The Panjshir Valley, in Afghanistan, is the valley of women. In an area with one of the highest maternal mortality rates in the world, a revolutionary centre for mothers and their children has been established. It is Emergency's maternity centre in Anabah, which has just turned 15.
When in 1999 we reached the Panjshir Valley, in Afghanistan, for the first time, we found ourselves facing an enclave accessible only via a military heliport. There were no roads, except for the single dirt track running alongside the river; there was no electricity, no infrastructure, no sewage system. The wreckage of tanks, armoured vehicles and cannons — relics of the battles fought by Commander Massoud against the invasion army of the then Soviet Union — was scattered everywhere. Added to the disasters of the Valley's "old" history were the misfortunes of more recent events: a new Taliban offensive had caused a massive influx of refugees. And within a month, the population had more than doubled.
When we arrived, it was clear that something was missing from the Valley. There was no hospital. So we identified the building of a former military school and, after a few months, Emergency's first surgical centre in the country opened its doors to the population. And it is right here, in the Panjshir Valley, that everything began. Everything that Emergency has managed to build in Afghanistan over these years. From that moment on, the organisation expanded its activities to respond increasingly to the needs of the Afghan population: more than 40 first-aid posts were opened, stabilising patients and referring them to hospitals, and today they are spread across Afghan territory; in 2001 the second surgical centre for war victims was opened, and in 2003 the third hospital for war victims, in Lashkar-gah, in Helmand province.
2003 was an important year for Emergency. While on one hand the number of war casualties demanded an ever greater effort, on the other there were — and still are — other needs of the population that required an immediate response. Afghan women needed to receive care. Afghan mothers needed assistance during pregnancy, childbirth and in the care of their newborns.
The country's maternal and infant mortality rates were among the highest in the world: every year 16,000 women died from pregnancy-related causes and roughly 1 in 4 children did not reach the age of five. For these reasons, Emergency decided to open a maternity centre in the Valley, where the needs of the female population were even more acute. The objective was clear from the outset: to open a centre for women, built by women.
It was precisely for this reason that, at the beginning, reactions of bewilderment broke out: "You're crazy. Opening a maternity centre in rural Afghanistan, where international and Afghan women work together. It's madness." And yet history has proved the opposite. If at first Afghan women and their families were sceptical about coming to our hospital to receive care, or even to work there, today, after fifteen years, we can say that we have achieved what many considered a miracle.
I met some of these women not long ago, and each one of them made me truly believe and become convinced that Emergency's work in the Valley has been extraordinary. I met A., a health worker. She tells me about the day her brother wounded her hand with a knife to stop her from working. He and the people of her village were absolutely opposed to the idea of her working outside the home. A. did not give up. She kept coming to work, convincing her family and all those who stood against her that she would not abandon that job. She smiles as she tells me her story. Today, in the village where she lives, everyone asks her for health advice, and many young women are following her example.
The face of S., on the other hand, I think will stay with me for a long time. S. is one of the patients admitted to the maternity centre. She is hypertensive, obese, diabetic and at the end of a complicated twin pregnancy. She has deep, dark eyes, and an intense gaze like so many Afghan women. When I meet her for the first time, Angela, one of our international gynaecologists, describes the patient's situation to me with concern: "The woman's health is critical and the two twins are also at risk. I'm undecided whether to perform a caesarean section on her."
In Afghanistan, each woman has an average of 5–6 children, and for this reason a caesarean section, although it is becoming an increasingly common practice in many hospitals across the country, can be dangerous for future pregnancies and for the mothers' health. The following morning, during the morning rounds, I see S. again. Next to her is a cot with two beautiful baby boys inside. The language barrier prevents me from telling her everything I would like to, but we both look at each other and smile. "Tashakor," "Thank you," she whispers in Farsi. Angela is beside me too. She is radiant. She asks the woman if she can hold one of the two twins and she nods. "Everything went well," she tells me, looking at that little bundle in her arms.
There are many stories like theirs in the maternity centre that Emergency has been running for 15 years. Success stories. Wonderful to hear and to tell. There, in a country where the role of women is full of contradictions and where many questions that come naturally to those living within a different culture arise — but whose answers require time, reflection. And above all listening, because only this can give us the opportunity to put ourselves in someone else's shoes.
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Another of the main aspects of this centre is the continuous work, side by side, of national and international staff. Day and night the radios record dozens of calls. "Falcon 33, please come to delivery", "Falcon 21, babies with convulsions in Nicu, please come", "Falcon 25, urgent c-section in Ot, please come". And on the other end there is always someone who replies "Ok, I'm coming". This is why without this teamwork we would never have got to where we are today.
Explosions, fighting, suicide attacks are far away, and in the Panjshir Valley one often has the feeling of being in a different country. There is a sense of being sheltered by those mountains. It seems absurd to think it, but in that Valley it almost feels as though peace reigns, almost as though it offers a glimpse of how another world is possible.
Emergency's maternity centre today assists more than 700 births a month, over 20 a day. The Afghan women working with us as midwives, nurses, gynaecologists and auxiliary staff number more than 100. And the hospital has been recognised by the local Ministry of Health as an official training centre. Perhaps another world is truly possible: a maternity centre for women, built by women, in Afghanistan.