03 August 2018

“Afghanistan, as a whole, is a country that has faced four decades of conflict. Our interest as Doctors Without Borders (MSF), however, is not on who is fighting who, but to provide medical assistance to the people who need it most,” says logistician Towani Mkandawire.

Having worked for MSF for over 13 years, Towani has been on assignment in six African countries, including his home country, Malawi. He recently spent six months in Kunduz, Afghanistan supporting the preparation phase for the construction of a new trauma hospital that will assist distressed communities with essential medical care.

MSF, Doctors Without Borders, Fieldworker, Towani
Towani Mkandawire, recently returned from Kunduz ,Afghanistan where he worked for 6 months as a Logistician

MSF’s return to Kunduz comes after its previous trauma centre was destroyed on 3 October 2015, in a US military attack that killed 42 people, including patients in their beds and MSF staff attending to them. It was one of the darkest days in MSF history, which left thousands of people without lifesaving care and made an indelible mark on MSF.

Following the attack, MSF engaged in an almost two-year-long period of internal reflection and intense discussions with all parties to the conflict, before the decision to return to Kunduz was made. It remains a step-by-step process, and the new trauma hospital will open in Kunduz city in 2019.

The hospital will be built using modular construction methods and will offer high-level medical expertise for trauma cases in the community and surrounding areas where conflict is still a part of everyday life.

Besides the armed conflict, Afghanistan continues to have some of the highest infant and maternal mortality rates in the world.  People struggle to access healthcare for everyday ailments, and there are also seasonal diseases affecting patients, Towani says.

Contributing to help communities

 Much of Towani’s time as a logistician in Kunduz was spent processing paper work, usually orders from different departments, including the administration and medical departments. He also worked to source supplies from local markets, where possible.

Upon arrival, his job was to coordinate the unload the materials from the delivery trucks, inspect the goods to ensure that the supplies were correct, and then deliver them to the respective departments.

MSF, Doctors Without Borders, Fieldwoker, Malawi, Afghanistan
Iron roofing and rubble litter a corridor in the MSF Kunduz Trauma Centre as the facility lies destroyed following the 03 October aerial attack which killed 22 staff and patients in northern Afghanistan. Photo: Andrew Quilty

“As logisticians, we do not necessarily interact directly with patients and beneficiaries at our projects,” he says. “Rather, we spend most of our days in and out of the office to ensure that everything runs smoothly so our medical teams who treat patients have enough of everything they need.”

Before joining MSF, Towani worked in Malawi, where he saw the gap between wealthy, privileged people who have access to everything they need – most importantly healthcare – and those who remain wanting. It is this disparity that showed him the importance of humanitarian work and bolstered his interest to work in the aid sector, particularly with MSF.

“There were two very big HIV/AIDS projects run by MSF in Malawi during a time when access to life-saving antiretroviral therapy was only afforded by the wealthy. These projects contributed immensely to communities especially for the people who couldn’t afford to pay for their own treatment,” he says. “This is what inspired me to join MSF.”

MSF’s activities in Kunduz:
On 3 October 2015 – one of the darkest days in MSF history – a US airstrike destroyed the MSF trauma centre in the city of Kunduz, killing 42 people, including 14 of our colleagues. This attack on a medical facility left thousands of people without lifesaving care and made an indelible mark on MSF in Afghanistan and around the world. We received an overwhelming outpouring of support from our donors and the public worldwide. At stake was not only MSF’s work in Kunduz, but the ability to provide trauma care on the frontline in conflicts all over the world.

Following the attack, MSF engaged in a period of internal reflection and intense discussions at the highest levels with all parties to the conflict. The objective was to understand the limits of providing trauma care on the frontline and reduce the likelihood of any such attacks happening in the future. After a year and a half of negotiations, formal commitments were given that our staff, patients and hospitals would be safe from attack and that MSF could provide medical care to anyone who needed it, regardless of their ethnicity, political beliefs or allegiances.

The need for lifesaving trauma care and free, quality medical services remains extremely high in Kunduz. While we know there can never be full guarantees when working in an active conflict zone, we believe the commitments obtained allow us to return and manage the risks that come with providing trauma care in this context. MSF’s return to Kunduz remains a step-by-step process. It started in July 2017 with the opening of an outpatient clinic for stable patients with minor burns, wounds from previous surgical interventions, minor trauma or diseases such as diabetes that cause chronic skin lesions. MSF continues to run a small stabilisation clinic in Chardara district outside the city, and plans to open a new trauma hospital in Kunduz city in 2019.

Read more: Memories of Kunduz

Find out more about MSF’s work in Afghanistan