By Elaine Jung & Tom Donkin
A malnourished child in Kandahar in October. (GETTY IMAGES)
Doctors in Afghanistan's crisis-hit hospitals, many of whom are now working without pay, spoke to the BBC about the country's deepening humanitarian crisis.
All names have been changed
The young woman was crying, begging the doctor to kill her and her baby. Dr Nuri, an obstetrician in central Afghanistan, was about to deliver the baby by Caesarean section when the mother broke down.
"I don't know how I can stay alive," she said, according to Dr Nuri, "so how can I give birth to another human being?" The women on Dr Nuri's ward are so malnourished that they know they are unlikely to have enough breast milk to feed their children.
Dr Nuri says the wards are so crowded that she has to squeeze past women in labour pressed up against blood-stained walls, or lying on dirty sheets. Most cleaners left her hospital months ago, fed up with working without pay. And the maternity ward is so crowded that sometimes there are several women to one bed. Nearby facilities and private clinics have had to close, and this once prestigious modern hospital in central Afghanistan sees three times the number of women that it used to.
"The maternity ward is one of the happiest wards of any hospital, but not anymore in Afghanistan," says the obstetrician. She says that in just two weeks in September she watched five newborn babies die of starvation.
"It's like hell in here."
Afghanistan was already reeling from severe drought and decades of conflict, but the Taliban's takeover hastened the country's descent towards economic collapse. The slowing trickle of international aid, which propped up the economy and its health system for decades, came to a grinding halt in August. Western donors cited serious concerns in moving money through a government which denies basic rights to women and girls, and threatens harsh Sharia punishments. This means Afghanistan is facing its worst hunger crisis since records began, according to the latest UN figures. About 14m children are expected to suffer acute levels of malnutrition this winter.
Across the country, hospitals treating the starving are on the brink of collapse, with nearly 2,300 health facilities already closed. Doctors in remote areas have reported being unable to provide basic medicines - even something as simple as paracetamol for the gravely ill who have walked 12 hours to seek treatment.
In the capital Kabul, a major children's hospital is seeing some of the country's worst cases of starvation. It's currently running at 150% capacity.
The hospital's director Dr Siddiqi saw a surge in fatalities in September after funding was cut, when up to four children under the age of 10 died every week from malnutrition or related diseases, such as poisoning from poor food hygiene. He says it's the youngest who bear the brunt of the crisis, with most under the age of five arriving too late to be saved.
"These children are [effectively] dying before they're admitted… We lose many cases like this," he says.
For those that do make it in time, there are few resources with which to help them - the hospital is suffering serious shortages of food and medicine, and struggles to even keep the patients warm. There is no fuel for central heating, so Dr Siddiqi now asks staff to cut and collect dried tree branches every day to feed a wood burner. "When we finish the branches we're worried about the next month and what to do next."
On Dr Nuri's maternity ward, regular power cuts are proving fatal. Several premature babies have died when their incubators failed during outages, she says.
"It is so sad to see them dying in front of your eyes."
And she says the power cuts can have potentially fatal implications for patients undergoing surgery too.
"The other day, we were in the operating theatre and the electricity was cut off. Everything stopped. I ran and shouted for help. Someone had fuel in their car and gave it to us so we could run the generator."
So, she says, every time the hospital performs an operation, "I ask people to hurry. It is a lot of stress."
Despite being forced to work under such challenging circumstances, most healthcare staff are not even paid at the moment.
Dr Rahmani, the director of a hospital in Farah province which specialised in treating Covid patients, shared with the BBC a letter from the Taliban-led health ministry, dated 30 October, which asked staff to keep working without pay until funding was secured.
On Tuesday Dr Rahmani confirmed that his hospital had now had to close when those funds did not materialise, and photos show patients being wheeled out of the hospital on stretchers. It is not clear what will now happen to them.
Nearby, another hospital specialising in treating drug addicts is also struggling to adequately care for its patients, whose withdrawal from heroin, opium and crystal meth can no longer be supported with medication.
"There are patients who have to be tied to the bed with chains, or there are patients who need to be handcuffed because they experience severe attacks. It's very difficult for us to take care of them," says Dr Nowruz, the hospital's director, adding that - without proper care - "our hospital is exactly the same as jail for them".
But this hospital too is on the brink of closing in the face of dwindling staff, and if it does shut, Dr Nowruz worries what will become of his patients in the brutal winter ahead.
"There is no shelter for them. They normally go and live in places like under bridges, in ruins, in graveyards, in a situation which is unbearable for a human," he says.
Dr Qalandar Ibad, the Taliban-appointed health minister, told BBC Pashto in November that the government is working in step with the international community to re-implement aid efforts.
However, major donors are looking to sidestep the Taliban, fearing that otherwise the aid won't be used for its intended purpose. On 10 November the UN succeeded in doing this for the first time - injecting $15m directly into the country's health system. About $8m was used to pay some 23,500 health workers over the past month. Though a relatively small amount for now, other international donors are hoping to follow suit. But time is running out.
"Soon we will not have enough drinking water," says Dr Nuri, as patients struggle to keep warm in the dropping temperatures.
Harsh weather conditions will soon restrict the remaining passage of goods being driven in from countries like Pakistan and India.
"Whenever these women leave our hospital with their babies, I keep thinking about them. They don't have any money, they can't afford to buy food," she says. Her own family is also struggling to stay afloat.
"Even I don't have enough food to eat as a doctor - I can't afford it and have almost finished all my savings.
"I don't know why I still come to work. Every morning I ask myself this question. But maybe it's because I'm still hopeful of a better future."
Additional reporting by Ali Hamedani, Kawoon Khamoosh, Ahmad Khalid, and Hafizullah Maroof