'Basic things are just not there': Health care collapse in Afghanistan threatens lives of millions as winter approaches

Female nurses takes care of patients at Wazir Akbar Khan hospital in Kabul on September 1, 2021.

(CNN)Health care in Afghanistan has literally collapsed in a matter of months, disrupted by conflict and starved of foreign assistance, according to UN agencies and NGOs working in the country. Thousands of medical staff have not been paid in six months and clinics have no medicine or equipment.

The NGO Save The Children says the break down of Afghanistan's health system will result in the deaths of thousands more children under the age of five every month as winter approaches.
The absence of health care for a majority of Afghans -- especially outside the cities -- is part of a perfect storm of crises descending on the country.
    There are chronic food shortages. More than 12 million Afghans face hunger and depend on food aid, according to the UN; malnutrition is rising sharply. There is an acute shortage of cash, making it difficult for NGOs still working in Afghanistan to pay salaries and buy supplies.
      More than 600,000 Afghans have been displaced this year. According to UN figures, 80% of them are women and children.
      A woman gives bread to young people in need in front of bakery in Kabul on September 19, 2021.
      Coronavirus infections are rising again, with the vast majority of the population still not fully vaccinated. A lack of reliable figures and very little testing make the impact of the pandemic difficult to gauge. According to the UN, before August of this year, 2.2 million Afghans had been vaccinated against Covid-19.
      The UN Office for the Coordination of Humanitarian Affairs (OCHA) said this week that aid agencies in Afghanistan "are in a race against time to deliver life-saving aid to crisis-affected people and preposition supplies ahead of winter."
        Mary-Ellen McGroarty, country director for the World Food Program, told CNN that she had "never before seen a crisis unfold at this pace and scale."
        "We are witnessing a new depth of destitution as the drought and the economic crisis drives up food and fuel prices," she said.

        Catastrophe ahead

        One expert who has seen all this unfold is Bahman Shahi, who works for the health and education consultancy ACASUS in Afghanistan. He has just finished a two-week tour of clinics in the south of the country and paints a grim picture.
        Shahi says his tour, which focused on Helmand, Kandahar and Kabul provinces, revealed a collapsing health system. At the majority of the centers he visited, there were no patients at all, nor health staff. He also found an acute shortage of basic equipment, supplies and medication. "The very basic things are just not there," he told CNN.
        Many people, he says, are not even aware that the coronavirus exists.
        Shahi says the worst affected are the poorest, who can't afford to travel to private health facilities in the cities. He estimates that this amounts to about 11 million Afghan citizens, some of whom have returned to rural areas because there are no jobs in the city.
        UN agencies, assisted by NGOs such as the Global Fund, are trying to plug gaps in the absence of foreign assistance, which dried up when the Taliban took control of the country. The World Bank, the United States, the European Union and others suspended aid through the Afghan Health Ministry pending guarantees from the Taliban.
        World Bank-administered funding for Afghanistan's nationwide health program, known as the Sehatmandi project, came to a halt in August.
        Now somewhere between 80 and 90% of the 2,300 facilities remain functional in any way, according to the World Health Organization and Save the Children. Two-thirds have run out of essential medicines, according to OCHA.
        The EU has promised a new aid package, and a UN conference in Geneva last month raised pledges of $1 billion in assistance. But with the onset of winter weeks away, little of this aid has reached those most in need. OCHA said this week that the urgent appeal launched last month for $606 million for the most vulnerable in Afghanistan remains only 35% funded.
        The Global Fund, which funds campaigns against H.I.V., malaria and tuberculosis, and the UN Development Program are