After the Afghan maternity ward attack, MSF has no choice but to close it

We have to protect our staff from such gruesome attacks in the future

In May, 24 women, children and babies – including one midwife – were killed when gunmen entered the Dasht-e-Barchi hospital in western Kabul and opened fire. Frederic Bonnot / Médecins Sans Frontières

People react at the scene of an attack at an MSF (Doctors without Borders) clinic in Kabul, Afghanistan. EPA

An Afghan man reacts at the scene after an attack at MSF (Doctors without Borders) clinic in Kabul, Afghanistan. EPA

Babies are taken away by ambulance after gunmen attacked a maternity hospital, in Kabul, Afghanistan. AP Photo

People shift injured victims of a suicide bomb attack to a hospital in Jalalabad, Afghanistan. EPA

An Afghan security officer carries a baby after gunmen attacked a maternity hospital, in Kabul, Afghanistan. AP Photo

An Afghan man reacts after his relative was killed in an attack at an MSF (Doctors without Borders) clinic in Kabul, Afghanistan. EPA

Afghan women sit in an ambulance after being rescued by security forces during an attack and gunfire at a hospital in Kabul, Afghanistan. REUTERS

People shift injured victims of a suicide bomb attack to a hospital in Jalalabad, Afghanistan. EPA

Smokes rises from a hospital after gunmen attacked in Kabul, Afghanistan. AP Photo

Afghan security forces arrive at the site of an attack in Kabul, Afghanistan. REUTERS

Afghan security personnel arrive at the site of an attack outside a hospital in Kabul. AFP

An Afghan soldier stands guard near the scene of an attack at an MSF (Doctors without Borders) clinic in Kabul, Afghanistan. EPA

An Afghan woman is brought to Emergency hospital for medical treatment after she was injured during an attack at an MSF (Doctors without Borders) clinic in Kabul, Afghanistan. EPA

Afghan security personnel arrive at the site where gunmen attacked, in Kabul, Afghanistan. AP Photo

About 10am on May 12, the maternity ward opened six years earlier by Doctors Without Borders (MSF) in the Dasht-e-Barchi neighbourhood of Kabul, was attacked. The assailants went from room to room, killing 16 expectant mothers in their beds. Five of them were about to give birth. Several other people were murdered, including a midwife employed by MSF and two children aged seven and eight, who were at the hospital that day to get their jabs.

Nobody has claimed responsibility for this horrendous attack. The Afghan government immediately accused the Taliban, which denied any involvement; the US accused the ISIS affiliate known as Islamic State Khorasan Province. The assailants were reportedly killed during the assault carried out by Afghan and international armed forces, while a hundred or so terrified mothers and MSF employees hid in the hospital's safe rooms. And no official investigation has produced any evidence on who perpetrated the attack.

One month later, we know next to nothing, but we know enough: whoever the perpetrators were, the targets of their attack were the Hazara women of Dasht-e-Barchi and the healthcare staff. And this is no isolated tragedy: it is part of a series of attacks against this particular Shia minority group, as well as civilians and aid agencies. It is also one among several assaults mounted against MSF, with more than 70 of our patients and personnel losing their lives since 2004.

In June 2004, five employees – two of them Afghans – were killed in the Badghis Province. Allegedly committed by a local police chief, these killings were treated in the most off-hand manner by authorities, with no one punished for it. This resulted in MSF withdrawing from Afghanistan for five years.

We returned in 2009 after negotiating an agreement with the government and the Taliban, which had since retracted statements it had made years earlier, declaring us as legitimate targets. In October 2015, MSF's hospital in Kunduz was destroyed by a US air force bomber, killing 42 people, including 24 patients and 14 staff members, and injuring 37 more. We returned to Kunduz two years later, after receiving assurances from all the armed groups with which we were in contact that we could resume our activities as humanitarian healthcare providers.

We were aware that our presence in Dasht-e-Barchi carried risks. This neighbourhood in Kabul, home to much of the Hazara community, has been the target of murderous attacks. One such attack, on a university in August 2018, left a deep impression on our personnel. And yet, we just could not believe that the worst would happen nearly two years later; that men would kill women about to give birth, as well as their babies. But it did happen, and it could happen again. Today, we have to accept this reality.

We cannot protect ourselves from those determined to kill our patients and colleagues. Reinforcing security measures, such as building higher walls and increasing the number of safe rooms, will not be enough to protect us from another nightmare.

Today, Afghanistan is a high-risk country. Since its emergence there in 2014, ISIS has grown in prominence, as evidenced by the attacks it has perpetrated on civilians and aid organisations in recent years. Meanwhile, the cycle of violence and reprisals between Taliban and the Afghan National Army continue unabated.

Intra-Afghan negotiations for a peace deal remain uncertain. And there is the risk of those in the business of violence refusing to compromise or seeking to demonstrate their importance by exercising their power to harm. In such a setting, the lives and deaths of humanitarian healthcare workers and patients are little more than adjustment variables on the agendas of these forces.

If we were to continue working in Dasht-e-Barchi, we would have had to be honest with our staff, telling them that attacks, such as the one in May, could happen again and at any time. And that would have meant MSF becoming an organisation that accounted for the loss of human lives. To our minds, this was unthinkable.

This is why we are ceasing our activities in Dasht-e-Barchi and withdrawing our personnel from the area. We will not be reopening the maternity wards. It is a heartbreaking decision, but one that we believe is necessary.

The Dasht-e-Barchi maternity ward was the only provider of emergency obstetric and neo-natal care for the underprivileged people living in this part of Kabul. It was one of the busiest maternity wards supported by MSF in the world: in 2019, almost 16,000 women gave birth in that ward. More than 350 employees devoted their days and nights to the cause.

Some of them are willing to take a risk and return. But we refuse to send them back to a place where courage and hope would be the only means of protection against another massacre.

Thierry Allafort-Duverger is general director at Medecins Sans Frontieres