Afghan hospital in coma for poor workmanship

At first glance, Jumhoriat hospital looks like a modern new facility – just the sort of place Afghanistan desperately needs. But when one reaches the front door, it becomes clear that all is not as it first seems.

The place is deserted. Two unused ambulances are parked under the entrance canopy, and the vehicles are covered with a thick layer of dust. Tiles are falling from the façade. At one place, holes in the brickwork expose the polystyrene that has been used to fill the wall cavities. There are gaps in the doors, allowing Kabul’s dust and pollution to blow into the hospital.

Afghan President Hamid Karzai opened Jumhoriat hospital in Kabul on August 16, 2009, with great fanfare.

One day later, the hospital closed again. It has not re-opened since.

Shoddy construction

The facility, built by a Chinese contractor and paid for by the Chinese government, has such poor workmanship that the hospital is not safe enough to open to patients.

But there’s another problem: even if the hospital were fit for opening, the government could not afford to run it.

Jumhoriat is one of 19 hospitals funded by foreign donors due to be completed within the next two years. The Afghan government can’t afford to run any of them.

Al Jazeera was shown an engineer’s survey that lists a catalogue of alarming construction defects in Jumhoriat.

“This is another major problem that has plagued Afghanistan since the fall of the Taliban: Hundreds of millions of dollars in aid money has been spent here with almost no co-ordination between donor groups and the government.”

The myriad errors are clear even to the untrained eye. The air conditioning exhaust unit, which should be on the outside of the building, has been fitted on a wall in an indoor corridor by a waiting room, and the radiators touch the floor, meaning that when they get hot the plastic floor will melt.

Suraya Dalil, Afghanistan’s health minister, inherited this mess.

Dalil told Al Jazeera that while she is “grateful to the government of China for it’s assistance in constructing this hospital and equipping this hospital”, the hospital is a long way from functioning.

“The assessment shows that the hospital needs some refurbishment and some equipment need to be upgraded so that will also require some resources including financial resources and some efforts to upgrade the building itself, the construction itself to refurbish some of the equipment and prepare it for a full use,” she said.

Dalil is being diplomatic: the survey Al Jazeera has been shown concludes that $44m of remedial work needs to be done to bring the hospital up to international standards.

With a total annual health development budget of $135m, the country’s Ministry of Health cannot afford to do the work, making Dalil’s team scramble to find a private company willing to take on Jumhoriat.

“The Jumhoriat hospital will be a kind of public-private partnership in healthcare delivery,” she said. “It will hopefully be a model of public healthcare partnership to a large scale.

She added that services will not be free, but the hospital would have a “welfare fund” to cover poor patients.

Lack of oversight

Only the Aga Khan foundation, a private international development agency, has shown interest in running the hospital, but it has yet to make a formal offer.

But the government needs someone to take over Jumhoriat soon, and the other 18 hospitals also need running and managing.

The health minister hopes that Jumhoriat will prompt foreign health companies to come in and run the other new hospitals.

Many  exit signs in Jumhoriat are in English and Chinese  and point to dead ends [Abdullah Shahood/Al Jazeera]

But before the government can start inviting bids for these hospitals, it needs to conduct feasibility studies into each one. 

While it is unlikely that any of them are structurally as bad as Jumhoriat, the government is not completely sure as none of them were built with any government oversight.

This is another major problem that has plagued Afghanistan since the fall of the Taliban: Hundreds of millions of dollars in aid money has been spent here with almost no co-ordination between donor groups and the government.

Need for strategy

The US government’s aid arm, USAID, is currently building two hospitals.

Ken Yamashita, USAID’s director in Afghanistan, acknowledges the problems the Afghan government is being left with.

“In the rush and in the attempt to increase the delivery of services, a lot of building of infrastructure may have taken place, without thinking through exactly what the implications are for the longer term sustainability,” he said.Ken Yamashita, USAID’s director in Afghanistan, acknowledges the problems the Afghan government is being left with.

“Now we have an opportunity to rationalise it, by thinking about what we will do with hospitals that are built and are available, and how they fit into the overall system of healthcare, this government wants to put together.”

The Afghan government estimates that its citizens spend $90m a year on hospital treatment in neighbouring countries.

Unsurprisingly, it wants to keep that money at home, but these 19 hospitals need staffing and managing, ideally in the next 24 months.

Ken Yamashita told Al Jazeera he is confident the health minister can make it work.

“On the US government side and I think for a lot of our other partners in the international community the first several years – the last five to eight years – so much of our effort has been building back-up to that service delivery capacity,” he said. “Training the individuals, buy the equipment, getting the hospitals refurbished and so-on. I think we are in a good place.”

Back inside the crumbling Jumhoriat hospital, ceiling tiles are falling onto the floor.

Many of the emergency exit signs are placed just 10 centimetres above the floor and written only in Chinese or English – some just point to dead ends.