“It’s one of the biggest and most important hospitals for women in Afghanistan,” she explained. The patients were female, of course, but so were nearly all the 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 fetid with bodily fluids and waste. The hospital, too, had suffered from the corruption and dysfunction endemic to the republic. Much of the Civil Service stopped receiving salaries as early as April or May. The former government had been trying to switch to a new payroll system, while simultaneously burning through its cash reserves in a last-ditch attempt to fund anti-Taliban militias. At the hospital, the staff kept working for months without pay, and begged for donations of food and other supplies from local businesses. “It was heartbreaking to think that this was on the verge of collapsing,” Stocker said.
In the recovery room, the nurses were transferring a young patient from a gurney into her bed, her back arched in agony. Twenty-four years old, she was suffering from eclampsia, a complication from pregnancy that caused seizures so intense she’d lacerated her tongue and cracked her teeth; the doctors had performed an emergency abortion to save her life. Her gray-haired mother sat at her bedside, the relief apparent on her face. “She would have died,” she told me.
Now that fighting had stopped in the countryside, more patients were able to make it into the capital from remote areas, where women’s reproductive health, in particular, was often abysmal. As a result, the staff was struggling 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 like Malalai, where treatment was free, had experienced a surge in admissions — in some, outpatient visits were up tenfold. The strain on the medical workers was evident, but at least — unlike much of Afghanistan’s public sector — they could expect regular salaries. But for how long?
In addition to its appeal for emergency aid, the U.N. was seeking funding for a $3.42 billion plan to provide basic services directly to the Afghan people, bypassing the Taliban government, what some call “humanitarian plus.” But as Stocker pointed out, the intervention of groups like the I.C.R.C. entrenched the very dependency that was the problem. “Our sense was that a national health care system needs a ministry holding it together,” Stocker said. “You need a state.”
As a teaching hospital, Malalai also helped to 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. Dressed in a white coat and colorful head scarf, Afzali was fresh out of her residency. It was a daunting time to be entering her profession, but she told me she was glad to be working, unlike many of her classmates who had fled abroad. “They’re sitting inside, depressed — I stayed,” Afzali said, and shrugged. “I’m a hopeful person.”