Strengthening of EMERGENCY Surgical Activity in Afghanistan

Project location: AFGHANISTAN, Kabul; Lashkar-gah; Anabah
Project start date: December 2014 - Project end date: December 2013
Project number: 2014-015
Beneficiary: Emergency ONG ONLUS


Time-line of this final report: July 2014 - December 2014

EMERGENCY works in Afghanistan since 1999.

During these years EMERGENCY has built and managed a Surgical and Medical Centre and a Maternity Centre in the Panjshir Valley, a Surgical Centre in Kabul, a Surgical Centre in Lashkar-gah, a network of First Aid Posts and Health Centres, a programme of medical assistance to the inmates of the largest prisons in the country.
Since 1999, EMERGENCY has treated over 3,940,000 people (as of December 31, 2013) in Afghanistan.
The specific goal of this project was to respond promptly and effectively to the needs of high-standard and free of charge surgical care of the Afghan population affected by the strengthening of the conflict in Afghanistan.
The Afghan war began in 2001 has been worsening more and more in the last 3 year. As expected the situation has not improved during 2014, in fact there was a further escalation of the conflict that is supposed to deteriorate again with the beginning of 2015.
In 2014, the fight for power between the state and non-state armed actors increased and caused complex social, political and economic tensions and rivalries. In the year of the transfer of political and military power, legitimacy of the authorities remained disputed. The conflict continued unabated, partly fuelled by the effort to control economic resources in an era of declining international aid expenditure.
The expansion and changing nature of the conflict led to an increasing number of civilians killed and injured in 2014. The transfer of military power from international to national control left state security forces with the challenging task of ensuring a degree of central government control in remote districts and provinces.
While education and healthcare have improved in urban areas, rural populations remain largely vulnerable to maternal and perinatal mortality and to childhood death and disease, with malnutrition a key concern.
Civilian casualties increased as the nature of attacks changed and more were caught in the crossfire of large scale offensives.
Improvised explosive devices (IEDs) were the second biggest cause of civilian casualties.
In this background EMERGENCY has been committed during these months to keeping its hospitals in perfect working, in order to face the further increase of the activity and in order to respond promptly and adequately to the needs of the local population.
In fact the rise of the number of war wounded patients created a greater need for surgical material.
EMERGENCY has purchased supplies of orthopaedic external fixators for the reduction of fractures for all its Surgical Centres.
EMERGENCY has also purchased supplies of sutures used during surgeries in all its Surgical Centres.
All these supplies restore the stocks of the same materials already sent to Afghanistan before the summer in order to cover the last month of 2014 and also, as written in the project proposal approved, the first months of 2015.

In fact for the beginning of the next year, along with the progress of the withdrawal of the U.S. troops from the Country is expected a further worsening of the Afghan situation.
Given the unstable security situation and power transition and the uncertainty about the government's capability to meet recurrent expenditures, the NGOs are preparing for a continued complex and unpredictable operating environment. Economic uncertainty, security and political transitions, and increased conflict levels may continue after the formation of a new government. A sharp downward trend in external assistance combined with weak economic growth and low government revenues is likely to have a negative impact on the humanitarian situation.

A realistic, but not alarmist, outlook for 2015 includes continued humanitarian needs on a par with 2014 arising from widespread but low to medium- level conflict.
That's why recreating the stocks of surgical material in preparation for 2015 it's truly important in order to fulfil the goal of this project, and of all the EMERGENCY humanitarian activities in Afghanistan, that is to continue to respond promptly and effectively to the needs of the Afghan population.
EMERGENCY purchasing office has handled the request for quotes from the suppliers and then the orders of all the surgical and orthopaedic material. All the supplies have been sent already from the Italina warehouse to Afghanistan. Most of the material has arrived in the Country in the second half of October, and the remaining part has arrived during November.

The supplies have been purchased only starting from October because a big stock of surgical and orthopaedic materials had already been purchased and sent in Afghanistan in April in order to supply the hospitals for the summer, historically characterized by a greater number of fights and consequently of victims.

During these months EMERGENCY continued to performs all its activities in its Surgical Centres in Afghanistan:

- First-aid;

- Diagnostics;

- Surgery: surgery for war injuries, emergency surgery, trauma and elective surgery;

- Postoperative hospitalization;

- Follow-up;

- Physiotherapy;

- Training on-the-job.

As of the end of November 2014, EMERGENCY NGO Surgical Centres especially in Kabul and Lashkar-gah, admitted 4.449 patients with war wounds, 15% more than last year, 37% more than 2012, 50% more than 2011.
Of these 2.166 are bullet wounds, 1.339 shell injury, 506 mine injury and 438 are other penetrating injury by stab.
As usual, women and children account for a great number of casualties: 33% of patients were children and 14% were women. In 2014, a total of 1327 children and 622 female patients were admitted for medical care.
Compared to 2013 the percentage of child admitted is 18% more, 67% compare to 2012, 97% more than 2011.
Differently from the budget forecast EMERGENCY purchased a greater supply of sutures and a smaller amount of external fixators than expected. This because causalities encountered in recent months in EMERGENCY centers caused a different consumption of the previous supplies than expected.

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