By Tan Ee Lyn
Afghan labourer Chaman travelled a whole day to bring his son to Kabul to have a kidney stone removed after doctors in their home province turned them away because they could not afford the fees.
The two-year-old boy, who suffered excruciating pain for three days, finally had the stone removed in a charity hospital funded by Turkey.
"The private hospitals are only for rich businessmen. Poor people have to use government hospitals and if they can't help, the children die," said the young father from Ghazni province as he unwrapped a piece of paper to show a brown pebble measuring half a centimetre in diameter. Ghazni is southwest of Kabul.
Thirty-nine percent of children under five are malnourished due to poverty and 54 percent of Afghan children are stunted and 40 percent are underweight, according to UNICEF.
Foreign donors have given some $15 billion in aid to Afghanistan since U.S.-led and Afghan forces toppled the Taliban in 2001, but several times more was spent per person in other conflict zones such as Bosnia and East Timor.
The U.S. military alone spends $100 million a day fighting Taliban insurgents in Afghanistan while the total spending by all donors is only $7 million a day, aid groups say.
Nevertheless, the number of health facilities in Afghanistan has risen from 550 in 2001 to 1,429 now.
The government says free basic healthcare is available within two hours walking distance to 85 percent of the population, from just 9 percent in 2003. But people say they are far from adequate and decent healthcare is available only to those who can afford to pay, travel to the capital city, or go overseas.
"My friend's son died last year from pneumonia because he could not borrow enough money in time to take him to Kabul. In Ghazni (where they were living), good medicines aren't available in the public hospitals," said Afghan driver, January
Afghanistan has one of the world's highest infant and child mortality figures. Out of 1,000 live births, 128 die before they are a year old, and one out of every five children will not live beyond the age of five, according to official statistics.
Thirty-nine percent of children under five are malnourished due to poverty and 54 percent of Afghan children are stunted and 40 percent are underweight, according to UNICEF.
LOTS OF CRYING
"Every 24 hours, 10 to 15 children under five die in the pediatric ward," said Sister Mary Francis, a volunteer nurse from India who works at the 500-bed Herat General Hospital.
"They die of meningitis, infections, pneumonia or because they are premature. The children are very anemic because of malnutrition which makes them very susceptible to infections."
"There is a lot of crying (by parents). It is very sad."
Healthcare workers and NGO groups say many government hospitals are poorly equipped and often, doctors do not have the skills or equipment to perform some surgeries.
Institutions fell apart over the last 30 years of violence, leaving few facilities to train recruits with.
"There is only oxygen available in ICUs (intensive care units) and there is no equipment even to monitor heart rates," Francis said, referring to the Herat hospital.
While many seek treatment in Kabul, hospitals here are grim. At the Indira Gandhi Children's Hospital, a leading pediatric facility in the country, patients need to buy their own sutures, gauze, medicines, and even surgical gloves for their doctors.
"We don't have the budget, we only provide the bed and the doctor. We don't even have enough detergents to clean the floor," said a doctor, who declined to be identified. He earns $100 a month.
Many doctors run their own private practice. The facade of tattered buildings in downtown Kabul is plastered with signs advertising the many tiny clinics inside.
Observers, however, say there has been marked improvement in Afghan healthcare compared to the bleak decades of the past.
"You have to put it in perspective, this country has just come out of 25 years of devastation and war, health facilities will take time to build up," said Eric Sinclair, chief operating officer of the Cure International Hospital in Kabul.
Cure is one of several foreign aid groups helping Afghanistan run some of its hospitals. These are to be handed back eventually with more skilful medical staff and better facilities.