In Afghan hospital, unpaid doctors and rigid Taliban clash

Wages in Afghanistan had been unpaid for months before the government collapsed

The Taliban-appointed supervisor of a small district hospital outside the Afghan capital has big plans for the place — to the dismay of the doctors who work there.

Mohammed Javid Ahmadi, 22, was asked by his superiors, fresh off the fields of battle from a war that has spanned most of his life, what kind of jobs he could do. On offer were positions in an array of ministries and institutions now under the Taliban's power following their August takeover and the collapse of the former government.

It was Ahmadi's dream to be a doctor; poverty had kept him from gaining admission to medical school, he said. He chose the health sector. Soon after, the Mirbacha Kot district hospital just outside of Kabul became his responsibility.

“If someone with more experience can take this position it would be better, but unfortunately if someone (like that) gets this position, after some time you'll see that he might be a thief or corrupt,” he said, highlighting a perennial problem of the former government.

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It's a job Ahmadi takes very seriously, but he and the other health workers in the 20-bed hospital rarely see eye-to-eye. Doctors are demanding overdue salary payments amid critical shortages of medicine, fuel and food. Ahmadi's first priority is to build a mosque inside the hospital quarters, segregate staff by gender and encourage them to pray. The rest will follow according to the will of God, he tells them.

The drama in Mirbacha Kot is playing out across Afghanistan's health sector since the Taliban takeover. With power changing hands overnight, health workers have had to contend with a difficult adjustment. The host of problems that preceded the Taliban's rise were exacerbated.

The US froze Afghan assets in American accounts shortly after the takeover, in line with international sanctions, crippling Afghanistan's banking sector. International monetary organizations that once funded 75 per cent of state expenditures paused disbursements, precipitating an economic crisis in the aid-dependent nation.

Health is acutely affected. World Bank allocations funded 2,330 out of Afghanistan's 3,800 medical facilities, including the salaries of health workers, said the Taliban's Deputy Health Minister Abdulbari Umer.

Wages had been unpaid for months before the government collapsed.

“This is the biggest challenge for us. When we came here there was no money left,” said Umer. “There is no salary for staff, no food, no fuel for ambulances and other machines. There is no medicine for hospitals; we tried to find some from Qatar, Bahrain, Saudi Arabia, Pakistan, but it's not enough."

In Mirbacha Kot, doctors have not been paid in five months.

Disheartened staff continue to attend to up to 400 patients a day, who come from the neighbouring six districts. Some have general complaints or a heart condition. Others bring sick babies.

'What can we do? If we don't want to come here there's no other job for us. If there was another job, nobody can pay us. It's better to stay here,” said Dr Gul Nazar.

Every morning, Ahmadi makes his rounds. His small frame, topped by a black turban, is a sharp contrast to the sea of white coats that routinely rush in and out of the facility to tend to patients.

The first order of the day is the registration book. Ahmadi wants every doctor to sign in and out. It's a formality most health workers are too busy to remember, but neglecting it is enough to inspire Ahmadi's ire.

Second, the mosque.

Workers come to the hospital to take measurements for the project and Ahmadi gives them orders.

“We are Muslims, and we have 32 staff members, and for them, we need a mosque,” he said.

There are many benefits, he added. Relatives can stay with sick patients overnight, sleeping in the mosque, as the hospital lacks extra beds especially during the winter months. “And this is what is needed the most,” he said.

Dr Najla Quami looked on, bewildered.

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She, too, has not been paid in months and routinely complains of medicine shortages in the maternity ward. They have no pain medication for expectant mothers. The pharmacy is stocked only with analgesics and some antibiotics. Is this the time for a mosque, she asked.

But Ahmadi said it was the responsibility of non-governmental organizations to resume their aid programs to finance these shortages. The money for the mosque will come from local donations.

His arrival ushered in other sweeping changes.

Men and women were told to stay in separate wards. Female doctors are forbidden to go to the emergency room. Ahmadi ordered them to wear a head covering and focus on female patients.

“We can't go to the other side of the hospital,” said Dr Elaha Ibrahimi, 27. “Woman is woman, man is man, he told us.”

Due to shortages, doctors advise patients to find medications elsewhere and return. Ibrahimi said Ahmadi often scrutinizes her prescriptions.

“He isn't a doctor, we don't know why he is here, we ask ourselves this all the time,” he said.

But Ahmadi is quick to allege deeply entrenched corruption in the hospital under the former hospital administrator, his predecessor from the former government.

He said he was aghast to uncover an entire warehouse full of medical equipment, furniture and other stolen goods to be sold in the market for personal profit. He could not offer proof that this was the intention of the previous administrator.

He sees his job to meticulously ensure that never happens again, echoing the Taliban's broader aims for the nation.

Doctors are routinely lambasted by angry patients, most of whom can't afford to pay for the life-saving medicines. “All of them fight with us,” Ibrahimi said.

Staff working the night shift say there is no food. The power shuts off for hours in the day with generator fuel quickly running out.

Quami holds a mobile phone for light as she makes her way to check on malnourished babies.

“Every doctor here is in a deep depression,” she said.

Ahmadi, by contrast, said his dreams were finally coming true.

Working in the hospital has afforded something life growing up poor never could: A medical education.

He claims that in the past two months he has learned how to administer injections and prescribe basic pharmaceuticals. He said that's part of the reason why he scrutinizes Ibrahimi's prescriptions.

“I know the names of the medicines needed for different conditions,” he said proudly. Recently, after a car accident, he was on the scene to provide an injection of painkillers, he added.

Ahmadi still dreams of being a doctor, and, like the health workers he supervises, hopes the money comes through somehow.

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