KABUL: As rescue operations continued in eastern Afghanistan on Sunday, a week after a deadly earthquake devastated the region, World Health Organization and doctor accounts show how the withdrawal of foreign aid has undermined the country’s ability to respond to disasters.

At least 2,205 people have been killed and another 3,640 injured by the quake that hit the densely populated rural areas of Kunar and Nangarhar provinces on Aug. 31.

While the Afghan government quickly flew dozens of doctors to support overwhelmed hospitals and sent helicopters to reach the wounded, many mountain villages were cut off by landslides. First responders reported how poorly equipped rescuers had to walk for hours to reach the affected areas and often used basic tools and even their bare hands to pull survivors from the rubble.

The WHO, whose teams are also on the ground, said in its situation report on Saturday evening that timely emergency response and access to higher-level care for critical cases was limited by “severe shortages” of functioning vehicles, fuel and sustained health services.

“Afghanistan’s fragile health system — already strained by prolonged humanitarian crises and widespread poverty — faces chronic shortages of medicines and staff,” the WHO said, citing a gap of $4 million only for its own life-saving interventions, amid a widespread shortage of funding among all UN agencies and other aid groups operating in the country.

Cuts in international aid for Afghanistan followed the collapse of its Western-backed regime to the Taliban in 2021. When US-led troops subsequently withdrew from the country, international donors also froze all projects overnight, after spending billions on two decades of military and development operations.

This also disrupted the state health program, which previously funded about 75 percent of Afghan health services, leading to facility closures and staffing disruptions.

After a brief infusion of humanitarian support, funding cuts resumed by late 2022 and into 2023 — resulting in more closure of health facilities, particularly those run by nongovernmental organizations.

The US government’s decision in February to further cut funding to Afghanistan has since led to the closure of 422 health facilities across the country.

At least 80 clinics were suspended or closed in four provinces of the eastern region — Nangarhar, Kunar, Laghman and Nuristan — that were hit by the earthquake last week, leaving 15 percent of their 4 million population without critical care.

“Several villages still have no access to medical teams,” a doctor assisting the injured in Kunar province told Arab News on Sunday, as rescuers were still looking for survivors.

“In some remote villages, people remain trapped under the rubble, and the number of casualties continues to rise daily … There is an urgent need for mobile health teams equipped with essential medicines and trained medical personnel.”

Afghan doctors have been warning for months that foreign funding cuts were depriving the country’s most vulnerable of healthcare, especially in rural areas, where aid-dependent NGOs are the sole providers.

“Afghanistan’s public health system has long relied on international funding … Although the current administration has made efforts to keep the system afloat, these measures have fallen short,” said Dr. Ahmad Obaid Mujadidi, clinical consultant and CEO of Rifah Hospital in Kabul.

Less than 3 percent of Afghanistan’s annual health spending comes from the national budget, while nearly 78 percent is paid out of pocket by citizens.

Due to the lack of medical facilities in the quake-affected areas, many of the wounded were taken to the nearest hospital in Jalalabad, some 120 km from the worst-hit Noorgal district in Kunar.

“The recent earthquake has placed enormous strain on an already fragile and underfunded health system. Critical health infrastructure in the affected areas sustained damage, while major hospitals such as Nangarhar Regional Hospital — receiving a high influx of injured patients — have seen their routine services severely disrupted,” Mujadidi said.

“Without coordinated international support, post-disaster recovery will remain out of reach … Short-term health interventions spanning six to 12 months are urgently needed, particularly those targeting maternal and child healthcare, as well as the prevention of communicable diseases. However, the crisis extends beyond immediate relief. Long-term, sustainable investment is essential.”