KUNDUZ, Afghanistan — The Taliban controlled the nearby streets and bullets were popping in the dark when Dr. Marzia Salam Yaftali’s neighbors in Kunduz City turned to her for help.
Their relative had gone into labor with twins and was having trouble, the streets to the hospital were blocked, and Dr. Yaftali was their best hope. With urban battle all around, she took the risk of leaving her two young children at home to try to save three lives.
But on that evening last fall, the doctor did not feel like a hero — she felt guilty. Her place was at Kunduz Regional Hospital, where she was the chief doctor, directing her staff members as they handled a wave of casualties. But they had begged her to stay home, feeling she would be at risk if the Taliban or even the militiamen fighting them found a woman in charge.
“I still struggle with that feeling — why I was not able to come to the hospital that day,” Dr. Yaftali said in an interview at the hospital months later. “I am still uncomfortable.”
KUNDUZ, Afghanistan — The Taliban controlled the nearby streets and bullets were popping in the dark when Dr. Marzia Salam Yaftali’s neighbors in Kunduz City turned to her for help.
Their relative had gone into labor with twins and was having trouble, the streets to the hospital were blocked, and Dr. Yaftali was their best hope. With urban battle all around, she took the risk of leaving her two young children at home to try to save three lives.
But on that evening last fall, the doctor did not feel like a hero — she felt guilty. Her place was at Kunduz Regional Hospital, where she was the chief doctor, directing her staff members as they handled a wave of casualties. But they had begged her to stay home, feeling she would be at risk if the Taliban or even the militiamen fighting them found a woman in charge.
“I still struggle with that feeling — why I was not able to come to the hospital that day,” Dr. Yaftali said in an interview at the hospital months later. “I am still uncomfortable.”
Kunduz was already known for danger to medical workers, after an American warplane bombed its best hospital to ruins during a previous Taliban siege, in 2015, leaving Kunduz Regional Hospital as its only significant care facility.
For female health workers in Afghanistan, the risk is compounded by the traditional beliefs of a society that still struggles with the notion of women in the workplace.
The Taliban, despite their statements that they have reconsidered their position on female education and women in the work force, have not behaved that way in practice.
The siege last fall was the second time in a year that the Taliban had invaded Kunduz City. The first time, in fall 2015, women in prominent roles reported being methodically targeted. And the insurgents have never reconciled one of the central contradictions of their regime in the 1990s: The Taliban government strictly insisted that women be treated only by female doctors, yet they barred girls from going to school.
The 300-bed Kunduz Regional Hospital was built on German donations but is run by the Afghan government. Dr. Yaftali, a gynecologist, was at home the morning of Oct. 3 when the Taliban entered the city.
“I called the director of the hospital. I told him that I would come to the hospital even if it rains fire,” Dr. Yaftali said. “He told me: ‘How will you come to the hospital? There is no way to get here.’”
The director, a burly surgeon, Mohammed Naim Mangal, expressed another fear over the phone: Many of the staff members had fled already, and Dr. Yaftali would be the only woman if she made it to the hospital. There was risk to her not only from the extremist Taliban, but also from the unruly militias fighting on behalf of the government.
At the hospital, about two dozen staff members remained, working nonstop for more than a week. They ran out of food quickly, surviving on boiled rice. Their trips to the medicine depot around the corner from the main building were daunting operations that brought them under fire several times.
Their task became only more difficult after mortar shells hit the hospital and patients had to be moved from some of the rooms to the hallways. At the peak of the fighting, hospital employees were treating more than 300 wounded people.
Stuck at home, Dr. Yaftali essentially took over the public relations campaign for a hospital under fire. She spoke to radio stations and newspapers and regularly updated her Facebook page with urgent calls to both sides not to fire on the hospital, and notices to the public about which facilities were still functioning.
“Others in Kunduz were looking for water, and I was after a liter of gas — to make sure I could turn on the generator to charge my phone so I am updated on what is happening at the hospital,” she recalled.
Then, one night around 9 o’clock, she heard a knock at her gate and the voices of her neighbors outside. Their pregnant relative, a 30-year-old named Fatima, was in intense pain and desperately needed help.
Dr. Yaftali said she had first examined Fatima, who had traveled to Kunduz from an outlying a district, a couple weeks before and knew that natural birth would be difficult. One of the babies was large and in what she described as “shoulder presentation.”
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The streets outside were a battlefield. Both sides fired at anyone caught in between.
“I was nervous — how could I go to the house of the neighbor, and their house was just 100 or 200 meters away from mine?” Dr. Yaftali said. “On the other hand, if I don’t go to their house, what will the mother do? She came to our area and close to me, and she hoped I would help her, I would take care of her.”
She braved the street, and when she got to the house, Fatima was already giving birth on the floor to the first child. The second child, however, was stuck, and the mother was in agony.
Dr. Yaftali intervened to try to reposition the baby for a safer delivery. But her patient’s pain was intolerable.
“I don’t have any medical equipment with me — my hands are empty,” Dr. Yaftali recalled. “I worked for them like a local midwife. There was no place to do a cesarean or an operation. Professionally, a cesarean was needed.”
The provincial police chief was called, and he sent an armored vehicle to the house to transport Fatima to the hospital. But the woman’s relatives would not let her go without them, and would not go themselves because of the risk: At the time, civilians were frequently hit by crossfire, and reports of corpses being left on the streets were circulating.
“Their logic was this: We can sacrifice one mother, but we cannot sacrifice several family members by going with you to the hospital,” Dr. Yaftali said.
So she sent the police chief’s armored car back to the hospital to bring drugs and medical equipment, and she tried again to help deliver the baby. But she knew the second infant was lost, and there was little she could do other than try to reduce Fatima’s risk and pain.
Dr. Yaftali went back home to her two children, the youngest just 6 months old. And in the morning, after the fighting quieted a little, Fatima was able to go to the hospital for treatment, but with just one of her children alive.
“It was very painful for me. The scene was not tolerable, as I saw a child dying in the womb of the mother, and I was not able to help him, to help him even a bit,” Dr. Yaftali said. “That was the darkest night, and I will never forget.”
After the Taliban were cleared out, Dr. Yaftali returned to her work. Her Facebook page, after a last plea to all the hospital workers who had fled the city to return, returned to her usual dose of medical advice to her readers.
To this day, though, she is racked by remorse.
“The day the fighting quieted down, my suggestion to the hospital and the Ministry of Health was that the first thing I do is resign,” Dr. Yaftali said.
The officials turned down her resignation, though, praising her service from home and the fact that she had helped put a system in place at the hospital that had held up even in her absence.
Fatima, for one, will never forget her.
“In a time that no one could be relied on, the doctor came, and she went through so much trouble with me,” Fatima said in an interview. “How can I not be thankful to her? Everyone was trying to get out of Kunduz, and Dr. Marzia came to help me.”
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