[Compa ny name] Assessment Report- Health and Integrated Protection Needs in Kunduz Province Dr. Noor Ahmad “Ahmad” Dr. Mirza Jan Hafiz Akbar Ahmadi Vijay Raghavan Final Report Acknowledgements The study team thank representatives of the following institutions who have met us in both Kabul and Kunduz during the assessment. WHO – Kabul and Kunduz; UNOCHA – Kunduz; MSF (Kunduz); UNHCR- Kunduz; Handicap International Kunduz; Provincial Health Directorate, Kunduz; Regional Hospital, Kunduz; Afghanistan Red Crescent Society (ARCS), Kunduz; DoRR, Kunduz; Swedish Committee for Afghanistan, Kunduz; JACK BPHS team in Kunduz Thanks of INSO for conducting the assessment of the field locations and also for field movements Special thanks to the communities and their representatives – Thanks to CHNE and CME staff and students District Hospital staff of Imam Sahib Our sincere thanks to the District wise focal points, health facility staff and all support staff of JACK, Kunduz who tirelessly supported in the field assessment and arrangement of necessary logistics for the assessment team. Thanks to Health and Protection Clusters for their constant inputs and support. Thanks to OCHA-HFU team for their feedback on our previous programme and that helped in refining our assessment focus and added the components of additional issues like operations, logistics and quality of supplies which were discussed elaborately with the field team of JACK. Thanks to Access and Security team in OCHA for their feedback on access and security sections. Page 2 of 102 Final Report Abbreviations IEA Islamic Emirates of Afghanistan MoPH Ministry of Public Health ANSF Afghanistan National Security Forces JACK Just for Afghan Capacity and Knowledge OHPM Organisation for Health Promotion and Management UNOCHA United Nations Office for the Coordination of Humanitarian Affairs WHO World Health Organization UNHCR United Nations High Commissioner for Refugees WAW Women for Afghan Women SCA Swedish Committee for Afghanistan ALP Afghan Local Police AOG Armed Opposition Groups AGE Anti Government Element ACG Armed Criminal Group INSO International NGO Safety Organization HAG Humanitarian Access Group ACBAR Agency coordinating Body for Afghan Relief and Development DAC District Administrative Centre AHF Afghanistan Humanitarian Fund HFU Humanitarian Funding Unit IMF International Military Forces BBC British Broadcasting Centre UNAMA United Nations Assistance Mission in Afghanistan MSF Medicine Sans Frontiers HI Humanitarian & Inclusion/ Handicap International SIGAR Special Inspector General for Afghanistan Reconstruction BPHS Basic Package of Health Service EPHS Essential Package of Hospital Service CHC Comprehensive Health Center BHC Basic Health Center DH District Hospital PHC Primary Health Centre Page 3 of 102 Final Report PPHD Provincial Public Health Directorate TP Trauma Post FATP First Aid Trauma Post CSO Community Social Organizer CBPF Country-Based Pooled Funds RAF Rapid Assessment Format HMIS Health Management Information System IED Improvised Explosive Device GOA Government of Afghanistan PHCC Provincial Health Coordination Centre EPI Expansion Program on immunization Page 4 of 102 Final Report Glossary Shura Community Development Council Malik Head of Community Development Council IEA/Taliban Islamic Emirate of Afghanistan/Taliban Zakat payment made annually under Islamic law on certain kinds of property and used for charitable and religious purposes, one of the Five Pillars of Islam. Oashar Kind of Tax under Islamic Law in different kinds of cultivation product Rules Statement that establishes a principle or standard, and serves as a norm for guiding or mandating action or conduct. Masuliyat Responsibility Arbaki Afghan Local Police Breshna Electricity provider company in Afghanistan Page 5 of 102 Final Report Contents Acknowledgements ............................................................................................................................................... 2 Abbreviations ........................................................................................................................................................ 3 Glossary ................................................................................................................................................................. 5 Section 1 : Background ....................................................................................................................................... 8 Background of Kunduz Province ........................................................................................................................ 8 Background for the Assessment .......................................................................................................................... 9 Assessment Methodology ................................................................................................................................... 10 Section 2: Summary of the findings ............................................................................................................... 13 General ................................................................................................................................................................ 13 Security ................................................................................................................................................................ 13 Health .................................................................................................................................................................. 14 Access Related ..................................................................................................................................................... 15 Protection ............................................................................................................................................................ 16 Recommendations ............................................................................................................................................... 17 Section 3: Introduction .................................................................................................................................... 18 Security ................................................................................................................................................................ 18 Conflict situation................................................................................................................................................. 20 Section 4 : Health Assessment ......................................................................................................................... 22 Health Facilities in Kunduz ............................................................................................................................... 26 Trauma Cases details in Kunduz Province ...................................................................................................... 30 Internal Displacement ........................................................................................................................................ 38 Recommendations ............................................................................................................................................... 40 Supporting Referral Sites with capacity to respond mass casualty ................................................................ 42 Coordination with relevant health actors at Kunduz and Kabul ................................................................... 42 Learning key lessons from past experiences of trauma care........................................................................... 45 Recommendations from the stakeholders on the recruitment of qualified staff ........................................... 45 Training of Health Facility Staff on Triage, First Aid and First Responder’s training and Mass Casualty Management ........................................................................................................ 46 Advocacy related to health and trauma care ................................................................................................... 46 Section 5: Access Assessment ........................................................................................................................... 48 Active Fighting in Kunduz ................................................................................................................................. 59 Violations of Health Facilities noticed in the assessment by the actors involved in conflict. ....................... 61 Violation are seen but not regular by AOGs .................................................................................................... 62 Top four violations by ANF ............................................................................................................................... 62 Recommendations ............................................................................................................................................... 64 Key Activities considered for the proposed project ......................................................................................... 66 Section 6: Protection Assessment ..................................................................................................................... 67 Barriers to access schools ..................................................................................................................................