Reuters/Kabul

The US air strike in Afghanistan that killed at least 22 patients and staff at a Medecins Sans Frontieres hospital wasn’t the first time the escalating war has affected an aid-run medical facility. There have even been instances since.
Foreign aid workers and Afghan colleagues shaken by the weekend tragedy in Kunduz, one of the worst incidents of its kind in the 14-year war, say increased violence around the country makes it harder to provide basic services in a country where NGOs help provide the vast majority of healthcare.
In recent months, local and international non-governmental organisations (NGOs) have seen equipment and ambulances damaged in suicide attacks, raids by Afghan security personnel and threats to their lives from militants, staff members said.
“A few years ago the situation was much more stable,” said Antoine Sagot-Priez, head of the Afghan mission for French aid agency Premiere Urgence Internationale, which has contracts through the government to run 80 health facilities in Kunar and Daikundi provinces.
“Now we have more and more casualties because the fighting is spreading all over the country,” he added.
According to Sagot-Priez, in mid-August intense fighting broke out near a remote clinic operated by Premiere Urgence in Kunar, in the east. The staff evacuated with their patients and none too soon: that day, the clinic was damaged in the shelling.
“We expect this kind of event to happen more and more,” he said.
The Afghan government recognises the growing risks.
“Staff no longer feel safe in any health facility anywhere in the country,” the Ministry of Public Health said in the wake of the Kunduz attack.
Afghanistan was the most violent country for aid workers last year, according to the Aid Worker Security Database, and international medical NGOs have been targeted before.
In 2004, five MSF staff were killed in Badghis province, prompting it to pull out of the country temporarily. In 2013, a ICRC staff member in the eastern city of Jalalabad was killed.
But changing tactics by Taliban insurgents this year, coinciding with the withdrawal of most foreign troops that made the country less stable, has seen district and provincial centres targeted more frequently and across a
broader area.
“My staff always tells me the situation is deteriorating,” said Qudratullah Nasrat, chief executive of Organization for Research and Community Development, operating government clinics in Ghazni province. “They say it’s getting worse, day by day.”
Health clinics and hospitals, particularly in remote areas, can be affected by both sides of the conflict.
On Monday, just two days after the MSF hospital in Kunduz was hit, members of Afghanistan’s National Directorate of Security intelligence agency broke into an ambulance at a clinic in Wardak province, west of Kabul, operated by the Swedish Committee for Afghanistan, staff reported.
The agents, who said they suspected explosives were hidden inside, detained two SCA staff members overnight, according to Khalid Fahim, SCA’s programme director in Afghanistan.
The NDS was not immediately available to comment.
On Thursday, the same charity received news that the head of another clinic in Wardak was kidnapped by unidentified armed groups. His kidnappers told local elders he would be released on condition he left the district within a month, SCA said.
Fahim said that “all warring sides” have used the group’s facilities as shelter at some point during the long war.