Kandahar, Afghanistan- Naqibullah is a 15-year-old from Ghazni, and he was the primary caretaker for his mother when she fell ill. Of his 32-member family, 16 were diagnosed with drug-resistant tuberculosis (DR-TB) in the span of one month and admitted to the MSF DR-TB hospital in Kandahar, in southern Afghanistan.
“I had all the symptoms – I was coughing, I had a headache, I had pain in my legs and in my whole body, and I had a fever during the night … My grandmother was the first to suffer from TB and she was on medication, but she died earlier this year, some three months ago. We’re 32 people living in a two-room house. This number of people infected with TB is because of a lack of space,” says Naqibullah.
According to the World Health Organization, more than 10 million people continue to fall ill with TB every year around the world. In Afghanistan since 2016, MSF has been treating patients with DR-TB in Kandahar. MSF runs a hospital with a laboratory, an outpatient clinic, and a 24-bed inpatient department for patients diagnosed with DR-TB and patients who develop adverse side effects from DR-TB medications.
Many patients come from the nearby provinces of Helmand, Uruzgan, Nimroz and Zabul, but some others will travel up to 350 kilometres from provinces further away, including Daikundi, Badghis, Ghazni and Paktika.
MSF works in close collaboration with the National Tuberculosis Control Program in Afghanistan, and provides some medical supplies and financial incentives to staff involved in the diagnosis and treatment of drug-sensitive tuberculosis patients in other Ministry of Public Health (MoPH) facilities in southern Afghanistan, including Mirwais Regional Hospital, the provincial TB centres in Kandahar and Zabul, and Sarpoza Prison.
Challenges to accessing care
With many people in Afghanistan reliant on humanitarian aid, challenges such as increasing poverty prevent patients from accessing TB treatment. But difficulties reaching and affording medical care are not the only barriers faced by people in Afghanistan. Another factor is the widespread lack of knowledge about the disease.
Nazika, a mother of six, said she sought out medical care when she was sick: “They said I was infected with Brucellosis [a bacterial infection] and each time I was given medication prescribed for the treatment of Brucellosis. For one year, I was taking the Brucellosis medication, but I didn’t improve and when my health condition got worse, I was taken to the provincial hospital in Ghazni where doctors found that I was infected with TB.”
Zainab, 18, from Nangarhar Province explained that doctors told her she had “malaria or a microbial disease” before she was taken to the Jalalabad regional hospital and diagnosed with TB. Both were then referred to MSF.
Shorter regimens
In 2024, 95 per cent of patients enrolled for TB treatment in the MSF hospital completed their TB treatment successfully. This is in large part because of the six-month treatment regimen that was put in place in 2023. A shorter regimen means fewer side effects and few complications, so it’s easier for patients to cope and to complete their treatment. Patients with DR-TB usually stay at the MSF facility until they are no longer contagious and are then sent home with treatment – returning every month for the duration of their treatment for a check-up and a medication refill. MSF covers their transport costs and offers health promotion and psychosocial support to the family and the patient. Those patients requiring more complex treatment can stay at the facility as long as they need.
Living in close quarters
MSF teams carry out regular health promotion activities in local communities in Kandahar to improve people’s understanding of TB. We also provide information about TB to patients and caretakers at the MSF hospital in Kandahar.
Contact tracing plays a very important role in DR-TB treatment, to ensure that we can reach more people and track the spread of the disease. MSF screens patients’ family members for TB, as the disease is highly transmissible, particularly when many people live close together in houses with limited airflow.
“We are very rigorous when it comes to screening for TB in children,” continues Purity Kinyua, the project medical referent in Kandahar. “Immunity in children is lower, and so they are more susceptible to TB infection than adults.”
Accessing the necessary care
Globally, the number of men with TB is usually higher than women, but in Afghanistan this is not the case. In 2024, 66 per cent of the patients diagnosed with TB were adult women and children under the age of 15, while 34 per cent were adult men.
“Women and children stay at home in poorly ventilated rooms for longer periods of time than men,” says Kinyua. “And if a woman gets infected, the children are likely to catch the disease as well.”
An additional challenge for female patients is that they are required to be accompanied by a male family member to the hospital, and this coupled with the economic barriers can significantly reduce their access to timely healthcare.
Access to proper care remains a major challenge for many patients, mainly due to insufficient medical infrastructure, length of treatment and financial obstacles. But MSF collaborates with the national TB program and other medical facilities in the region to facilitate easier referrals for patients with DR-TB, enhancing access to lifesaving care.
“The doctors in the public hospital referred me to Kandahar for treatment. I’m improving and recovering with each passing day. When I first came here, I didn’t think I would survive,” says Zainab.
MSF’s Kandahar DR-TB hospital aims to provide patients with quality, free and effective treatment. In 2024, MSF staff started 85 patients on treatment for drug-resistant TB. Since the project started, more than 380 patients with MSF have completed treatment for drug-resistant TB. We provide patients with mental health support, carry out health promotion activities within the hospital and in the surrounding area, and deliver technical and financial support to provincial laboratories who offer TB testing. In 2024, MSF also provided some medical supplies and financial incentives to staff involved in the diagnosis and treatment of drug-sensitive TB in several Ministry of Public Health facilities in southern Afghanistan. Those teams provide 44,940 consultations for patients with drug-sensitive TB.
