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In Afghanistan’s battered healthcare system, power cuts can prove fatal

‘You simply can’t run a health facility without constant and reliable electricity.’

The premature birth ward at Kabul's Indira Ghandi Children’s Hospital, November 2021. Afghan hospitals and clinics have become increasingly reliant on expensive-to-run generators due to worsening power cuts. Adrien Vautier/REUTERS
The premature birth ward at Kabul's Indira Ghandi Children’s Hospital, November 2021. Afghan hospitals and clinics have become increasingly reliant on expensive-to-run generators due to worsening power cuts.

Every time Dr. Noor Ahmad Jamal buys heart monitors, ECG machines, and ultrasound scanners for his Kabul cardiology hospital, he must spend thousands of extra dollars to make sure each device stays powered through Afghanistan’s all-too-regular blackouts.

 

“I can spend tens – or hundreds – of thousands of dollars on the machinery itself, but then I have to [factor] in the costs of stabilisers… surge protectors, and other devices to ensure each one operates properly,” Jamal told The New Humanitarian.

 

Afghanistan still imports 80% of its electricity from its Central Asian neighbours and Iran, which leaves the country susceptible to wide-scale power shortages, especially in the cold winter months. The lack of a consistent electricity supply sees millions forced to choose between food and heat. 

 

For hospitals and health clinics, electricity can mean the difference between life and death. Health workers scramble to keep a steady power flow to everything from the storage fridges for life-saving medicines, to the incubators cradling premature babies – in which a drop of temperature can have drastic effects on a newborn’s health. 

 

“You simply can’t run a health facility without constant and reliable electricity,” Ahmadullah Safi, mission adviser for Médecins Sans Frontières in Afghanistan, told The New Humanitarian, explaining how most medical machinery requires a stable supply. 

 

Electricity and heating have long been a problem at this time of year in Afghanistan, but this winter has proven particularly difficult, and dangerous.

 

In December, and again in January, Uzbekistan, which provides the bulk of Afghanistan’s electricity, cut power to its southern neighbour, citing technical issues.

 

And the blackouts are coming even as Afghans struggle with capital flight, sanctions, aid cuts, and banking restrictions that have led to rising prices of staple goods and the loss of hundreds of thousands of jobs since the Taliban returned to power in August 2021. This means even middle-income households are more hesitant to purchase or run back-up generators or solar panels to power and heat their homes. 

 

Kabul residents told local media throughout December that they had electricity for only a few hours each day, with the least being one hour and the most being eight. Businesses are also taking a major hit. Many of the 600 factories based in the capital have had their productivity affected by the power shortages, reducing output reportedly by up to 60%.

 

Another blow to a struggling health system 

 

Since the Taliban returned to power and Western nations pulled their aid, the Afghan healthcare system has been “on the brink of collapse” and “on life support”, according to the World Health Organization and the International Committee of the Red Cross (ICRC).

 

Doctors and nurses are working longer hours and going weeks or months at a time without pay. And on top of having less money and assistance, healthcare providers now have to try and deal with an influx of wintertime patients at the same time as power cuts have been increasing across the capital.

 

In Kabul’s Wazir Akbar Khan neighbourhood, Najmussama Shefajo has had to make countless contingencies for her gynaecology clinic, which draws patients of all economic classes from several different provinces.

 

Shefajo, who began her career in the southern province of Helmand, told The New Humanitarian that health workers in the capital have many more facilities at their disposal compared to those in Afghanistan’s less-developed provinces. 

 

Still, even in Kabul she has faced extreme difficulties.  

 

“The other day we kept the generator on for 13 hours. Finally, we had to shut it off for a little bit to let it rest and reset,” she said. “We had to shut it for two hours, and we told the mothers to find a way to warm their newborns. If we kept them in the incubators without electricity they would freeze. If we took them out, they could have problems breathing.”

Private clinics like Shefajo’s and Jamal’s have had to invest thousands of dollars in generators and solar panels to try to guarantee that patient care isn’t impacted by the power shortages. They are at an advantage, as they can add the cost of extra equipment onto the charges for more well-to-do patients. Government-run hospitals, which offer free care to all patients, have little such leeway.

READ MORE: A long-term problem

During the 20-year rule of the Western-backed government, the Asian Development Bank alone provided more than $2.14 billion in loans and grants to help rebuild the nation’s energy sector, which was destroyed during the Soviet occupation and civil war of the 1980s and 1990s.

But despite the assistance provided by the international community over the last two decades, only 22% of the 1,600 megawatts consumed each year is domestically produced. This means millions of Afghans have had to contend year-in year-out with long periods of power outages, especially during the winter. 
  
Both the former Western-backed Islamic Republic and the current Taliban-led Islamic Emirate have tried to address the electricity situation in the country, but neither has been successful at providing reliable 24-hour electricity. 

One primary reason is Afghanistan’s inability to produce enough power domestically. The vast majority of Afghanistan’s electricity is provided by its regional neighbours at an annual cost of $220 million. That has left Afghanistan at the mercy of technical issues, like the ones plaguing Uzbekistan’s power supply. Sanctions and reduced revenues, meanwhile, mean the Islamic Emirate is struggling to keep up with payments, including debts incurred during the former Western-backed government.  

Uzbekistan, which has good relations with the Islamic Emirate, has been calling on the international community to unfreeze billions in assets belonging to the Afghan Central Bank, hoping that it will help the current government make electricity payments on time. 

For its part, DABS, the state-owned electricity company, says it is trying to address the shortfalls, but admits it will take time. 

“We are working on attracting foreign investment into Afghanistan’s electricity grid, while at the same time looking at domestic sources of additional power,” Hekmatullah Maiwandi, a spokesperson for DABS, told The New Humanitarian. 

Maiwandi said the utility is currently in the process of trying to restart wind turbines that were previously disabled. 

In the past, there have been proposals to expand wind and solar power facilities in the country, but a former official of the previous Western-backed government told The New Humanitarian it would require expensive adjustments to Afghanistan’s power grid to absorb the extra supplies. 

According to one dual-national entrepreneur who had tried to bring alternative sources of energy to the east of the country, the infrastructure is still lacking in many provinces despite billions in foreign aid over the last 20 years.

The entrepreneur, who did not want to jeopardise future negotiations in Afghanistan, asked for his name to be withheld, but said, “Currently, there aren’t proper transmission lines for provinces like Logar.” 

To bring those lines to a province like Logar, only 40 minutes south of Kabul, would cost $8 to 11 million, said the businessman. In the past, insecurity in Logar was cited as a reason for the lack of development, but now the fighting has ended, it’s the economic woes that are making it difficult to bring those power lines to the province, he added.

 

Afghanistan’s state-owned electricity company, Da Afghanistan Breshna Sherkat (DABS), said it gives hospitals priority during times of low electricity. However, doctors in both public and private facilities told The New Humanitarian they still frequently rely on generators.

 

“We turn on the generators. We have no other choice,” said an internist at a government-run hospital, speaking on the condition of anonymity because he wasn’t authorised to speak to the media. He says despite the promises by DABS, government-run hospitals experience the same power shortages as households and businesses in the city.

 “If there is sustainable public electricity in the country, it will help that the money spent on diesel for example will be spent on healthcare.”

“As many hours as electricity is out in the city, that’s how many hours we have to turn on our generators,” he says. They can only afford to run the generators because ICRC pays for the fuel, he added.

 

Currently, a litre of diesel fuel costs 91 afghanis, $1.02, compared with 76 afghanis, $0.83, a year ago. MSF said the health centres they’re in contact with are struggling to procure enough diesel to power every device they need to treat patients.

 

“The price increase has a direct impact on health centres,” said Safi.

 

Even something as simple as cutting generator costs could go a long way, he explained: “If there is sustainable public electricity in the country, it will help that the money spent on diesel for example will be spent on healthcare.”

 

The electricity problems have more direct impacts on human health as well. Without reliable power, Afghans turn to burning wood, coal, and even plastic to heat their homes – leading air pollution to increase by up to 50% during the winter months in Kabul. This extra smog, which often coats the capital’s skyline in a dense fog, drives up respiratory and pulmonary ailments.  

 

The surge in such illnesses also means more patients at hospitals and clinics, which requires additional heating and the increased use of equipment that need electricity to function, creating a vicious cycle for health providers.

 

Ordinary people struggling 

 

Even as reliable power becomes harder to access, Afghans are less able to afford alternatives than ever, with the economy suffering due to Western-imposed sanctions, aid cutbacks, and banking restrictions.

 

This winter, generator sellers have found themselves in an odd predicament. The increased power cuts mean more people than ever are in need of the devices, but the economic struggles mean fewer people are actually able to afford them.

 

Juma Gul first started selling generators in Kabul’s Qohai Markaz neighbourhood in 1997, a year after the Taliban first came to power in Afghanistan, but he says his business has never suffered the way it has this winter.

 

Despite being surrounded by rows of generators in a multitude of bright colours, shapes, and sizes, the lights in his store are off. 

 

Like millions of homes and businesses across the city, Juma Gul started the day without electricity. It could take hours for the power to return, but he doesn’t want to spend the 91 afghanis, $1.02, a litre on the diesel needed to run a generator.

 “It has been exactly one week that I haven’t had a single sale.”

In previous winters, Juma Gul said he had so many customers he couldn’t spare “even one minute” to sit down and have a glass of tea with his three employees. He used to make anywhere between 40,000 and 200,000 afghanis, $452-$2,260, a day.

 

This winter, however, he can go several days earning nothing. “It has been exactly one week that I haven’t had a single sale,” he told The New Humanitarian. 

 

Juma Gul said his monthly expenses, including rent for the store, a storage facility, his three workers, taxes, and other fees, exceed 160,000 afghanis, $1,808. So far this winter, he has been unable to recoup those costs, much less turn a profit.

 

And it’s not just Juma Gul: The other generator sellers on the street told The New Humanitarian they were faring no better. “People just have to sit in the dark,” Juma Gul said.

 

Edited by Abby Seiff.

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