Bamyan Province, Afghanistan- Moslima sits cross-legged on the edge of the bed, cradling her newborn baby.
It was a gruelling overnight journey to get here.
Nine months pregnant and about to go into labour, Moslima rode the family donkey through valleys and mountain passes for more than three hours, accompanied by her mother and husband.
She arrived in the early hours of the morning at the small clinic in Baghak, a remote village tucked away in the central highlands of Afghanistan.
The clinic is one of eight built in 2022 by Médecins Sans Frontières/Doctors Without Borders (MSF), creating access to free basic health services for an estimated 22,000 people living in three hard-to-reach districts of the mountainous province of Bamyan.
At each of the MSF-supported facilities, a male nurse and female midwife team offer general outpatient services, maternal and child health consultations and routine vaccinations. They also help women with uncomplicated pregnancies and labours to deliver their babies in a safe environment.
“We came here because we heard that giving birth assisted by a midwife is good for the baby’s and the mother’s health,” says Moslima. “During previous births, I didn’t feel well after the deliveries. But now I feel healthy.”
Since 2022, more than 400 women have given birth safely in the eight clinics. During that time, health staff have provided more than 80,000 outpatient consultations and more than 8,500 antenatal and postnatal consultations, while referring more than 100 women with complicated pregnancies for specialised care.
The Band-e-Amir Valley
That was the case for Roqia Hussaini, 35, who lives in a small village in the Band-e-Amir valley.
Sitting in a consultation room in the clinic, which is nestled at the base of a sandy cliff, Hussaini rolls up her sleeve for the midwife to check her blood pressure and then steps on the weighing scales.
“Even though you feel nauseous, your weight gain is much better than it was,” says the midwife. “Continue feeding yourself like this. It’s important that you eat enough food for both you and the baby.”
Hussaini is at the clinic for her second antenatal consultation. Three months pregnant with her fifth child, Hussaini knows the important role played by this health facility in ensuring that pregnant women can give birth safely.
When Hussaini was pregnant with her second child, there was no clinic in Band-e-Amir. She was in a private taxi, trying to make the two-hour drive to Bamyan provincial hospital through thick snow, when her baby arrived.
“My second child was born in the car,” says Hussaini. “There was a lot of snow, so we couldn’t reach the city. When my daughter was born, she fell under the seat of the car.”
Hussaini’s third child was born at home, but the baby had trouble breathing and experienced seizures shortly after birth. Hussaini says that both of her children still suffer from health issues, and that she was told it is because they were not born at a health facility supported by a midwife.
“Most people in Band-e-Amir are poor,” says Hussaini. “They can’t afford to take their children or the mothers to a health facility.
“Now, everyone [in the surrounding villages] can access the clinic, and they are very happy because they can receive treatment without any cost.”
‘The car would get stuck’
Sitting in the outpatient consultation room across the hall from Hussaini, Sayed Akbar echoes her sentiments. He lives one kilometre from the clinic and walked here today for a medical check-up related to chronic leg pain.
Before the clinic opened, Akbar said he would have to pay 2,000 Afghani (US$28) to hire a private taxi to travel to Bamyan provincial hospital every time he or his family members became sick. As a seasonal worker, these travel costs were unaffordable.
“There’s no work during the winter,” says Akbar. “We work in the summer to cover our winter expenses, but often it’s not enough.”
Travel in the region can be difficult, as roads are poorly maintained and community members have to pitch in themselves with shovels to clear the roads after heavy snowfall.
“During winter and spring, snow and mud make it very difficult to reach Bamyan,” says Akbar. “Sometimes we even had to spend the night on the way because the car would get stuck in the mud or snow.”
Climbing mountains to get a phone signal
As the midwife for the village clinic in Baghak, Masoma is always on call, ready to respond whenever a woman goes into labour.
A few months earlier, Masoma received enhanced midwifery training at MSF’s Khost maternity hospital and feels increasingly confident in her skills as a midwife.
“After I came back from Khost, like our people say, my heart became stronger – I became better,” says Masoma, recalling how she successfully treated two pregnant women for pre-eclampsia by herself in the clinic.
“It was flooding at the time – the roads were closed,” says Masoma. “It was not possible to go to Bamyan, so I dealt with them myself, and I didn’t have to refer the patients.” Both women recovered and were able to go home without further treatment.
For cases beyond her expertise, Masoma calls the MSF midwife supervisor based in Bamyan city and, when needed, refers women with complicated pregnancies or labours to Bamyan provincial hospital – a three-hour drive over poor roads.
“When we need to send a patient to the central hospital, it takes several hours due to the bad road conditions,” says Masoma.
Sending a patient to Bamyan can also depend on Masoma’s ability to get a mobile phone connection.
“We need to climb onto the roof to make a call to Bamyan,” says Masoma. “Sometimes, when it is cloudy, the connection doesn’t work on the roof, so we have to climb the mountain to get service.”
Even when the medical team in Baghak can get a mobile signal, they can’t always find a vehicle to transfer the patient to hospital.
“There are very few taxis or private cars available,” says Masoma.
Back in the midwife consultation room, Moslima is preparing for the long journey home after giving birth. Her mother, Bibi Aqila, says she will carry the baby in her arms while Moslima rides the donkey, supported by her husband.
“It’s difficult to go by donkey, but we will manage,” says Bibi Aqila.
Despite the difficulties, Moslima is already planning to make the six-hour return trip to the clinic in a few weeks.
“Soon it will be time for the baby’s first vaccinations,” she says.
MSF built eight clinics in the Yakawalang 1, Saighan and Shibar districts of Bamyan province in 2022, and provides financial support, medical and non-medical supplies, and training to ensure continued operation of the facilities. In 2024, medical teams across all eight facilities provided 57,171 outpatient consultations, gave 5,165 doses of routine vaccinations, provided 4,530 gynaecological consultations, and assisted 155 deliveries. MSF supports human resources in the maternity waiting area of Bamyan provincial hospital to increase timely access to healthcare for pregnant women with complicated or high-risk pregnancies. In 2024, MSF also provided support in the form of human resources and medical supply donations to Bamyan provincial hospital in response to a surge in measles cases and an outbreak of acute watery diarrhoea.
