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Medical care cut off as Taliban assaults key Afghan city

A patient arrives at Boost Hospital in Lashkar Gah, Afghanistan Kadir van Lohuizen/NOOR
A patient arrives at Boost Hospital in Lashkar Gah, a government facility supported by MSF, in June 2016
Civilians cannot access medical care in Lashkar Gah and aid agencies are preparing for a possible Taliban takeover as militants lay siege to the city, which is the capital of Afghanistan’s southern Helmand Province. 
Fighting since the beginning of August has displaced about 10,000 people, according to the UN's emergency aid coordination body, OCHA. About 6,000 people fled into Lashkar Gah as militants battled government soldiers in surrounding districts, while another 4,000 took refuge in an area under the control of anti-government forces.
Afghan security officials have noted that the Taliban fighters seem unusually well trained and are using new equipment such as night-vision goggles, but government forces have so far been able to withstand the assault and officials have repeatedly said they won’t let the city fall.
Despite such reassurances, aid groups are making contingency plans.
Médecins Sans Frontières has “a mass casuality plan prepared and ready to implement immediately in the case of a further deterioration of the security situation”, said Guilhem Molinie, MSF’s country representative. The medical charity has also been in contact with militants, as well as government and allied forces.
“We have to constantly reassess whether all parties fully accept us providing medical care impartially, whether the fighting is six kilometers away from Lashkar Gah, inside the city itself, or whether the control of the city changes hands,” he told IRIN.

Heading off another Kunduz

If Lashkar Gah were to fall to the Taliban, it would be the second provincial capital to do so since the regime was ousted in 2001. The Taliban briefly took over the northern city of Kunduz last October. During that occupation, the Taliban allowed MSF to continue treating war-wounded in its trauma centre until it was destroyed by a US airstrike. 
As in Kunduz, MSF has provided GPS coordinates of its facility to all sides in the conflict in Lashkar Gah. 
“We know very well that sharing our GPS coordinates is not a sufficient guarantee to protect our staff and patients,” Molinie said. “We not only need people to know where we are located, but we also need their firm commitment to respect the fact that we work in a neutral and impartial way.”
The US has conducted about 30 airstrikes in the area over the last two weeks, according to Colonel Michael Lawhorn, a spokesman for the NATO mission in Afghanistan. American air support has helped Afghan forces recover many checkpoints from the Taliban, which has suffered “a number of casualties”.
“In general, the situation in Helmand is not entirely clear,” he told IRIN.

Medical access

Between 3 and 15 August, MSF treated 25 war-wounded people in its emergency room, six of whom died of their injuries. But fighting has made it extremely difficult or impossible for many civilians to travel to Lashkar Gah to seek treatment.
“Patients report that roads are blocked and checkpoints are delaying them reaching the hospital,” said Molinie.
This has cost at least one life: a 15-year-old girl who died from meningitis.
The girl started showing symptoms as fighting raged in Nawa District, which borders Lashkar Gah. The journey to the city from her village usually takes a few hours, but it took the family a week.
“We knew when we admitted her for treatment that it was probably too late,” said the doctor, Erland Gronningen. “Twenty four hours after she started treatment, and subsequently falling into a coma, she died.”
Others are likely suffering and even dying from injuries or treatable diseases, because they can’t reach the hospital.
Gronningen said the usually bustling paediatric wards and the Intensive Therapeutic Feeding Centre in the government hospital that MSF supports are now full of empty beds.
“The wards should be full of noisy children and young patients getting treatment for malnutrition or life-threatening conditions, but instead the wards are eerily quiet,” said Gronningen.
Aid agencies are now distributing food, water, and items such as kitchenware to displaced people who have managed to make it to Lashkar Gah, according to OCHA. If the city does fall to the Taliban, civilians may be trapped, as the route to Kandahar City in the neighbouring province of Kandahar, is blocked by fighting.
“The highway linking Lashkar Gah-Kandahar has been inaccessible for civilians and threatens the delivery of assistance,” OCHA said. 
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