Afghanistan

AFGHANISTAN

Afghanistan has been embroiled in ongoing conflict between international and national armed forces and groups since 2001, when the International Security Assistance Force overthrew the Taliban government in Kabul.[1] The Taliban has continued its insurgency since being removed from power in 2001 and is seeking to regain territorial control in many provinces.[2] Other armed groups have also sought to destabilize the government, including ISIL-KP, which has maintained a hold on several districts in Nangarhar province.[3] Large swaths of territory in multiple provinces throughout Afghanistan remain contested; it is these areas in particular where conflict has escalated sharply in recent years, along with a rise in civilian casualties and attacks on medical facilities and personnel.

In 2017, parties to the conflict carried out at least 66 attacks on medical facilities and personnel, including at least five incidents that impeded access to care—three of which led to a total forced closure of 69 medical facilities. The main perpetrators of the attacks are the Taliban; ISIL-KP; and the Afghan National Defense and Security Forces (ANDSF), which include the Afghan Local Police, the Afghan National Police, the Afghan National Army, Afghan Special Forces, and the National Directorate of Security. Several incidents were also perpetrated by unidentified assailants.

Thirty-eight attacks were attributed to non-state armed groups. The Taliban carried out at least 27 attacks, ISIL-KP six, the ANDSF was reportedly responsible for at least four attacks, and unidentified assailants and others for at least 18. Six cases occurred in the context of fighting between two or more conflict parties.

Attacks occurred in at least 22 of Afghanistan’s 34 provinces and were most frequent in Nangarhar province, where parties to the conflict or unnamed assailants carried out at least 22 attacks.

Forced closure of medical facilities was the most common type of interference, with at least 69 closures occurring as a result of three orders. Other types of attacks included at least ten incidents of forcible entry and 14 incidents where health facilities were damaged directly or indirectly by IEDs, grenades, shelling, and arson. Parties to the conflict or unknown assailants also looted health facilities or medical supplies in transport on at least four occasions.

Abduction of medical staff was the most common type of attack on health workers, with at least 16 health workers kidnapped. At least nine health workers were arrested or detained by state forces or members of the Taliban, and at least 15 health workers reported threats or intimidation. The Taliban imposed access constraints by establishing at least two unofficial security checkpoints and denying passage of health and humanitarian workers. Parties to the conflict also damaged or destroyed at least four ambulances and abducted or attacked vaccinators on at least three occasions.

Between January and August 2017, 164 health facilities were closed temporarily due to insecurity and conflict, and 45 facilities remain closed.[4] These closures have restricted access to health care for three million people.

Attacks damaged at least 33 health facilities, and the resulting temporary closures or suspensions of humanitarian operations prevented tens of thousands of people from accessing health care for varying lengths of time. At least 59 health workers, patients, or nearby civilians were killed, and at least 97 were injured as a result of attacks.

In one particularly horrific event, on March 8, 2017, ISIL-KP militants disguised as medical personnel attacked a hospital in Kabul by detonating an IED near one of the hospital gates and opening fire on ANDSF soldiers. The gunfight lasted for more than six hours. At least 50 people were killed and 91 injured.[5]