As the war in Afghanistan escalated in 2009, Afghan civilians endured increasing levels of violence throughout the country. The insecurity has damaged an already beleaguered health care system, leaving only a few poorly functioning hospitals and clinics in provincial capitals. Afghans in need of any health care must now make an impossible choice: risk traveling hundreds of miles through a war zone to seek a medical care or allow a condition to worsen until it becomes life-threatening only to arrive at a health structure where services are greatly diminished.

MSF has cautiously returned to Afghanistan after nearly five years of absence following the murders of five of our colleagues in June 2004.

Unfortunately, as needs increase it has become more and more difficult for impartial and neutral aid organizations to assess areas and provide assistance. The once clear distinction between armies, reconstruction and development activities and humanitarian aid has become confused.

In order to be accepted by all parties involved in a conflict, a private medical-humanitarian organization like MSF must demonstrate, and clearly communicate, complete impartiality, neutrality, and independence by, for instance, negotiating with all parties to the conflict, refusing to accept funds from any governments involved in the war for our work in Afghanistan or Pakistan, and rejecting any attempt from armed belligerents to control or direct us.

Patients wait the Ahmed Shas Baba Hospital. Eastern Kabul, Afghanistan. [Afghanistan 2009 ? Pascale Zintzen/MSF]

MSF staff member examines a patient at Ahmed Shah Baba Hospital. Eastern Kabul, Afghanistan. [Afghanistan 2009 ? Pascale Zintzen/MSF]

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