FOR ailing Hadia, a three-year-old Afghan girl, the tiring 18-hour journey from her hometown Mazar-i-Sharif to Peshawar turned her life around.

Unlike millions of Afghans, who have lived and worked as refugees in Pakistan since 1980s, Hadia’s family had never ventured across the border. It was until 2017 when Hadia developed a health complication that led her family to visit Peshawar.

Afghans have traditionally sought healthcare in Peshawar for reasons of access, support from Afghan relatives and acquaintances based in the city as well as better healthcare facilities.

In August 2017, Hadia’s father brought her from Mazar-i-Sharif to Peshawar when she was only a year and a half old since doctors in her hometown had been unable to diagnose the disease.

He took her to a private hospital in Peshawar where lab tests revealed that Hadia had advanced liver disease — with liver failure an imminent possibility. Doctors in Peshawar then sent her to see Dr Huma, a pediatric hepatologist in the state-run Children Hospital of Lahore.

“I did not have resources for medical expenses,” said Ahmad Zia, Hadia’s father who is a schoolteacher with a monthly income of Afghani 9,000. “I put my trust in God and took my daughter to the Children Hospital, Lahore, where the doctor advised she needed liver transplant.”

Zia offered to donate a piece of his liver to his daughter. However, the cost of liver transplant was huge (in millions). There was no hope for the little girl. “Dr Huma advised me to go back to Afghanistan,” said Zia. “She said she would do whatever possible to save my daughter’s life.”

A few months later, Zia received a message from Dr Huma on WhatsApp: “Funds have been arranged and Hadia would go for a liver transplant in India.”

“We [friends and family of Dr Huma] decided we should do our best to help this beautiful girl from across the border. Everybody pitched in to create a fund to help the Afghan family,” Dr Huma told Dawn.

Dr Huma not only arranged money but also used her network of contacts in New Delhi to subsidise the cost of treatment. She spoke to Dr Anupam Sibal — Group Director of Apollo Hospitals in New Delhi — and asked to help the Afghan girl.

Apollo’s management agreed to cut the cost of transplant to Rs2.8 million from Rs3.5m (Pakistani rupees).

In May 2018, Zia got Indian visas and proceeded to New Delhi. Dr Huma donated Rs2.5m and Zia managed to raise Rs300,000 to bear the additional cost.

Hadia underwent a successful liver transplant with uneventful recovery at Apollo and is back in Afghanistan now.

Hadia’s is an exceptional case. Millions of Pakistanis, Afghans and Indians cannot afford quality healthcare because of abject poverty, high cost of healthcare and lack of specialised institutions.

In Afghanistan, the health sector has suffered due to four decades of conflict. Patients either go to Pakistan or India for treatment due to lack of medical professionals and health institutions. Both quantity and quality of essential medicines are major challenges for the health system in Afghanistan.

Until June 2017, when the border movement between Pakistan and Afghanistan was relaxed, the Afghans largely relied on healthcare facilities in Peshawar and Quetta.

Khalil Rehman, 56, a resident of Kabul was under treatment at the oncology ward of Rehman Medical Institute (RMI), Peshawar. “I remained in RMI for 15 days and the management charged Rs400,000 only for diagnosing the illness,” said Rehman, for whom travelling from Kabul to Peshawar was a harsh experience.

He was not happy with the treatment meted out to visa seekers at the Pakistani mission in Kabul. “The embassy staff told us to check the status of visas after 15 days when we applied,” he said. “Then we struck a deal through an agent and paid Rs30,000 (Rs15,000 as bribe for each passport) and got visas within four days,” he added.

Border restrictions

Another Afghan patient Bismillah Khan, 70 — who came from Jalalabad to Peshawar — said that restrictions at the Torkham border checkpoint had made movement for common travellers tough. “Earlier there was no restriction on cross-border movement and people travelled without passport,” said Khan, who suffered from a pulmonary condition.

In 2017, Islamabad introduced tough border management regimes under which only Afghans with valid travelling documents could enter Pakistan.

According to border officials, an average 20,000 Afghan citizens now enter Pakistan via the Torkham crossing point on a daily basis. Since the installation of the new border management system, the number of Afghans entering Pakistan has gone down to roughly 5,000 visitors per day. Among them are the Afghans in need of healthcare.

The flow of Afghan patients to hospitals in Peshawar has witnessed a sharp decline since Islamabad started fencing the western border with Afghanistan in an attempt to prevent infiltration of militants.

RMI’s Public Relations Manager, retired Major Syed Naweedul Haq Jillani, told Dawn that before border management, around 27,000 patients sought health care at his hospital daily. Of them, 40 per cent came from Afghanistan.

“Now hardly 10pc of patients come to RMI from Afghanistan because of the border policy,” said Jillani.

For neighbours tied in ethnic, religious and cultural bonds, a hostile environment and disputes among Pakistan, Afghanistan and India are taking a toll on the people.

Access to healthcare in the three countries is appalling due to abject poverty, high cost, lack of specialties and quality health services. Hadia, who underwent a successful surgery, cannot access post-surgery health care, because medicines are not available in her country.

“Medicines are not available here and I requested my friend in New Delhi to bring for Hadia doses enough to last her for three months,” said Zia.

Dr Huma said that India had made much progress in the field and she often referred patients for treatment there. “Private hospitals in Pakistan are money-minded and do not give subsidy to low-income patients,” she regretted. She said that she had recommended 178 children for liver transplant and only three cases had failed. Of these, she said, only nine cases were self-funded and others had undergone subsidised transplant surgery in India.

The Apollo Hospitals have been a partner to hospitals and citizens of Pakistan and Afghanistan in providing access to transplant surgeries.

“We continue to enjoy the goodwill of our neighbours in relation to our transplantation services. On an average we continue to receive close to three to four patients a month of liver transplant alone,” said Dr Anupam Sibal.

Published in Dawn, October 9th, 2018