The sound of crying and beeping medical devices fills the small room. Nurses rush from bed to bed, checking vital signs. Mothers push oxygen masks onto the faces of their children.
The emergency room doctor bursts through the swinging doors of the paediatric emergency room (ER) in Boost hospital in Helmand.
It’s 6pm, and the night shift has only just begun. Every bed in the paediatric department is full; they are often shared by two patients, and the next wave of patients is already arriving.
“This is a crazy time for us. Day by day, more and more patients are coming,” says Dr Ahmed.
The number of children under five coming to the ER triage at Boost hospital has more than doubled since 2020, rising from 53,923 to 122,335 patients in 2024.
In April of this year, 13,738 children under five were seen in the ER at Boost hospital – the highest monthly number of ER consultations since at least 2020.
Finding the space, time, and resources to treat the growing number of children is a challenge. They arrive with life–threatening conditions like sepsis, respiratory failure, and severe malnutrition.
This increase in paediatric patients is not just happening in Helmand, though. Health facilities are facing similar pressures elsewhere in Afghanistan, including the Mazar–i– Sharif Regional hospital in Balkh province and the Herat Regional hospital in Herat.
Between consultations with newly arrived children in the ER, Dr Ahmed gets on the phone, trying to find space in the paediatric and neonatal intensive care units elsewhere in Boost Hospital. Other staff members call nearby hospitals to see if they have free beds.
“If we don’t find space, then they will stay here. Some patients stay in the emergency room for one day, two days,” says Dr Ahmed.
Increasing numbers of patients at triage in Herat
In another hospital, some 500 kilometres to the northwest, women crowd in the large white tent that makes up the paediatric triage at the Herat Regional hospital, children clinging to their arms and legs. Some families spill outside, waiting their turn to speak to the registrar.
The number of families streaming into the paediatric triage in Herat Regional Hospital has been growing for years. On an average day in 2025, triage nurses see 1,300 patients. Some days, more than 2,000 infants and children arrive, waiting to be seen.
Many of the children are not in critical condition and their caretakers should be seeking care at basic health clinics.
“Parents are telling us they do not find sufficient services at local clinics, and cannot afford treatment at private clinics, so they come here where MSF provides free care,” she says.
This is creating a lot of pressure on the already busy triage nurses, who are also seeing an increase in very critical patients coming with life–threatening conditions.
In the first five months of 2025, an average of 354 children received consultations in the ER every day. That’s an increase of 27 per cent, as compared to the same period in 2024.
“Many families tell us they don’t have money for transportation to the hospital, so they’re waiting to see if their child recovers, or if they can find the money. It results in delayed care and worsened conditions,” says Jameela.
Delaying care until paid
All her money gone, Zarweena says she was out of hope. Then her brother took them to Boost Hospital, where Asma was admitted and has been receiving treatment for nine days already.
“Now, she is no longer having seizures,” Zarmeena says. “The doctors know what they’re doing. If she gets better, I’ll wait and then take her home. Even if it takes time, I just want her to get well.”
Patients coming later, and in more critical condition
On the other side of the country, Dr Fareed* sees many patients like Zarmeena in the pediatric department of the Mazar–i–Sharif Regional hospital in the northern Afghan province of Balkh.
In May, an average of 51 patients arrived every day in a very critical condition, requiring immediate treatment.
Many children have conditions that have become life–threatening because families couldn’t access treatment earlier, explains Dr Fareed. That could be for a range of reasons, including not enough money for transportation or medication, not realising the severity of the illness, and the unavailability of a mahram (male chaperone) to accompany the child and female relative to the hospital.
Back at Boost hospital in Helmand, Dr Ahmed walks out of the emergency room the next morning – tired at the end of his night shift, but with a smile on his face.
MSF and public health staff referred some patients to other hospitals and were able to find enough beds in the paediatric and neonatal wards.
None of the patients spent the night in the ER.
*The names of these MSF staff members have been changed to protect their identities.
