
This is the warning from the country’s acting health minister, Dr. Wahid Majrooh, who now oversees a sector he says is on the verge of collapse due to donor funding freezes.
After the Taliban’s rapid August takeover, many of the donor governments and development banks that had subsidised Afghanistan’s public sector over two decades quickly put a pause on funding flows. This meant sudden stoppages to a World Bank-managed programme that funds much of the public health sector.
“The decision leads the system close to collapse,” Majrooh told The New Humanitarian, speaking from Kabul.
More than 90 percent of health facilities funded by the programme, known as Sehatmandi, may close, the World Health Organization says. Health officials warn of medicine stockouts, staff desertions, interrupted COVID-19 vaccinations, and the preventable deaths of pregnant women and severely malnourished children.
The UN has called a 13 September summit to push for boosting humanitarian funding in Afghanistan. But aid groups say emergency relief is meant to complement a health system – not replace it.
Majrooh was appointed acting health minister in January in the now-deposed Afghan government. This week, the Taliban filled a range of government posts, including cabinet ministers, from within its ranks, but did not announce a new health minister.
Majrooh spoke to The New Humanitarian about how wary donors might fund healthcare under a Taliban government, why he decided to stay in Afghanistan when so many wanted to leave, and his own future at the helm of a troubled health ministry.
The interview has been edited for length and clarity.
The New Humanitarian: You warn that the public health system will ‘collapse’. It’s a very dire scenario. What do you see happening?
Wahid Majrooh: That’s something that has already started. I receive calls every day: messages that they are running out of fuel and there is no food – in most centres – for patients or staff members. Salaries are not paid. Our immunisation programme is badly affected. Polio is the other agenda in Afghanistan: Our routine immunisations will not be effectively delivered unless we have the primary healthcare centres in place. COVID-19: The fourth wave is approaching, and we have no options but to close down centres in a few provinces. And it will disseminate to other provinces as well. So there will be a human disaster. A human crisis.
The New Humanitarian: International donors are reluctant to fund a government that will be led by the Taliban. What do you think of these concerns?
Majrooh: During my tenure, what I did was to ensure that the health sector is impartial, neutral, and apolitical. We practised it during conflict in Afghanistan. We were expecting that the health sector would be kept as an exception.
The opportunity we have here in Afghanistan is that primary healthcare services are contracted out, in 31 out of 34 provinces, to NGOs. So we are not directly delivering the services; NGOs are representing the ministry. [Funding] could be paid directly to UN agencies, to a private sector facilitator, to any mechanism that fits their needs. In the new political context that our donors are promoting now, we are flexible with that.
For me as the leader of the health sector, I have no issue with what the political agenda is. The only concern I have is the availability of health services.
“I have no issue with what the political agenda is. The only concern I have is the availability of health services.”
I call on the international community to work with us to find a practical solution. Because what I hear right now is that they are working together, without coordination: The ministry is completely left out of the chain. I’m very worried that even if they find a solution, it will be uncoordinated. We will witness a lot of duplication. We will witness a lot of gaps and… wasted resources.
In the longer term, [international donors] have no other options but to refer back to the ministry – five years from now, three years from now. Then everybody will have to pay for the wrong decisions that we may make today.
The New Humanitarian: Afghan health NGOs generally kept working after the Taliban claimed control of the country. You are still working. Many people wanted to leave Afghanistan. Why did you decide to stay?
Majrooh: It was and it is a very difficult decision. I made a decision the day Taliban were entering Kabul. I was very worried and concerned about the continuity of service delivery, because I was prepared, and I made my hospitals be prepared, for the worst-case scenario: if something wrong happens in the city and a conflict starts in the streets.
When Taliban came in, I attended the office the next day. And to be honest, [the Taliban] were surprised. As the days go on, I’m just preparing for a smooth exit, to hand over most of the issues. The level of coordination between me and their health commision is good. But the way we work is different. I have to respect the way they work, because in the longer term, it will be them leading the ministry. So I prefer, at this point, to create a space for them and smoothly find a different option for myself.
The New Humanitarian: What is the Taliban’s position on COVID-19 vaccines?
Majrooh: I was able to convince them to issue a letter to their provincial commision members – they have a health commission with representatives in every province – to have them co-operate with our COVID-19 vaccination teams.
But the [vaccine] trend is declining, following the transition. The uptake is declining, and I’m very concerned. Because we have about three million doses of vaccines, which are very close to expiring. The fourth wave is approaching. We are not at the same level of preparation as we were in the third wave. I’m not feeling very well in that regard.
The New Humanitarian: Will COVAX, the UN-backed vaccine-sharing programme, be able to deliver COVID-19 vaccine doses?
Majrooh: The issue of logistics will be resolved. We will work with COVAX. But at the same time, I have to make sure that we [are able] to administer the vaccines. Importing vaccines is one part of the story. Administration of millions of doses of vaccines – in a different context compared to a month ago – is another story.
The New Humanitarian: Is vaccine administration also dependent on the local NGOs contracted by the Sehatmandi programme?
Majrooh: Both. It is local NGOs as well as our directly hired teams, which were, again, financed by USAID. They have now frozen their funds.
So when I use the word “collapse”, I say it responsibly. It is not some flourish, or that I like the word. I see that the frozen funds and suspended resources affect the whole continuum of care.
The New Humanitarian: The UN is holding a ministerial summit on 13 September, which will advocate for more humanitarian aid funding and access. As Afghanistan’s current health minister, what’s your message for international governments?
Majrooh: I urge them to help us avoid a human crisis in this country. And I challenge them: A lack of commitment or sense of urgency to fill the gap will question their mandate of the last 20 years.
They were claiming they were working here for the health of mothers and children. Per the current situation, it looks like they were just channelling funds for the political system, not specifically as a humanitarian agenda for the health of mothers and children and those who are in need.