Small Wars Journal

Taliban Targets Medical Clinics In New Afghan Insurgency Strategy

Taliban Targets Medical Clinics In New Afghan Insurgency Strategy

Sharifullah Sharfat and Ron Synovitz – Radio Free Europe / Radio Liberty

TARIN KOWT, Afghanistan -- When Sultan Mohammad's wife went into labor in Uruzgan Province last week, the medical clinic in Deh Rawood was not an option -- it had been shut down along with other local clinics by Taliban fighters who control most of the territory outside the provincial capital, Tarin Kowt.

Hoping for help from the southern province's main hospital, the desperate couple set off on an arduous overland journey to the capital. They traveled through the night on jarring dirt roads, across mountains, and through valleys as the pregnant woman's labor pains intensified.

But upon reaching the capital they realized that even in the government stronghold -- and just a few hundred meters from Uruzgan Governor Mohammad Nazir Kharoti's office -- Taliban threats had forced the closure of the Tarin Kowt hospital.

Hospital director Aminullah Tokhi told RFE/RL that all his staff left the facility on September 22 after repeated Taliban threats to "blacklist" and attack those who continued working there.

"When I took my wife to the hospital, they told me it was closed and the doctors were not working," Sultan Mohammad said. "Finally, she gave birth on the side of the road outside the hospital. There were no doctors to help us."

The main hospital in Afghanistan’s Uruzgan Province, in Tarin Kowt, stands empty on September 26 – closed after threats by Taliban fighters against doctors and medical staff.

It's a situation that has been repeated across Uruzgan Province during the past two weeks as all medical facilities built with international reconstruction aid in the past 15 years became targets in a new battle tactic by the Taliban.

"The armed militants are making demands," said Health Ministry spokesman Wahidullah Majroh. "They want health facilities [to be built] in areas they control where there aren't any clinics or hospitals yet."

The Taliban also are demanding better equipment and staff at existing clinics as well as the authority to vet surgeons and other medical staff who treat wounded Taliban fighters, Majroh said.

Public Demonstrations

A Taliban statement accused the government of failing to provide adequate medicine or medical equipment at existing facilities across the province.

In areas under Taliban control, militants have stormed into health clinics and taken the keys at gunpoint from medical staff – telling them they cannot work there anymore.

In Tarin Kowt, where Afghan security forces still hold sway, the Taliban issue threats against doctors and nurses to scare them from staffing hospitals and clinics.

Khan Agha Miakhel, director of the Uruzgan health department, said that authorities have been meeting with tribal elders from clans whose youths are Taliban fighters, hoping the elders can mediate an agreement that allows all 58 local clinics across the province to be reopene

An angry crowd gathers outside Uruzgan’s provincial health department in Tarin Kowt on September 26. Demonstrators also protested outside the province’s main hospital in Tarin Kowt.

Public demonstrations suggest the provincial government, rather than the Taliban, bears the brunt of the blame from civilians affected by the crisis.

On September 26, the fifth day that Uzugan's main hospital was closed, hundreds of angry Afghans gathered outside the Tarin Kowt facility to protest the government's failure to provide adequate security.

One protester forced his way inside the hospital's intensive-care unit, shouting through a window to describe the situation to demonstrators outside.

"This is the emergency ward and there are no doctors, no surgeons, and no health care workers at all here," he said. "We need answers from the governor. All of us need answers. If the governor cannot protect us, even here in the heart of this city, he should resign."

Mohammad Karim-Karimi, a member of Uruzgan's Provincial Council, told RFE/RL that it is natural for "the common people to hold local authorities responsible" -- the provincial government, health officials, and the hospital administration.

"People will take all of these people to task and seek justice, and they will insist on their right to health care," he said.

Indeed, as anger against the provincial government built on the streets during the September 26 protest, Afghan authorities ordered the hospital to be reopened.

But some hospital staff reportedly were continuing to stay away, slowing medical aid for sick and injured Afghans who have flocked from across the province to Tarin Kowt.

Patients 'Dying' En Route

Miakhel, the provincial health director, admitted to RFE/RL on September 27 that the ongoing threat of a Taliban attack has frightened many people away from Tarin Kowt's hospital.

But Miakhel insisted on September 27 that the hospital had reopened and was "fully functional" with "all doctors" back on duty.

Miakhel also said provincial authorities were continuing to meet with tribal elders on September 27 in an attempt to reach an agreement that would allow the reopening of clinics in districts under Taliban control.

"There is a war going on. People are running here and there, and there are no district clinics that are functioning," complained Noor Mohammad, an elderly Pashtun man from Uruzgan's Choray district.

"Weak patients are dying on their way to this hospital," he said outside the hospital. "I have been trying to help a man who no longer has the strength to speak. He is sick and so weak. There are so many other people who are sick here and there is nowhere else to take them for treatment."

Dad Mohammad, a villager in his mid-20s from the Deh Rawood district, said he paid more than a month's salary -- 6,000 Afghanis (about $90) -- for a driver to transport him and a sick relative one-way across the province to Tarin Kowt.

"He needed surgery, but the doctor refused," he said. "When we asked where we should go, he answered, 'It's up to you.' In fact, we just want our own clinics to open in our own districts."

Naqibullah says he traveled to Tarin Kowt before the hospital closed because he had been shot by a Taliban fighter in a district outside the provincial capital.

"I was admitted to this hospital after the incident," Naqibullah said. "Now they've forced us out because they say the Taliban called and forced them to close the hospital."

"One day, many patients were being operated on," he said. "The next day, they were outside with intravenous fluid bags hanging all over them. Women and elderly people are among the patients forced outside, and the road to Kandahar is not fully functioning. They will die unless they are able to get help."

Bargaining Chip

Holding medical clinics hostage across an entire province as a bargaining chip is a new tactic for Afghanistan's Taliban.

But medical workers have long faced danger in a country where rebuilding health-care clinics was a key element of the international strategy to win the hearts and minds of ordinary Afghans.

Militant attacks on clinics and staff have been increasing since the withdrawal of U.S.-led NATO combat forces in 2014.

The World Health Organization says 189 clinics were forced to close during 2016 because of militant threats.

It says more than 2 million people have already been affected in 2017, with more than 200 clinics forced to close so far, at least temporarily, across the country.

Thirteen medical aid workers have been killed by militants since the start of 2017, including foreigners working for the International Red Cross. More than 150 have been injured.

The U.S.-based Human Rights Watch notes that Afghan security forces have also put medical facilities on the front line by raiding a clinic in Wardak Province in February 2016.

A teenaged patient and aid worker were killed in that attack, which was justified by provincial officials who argued that Taliban fighters were being treated there.

Taliban fighters in September 2016 disguised themselves as doctors to infiltrate Mirwais Hospital in Kandahar city in September 2016 in a failed attempt to assassinate Kandahar's visiting deputy governor. But one patient was killed in that attack.

The deadliest attack on an Afghan hospital in recent years was a U.S. airstrike that killed 42 people in October 2015 in the northern city of Kunduz, which was under the control of the Taliban at the time.

U.S. military officials said the attack was launched because of intelligence reports that Taliban fighters were using the building as a command center.

The Paris-based international aid group that ran the hospital, Doctors Without Borders, denied that Taliban were using the facility as communications center.

Written by RFE/RL correspondent Ron Synovitz in Prague, with reporting by RFE/RL's Radio Free Afghanistan correspondent Sharifullah Sharfat in Tarin Kowt.