trapped
DESCRIPTION
TRAPPED. Between Rhetoric And Reality. AFGHANISTAN. war. poverty. mortality rates. politicised aid. CONFLICT. 35 years of war. 2001 US led intervention 2014 violence continues. Surge in civilian deaths. Humanitarian needs grow. POVERTY and HEALTH. 1/3 below poverty line. - PowerPoint PPT PresentationTRANSCRIPT
TRAPPED Between Rhetoric And Reality
war poverty mortality rates politicised aid
AFGHANISTAN
CONFLICT
35 years of war
2001 US led intervention
2014 violence continues Surge in civilian deaths
Humanitarian needs grow
POVERTY and HEALTH
Women: x 100 more likely to die giving birthChildren: 1/10 die before five years
Underestimations
1/3 below poverty line
AID as AMMUNITION
Win ‘hearts and minds’
Threat based, not needs based
Selective Storytelling
Fails the most vulnerable
Blurred Boundaries
“Best Performing” Reconstruction Area
“Best thing the US did in Afghanistan”
Exuberant claims
Veil
Spin
OBJECTIVES
Clearer picture: access to healthcare Understand
barriers: Types ExtentImpact
METHODSStudy period: Jun – Oct ‘13
Cross-sectional survey: 800+ patients, caretakers
LOCATIONS
DATA COLLECTION
Questionnaires, 763 : structured, pre-tested
Individual interviews, 35: semi-structured Focus groups, 12: semi-structured
Additional information:- MSF medical reports - Key interlocutor interviews
✓ MoPH permission for survey
ETHICS
✓ Informed oral consent
✓ Confidentiality
✓ No identifiers
Formal review not sought
RESULTS Deadly combination of barriers
PreventDelay
VIOLENCE
1 in 4 people experienced violence
7 in 10
4 in 10
barrier to reach MSF
conflict as a barrier
n=763
DISTANCE
Taking wounded to Kunduz distance a major difficulty
Perilous Journeys 1 in 3
COSTS
2 in 3 Poor, extremely poor
$1 day
Medical costs previous illness $32
Household spending/week $54
Total cost previous illness $41 costs more than 1 month of income
1 illness episodePeople per household 11
forced to borrow money or sell goods
2 in 5 44%
to obtain healthcare during a recent illness.
HEALTH SYSTEM GAPS
Rise in Numbers
Too Few
4 in 5 Bypass
Proximity ≠
Access
✗ availability
✗ quality
StaffServicesTreatments
“empty, lacking medicines, qualified staff, and electricity, closed, long queues, corruption, malpractice, high prices, no
referral“
PARTIES TO THE CONFLICT
Active fighting
Occupying facilities
Deliberate delaysHarrassment
Attacks,medical vehicles,personnel 450 health facilities
close - insecurity
Sharp increase in military intrusion
“I can’t go to the government doctor in my area because of the insurgents and other problems. They don’t like us to go to clinics supported by the government. If I go there, maybe the insurgents will arrest me, ask me why I was there, what I was doing there.”- Male, 22 years, farmer, Nawzad district, Helmand
EFFECT
1 in 5
LACK OF ACCESSto medical care
Death
JOURNEY 36%COST 32%
CONFLICT 18%
DEATH REASONS FOR LACK OF ACCESS TO CARE
“In the last years violence has blocked us coming to health centres and hospitals more
than 100 times. The fighting doesn’t stop when there are
injured people. So we wait, and then they die, and the fighting continues.”
- Male, 25 years, school principal, from Baghlan province
LIMITATIONSHealth facility survey
Underestimate barriersUrban v rural bias
Responder bias
CONCLUSION
Far from asimple success story
Remarkable gap – paper and practice
Meaningful medical care not available
Serious, often deadly, risks
Neutral, needs basedPragmatic, principledReality, not rhetoric
Uphill struggle
THANKS
Benoit deGryse, Renzo Fricke, Catherine Van Overloop, Mit Philips, Tom DeCroo, Silvia PinedaCorinne Baker, Jehan Bseiso, Jonathan Whittall
Shahab
Ilham
Kamal
Thank you