“It is one of the largest and most important hospitals for women in Afghanistan,” she explained. The patients were women, of course, but so were almost all members of the medical staff. As we walked through the corridors, which smelled of disinfectant, she pointed out that they were clean and freshly painted—a drastic change from a year ago, when they were foul-smelling with bodily fluids and waste. The hospital had also suffered from corruption and dysfunction endemic to the republic. Large parts of the civil service stopped receiving salaries as early as April or May. The previous government had attempted to switch to a new pay system while also burning through its cash reserves in a last-ditch effort to fund anti-Taliban militias. At the hospital, the staff continued to work for months without pay, asking for donations of food and other supplies from local businesses. “It was heartbreaking to think that this was on the verge of collapse,” Stocker said.
In the recovery room, the nurses were moving a young patient from a gurney to her bed, her back arched in pain. At twenty-four, she suffered from eclampsia, a complication of pregnancy that caused seizures so intense that she had torn her tongue and cracked her teeth; the doctors had performed an emergency abortion to save her life. Her gray haired mother sat by her bed, the relief evident on her face. “She would have died,” she told me.
Now that the fighting had stopped in the countryside, more patients managed to get into the capital from remote areas, where women’s reproductive health in particular was often abysmal. As a result, the staff struggled with very serious cases: women who, like this young patient with eclampsia, would have simply died at home. The economic crisis had gutted the private sector and ended medical tourism abroad, so public hospitals such as Malalai, where treatment was free, had seen an increase in admissions – in some, outpatient visits increased tenfold. The strain on the medical workers was clear, but at least – unlike much of Afghanistan’s public sector – they could expect regular wages. But for how long?
In addition to its appeal for emergency aid, the United Nations sought funding for a $3.42 billion plan to provide basic services directly to the Afghan people, outside the Taliban government, what some call a “humanitarian plus.” But as Stocker pointed out, intervention by groups like the ICRC entrenched the very addiction that was the problem. “Our view was that a national health system needs a ministry to hold it together,” Stocker said. “You need a state.”
As a teaching hospital, Malalai also helped train the next generation of Afghan maternity specialists, nurses and midwives, women like Dr. Rana Afzali, whom I met in the neonatal ward, where a young mother sat in the corner holding her newborn child. Dressed in a white coat and a colorful headscarf, Afzali was fresh out of the residence. It was a scary time to start her profession, but she told me she was happy to work, unlike many of her classmates who had fled abroad. “They sit inside, depressed — I stayed,” Afzali said, shrugging. “I am a hopeful person.”