Till the Last Bird Sings
A graphic novel about access to care in Afghanistan
Afghanistan has almost vanished from the media since the withdrawal of international troops in 2021 despite suffering one of the most serious humanitarian crises in the world, which has had unprecedented social, economic and health repercussions.
“How are Afghans doing?” was the question that prompted this project: a graphic novel conceived by EMERGENCY, written and drawn by Francesca Romana Torre and La Tram (Margherita Tramutoli), and produced thanks to humanitarian funding from the European Union.
Violence persists throughout the country. EMERGENCY’s surgical hospitals continue to admit patients with violent trauma from bullets, stabbings, landmines and explosive devices. Afghanistan is among the top countries contaminated by ordnance, the remnants of war intentionally left behind to devastate communities long after direct conflict ends.
Extreme poverty has increased, compounded by the consequences of natural disasters like drought and the earthquake of November 2023.
Through the drawings of La Tram and the words of Francesca Romana Torre, who visited our projects in Afghanistan together in July 2023, we want to shine a light on some of the issues the Afghan people currently face, from the vantage point of our hospitals and healthcare centres.
"How has Afghanistan changed since 15 August 2021? We wanted to answer that question from the point of view of the staff and patients at EMERGENCY’s hospitals, health centres and First Aid Posts. It’s a partial view, but a thorough one, revealing the changes in a society that is experiencing a period without direct conflict for the first time in decades. The narratives of different characters who cross the country during a working day intertwine to show the mark the organisation has made on access to care and protecting health as a human right.
We do not know what the future will hold for Afghanistan, but we wanted to capture the present with a story made up of extraordinary little moments, accompanied by the singing of goldfinches: a traditional metaphor for a people who endure in spirit and celebrate their innate poetry in spite of the enormity of their situation and the vulnerability of everyday life."
Francesca Romana Torre and La Tram
Access to Care in Afghanistan
Afghan people have always had to face a range of obstacles and barriers when trying to access healthcare, but since 2021 the situation has changed once again: many healthcare workers have left the country and training is insufficient, contributing to wide-spread understaffing. Treatment is too costly, there are few ambulances for emergencies, and facilities are inadequate, lacking specialist staff, machinery, electricity and water, especially in rural areas.
This is the legacy of 40 years of war, which have left the country dependent on international aid and its people extremely vulnerable.
Afghans often bypass their local health facilities, which struggle to provide basic services. This ultimately exacerbates problems of congestion in public hospitals intended to provide tertiary care, as well as those in urban areas. More and more Afghans are turning to EMERGENCY’s facilities to supplement the struggling public health system.
Women are a particularly vulnerable group. The lack of safe and efficient means of transportation, the absence of clinics providing obstetrics in rural areas, and financial barriers present women with serious obstacles to accessing prompt and effective care. In addition, recent restrictions on access to education for Afghan women and girls are expected to cause a long-term shortage of women healthcare workers, impacting the sustainability of both maternal and paediatric health services across the country.
EMERGENCY has been present in Afghanistan since 1999. Until August 2021, most admissions to our facilities were for war-related injuries. Now, civilian trauma is the main reason for patients coming to our facilities. However, we still receive patients with violent wounds, from gunshots, stabbings and explosions. The statistics show that although the conflict has formally ended, we can still speak of “victims of war and violence.”
A Graphic Novel on Access to Care
Till the Last Bird Sings is inspired by EMERGENCY’s report “Access to Care in Afghanistan: Perspectives from Afghan People in 10 Provinces”, through which we sought to take a snapshot of the healthcare situation in the country, using research we carried out in ten of the Afghan provinces where we work.
Gathered from patients, caregivers, EMERGENCY’s own medical staff and those at Afghan public hospitals, the findings show the extreme difficulties for Afghans to access and afford care in the country. More than one in every five respondents had lost at least one family member or friend in the past year due to the inaccessibility of care.
THE AUTHORS
EMERGENCY
EMERGENCY NGO is an independent non-governmental organisation that provides free, high-quality medical and surgical treatment to victims of war, landmines and poverty. It promotes a culture of peace, solidarity and respect for human rights.
Since 1994, EMERGENCY has worked in 20 countries around the world, providing free medical care in accordance with its core principles: equality, quality and social responsibility. EMERGENCY has been present in Afghanistan since 1999, treating over 8.5 million people.
This graphic novel was made possible thanks to humanitarian funding from the European Union.
Till the Last Bird Sings
The graphic novel by Francesca Romana Torre and La Tram about access to care in Afghanistan