Living with a health system devastated by decades of conflict, many Afghans are unable to access essential healthcare services.

Barriers including costs and distance mean that ordinary Afghans are struggling to access emergency, critical and maternal care—key components of a functioning health system, according to new research from EMERGENCY, which has been operating in Afghanistan since 1999, and CRIMEDIM.

Through surveys and interviews with more than 1,600 patients, caregivers and healthcare workers across 11 provinces, “Access to Emergency, Critical, and Operative Care in Afghanistan” centres Afghans’ first-hand experiences in order to understand the barriers to healthcare in the country.

INSIDE THE REPORT: ACCESS TO EMERGENCY, CRITICAL, AND OPERATIVE CARE IN AFGHANISTAN

After decades of resources directed toward military and defence, Afghanistan’s healthcare infrastructure is unable to meet the growing needs of the population.

Physical barriers prove one of the most difficult for patients to overcome: just over 2% were able to use a public ambulance to access health services. Nearly half—many of whom live in Afghanistan’s mountainous rural areas—had to travel on foot.

Once facilities have been reached, they often struggle to provide the appropriate care. As medical providers, the staff at public hospitals offered a unique perspective on the overlapping barriers to care, from infrastructure to finances to cultural expectations:

As a consequence of the widespread historic neglect of the public healthcare system, the vast majority of respondents were forced to travel to another city, province or even another country to access the services they need, including 76% of those seeking maternal care.

Women in particular were more likely to be scared when accessing care, and faced additional delays due to restrictive gender norms. Women may not disclose health conditions until they are severe, while expectations of being treated by female health practitioners limit treatment options.

Facing this widespread series of overlapping obstacles, one in four patients were forced to postpone a surgical operation at least once, the report finds, while one in five has missed a follow-up appointment. Delaying essential care frequently leads to worse health outcomes, in turn putting an even greater strain on the health system: over 33% of those surveyed reported a disability or death due to delayed care.

Based on the input of more than 1,600 Afghan participants, the report concludes with 10 recommendations.