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The mother was admitted at 9:30, the birth recorded at 9:35. Women often arrive in extremis at the Médecins Sans Frontières maternity ward in southeastern Afghanistan, one of the most active in the world, with more than 60 babies born every day.
The first hours of the morning are the most feverish for the hospital – nicknamed by the NGO "baby factory" -, close to the tribal areas of Pakistan, in the province of Khost.
The Taliban are active in the area and roads are often dangerous after dark. Asmad Fahri, 25, felt that she had to wait until daybreak to get to the hospital.
Finally, she rests, her baby swaddled and asleep between her knees.
On average, new mothers are kept in the ward for six hours, but she asked to leave after only three hours to make sure she returned home before dark.
Sometimes mothers have to travel for days, in pain and bleeding, on unpaved, unsafe roads in trolleys or by any means of transportation they may find.
In an opposite wing, delivery tables continually welcome newcomers.
Most only have time to lift the long layers of clothing that hide their bodies and stare their colorful veils between their teeth, too hurried to turn into MSF's standard red pajamas.
The Khost Maternity Hospital (KMH) opened in late 2012 in a conflict-ridden medical desert, with one of the highest infant and maternal mortality rates in the world.
It was an overnight success, with nearly 12,000 deliveries for the first full year in 2013.
In 2017, this figure had almost doubled to 23,000.
This year, the hospital is on track to deliver 24,000 babies, says Dr. Rasha Khoury, a Palestinian gynecologist who is a doctor on the site.
If so, it is close to the busiest maternity homes in the United States, where Atlanta's Northside Hospital welcomed 27,000 babies in 2016, the highest number in the country that year.
"We save lives for free," smiles Safia Khan, 24, deputy director of the midwifery team.
Behind her, a young mother of twins searches her skirts and hands her a folded bank note. This is a traditional gesture of gratitude after delivery, sometimes required in some hospitals, but declined politely here. "It's forbidden," Khan insists.
More deadly than the war
The United Nations and the World Bank estimated maternal mortality at about 396 deaths per 100,000 live births in Afghanistan.
But the figure is disputed, with experts pointing out that it's an unlikely drop from the 1,600 per 100,000 recorded in 2002.
Such a decline would mean that Afghanistan would have achieved its UN Millennium Development Goal of just five years, a study published in the medical journal Lancet noted in 2017.
The authors of this study claim that more credible figures released by the Afghan government in partnership with USAID suggest that maternal mortality could still reach 1,291 per 100,000, which means
If this is the case, it is a staggering figure, 17 years after the fall of the Taliban regime, despite international aid of billions of dollars, in a country with one of the youngest populations and more dynamic world.
Dr. Khoury says that MSF facilitates about 40% of births in Khost, which has about 1.5 million inhabitants.
But to make a real difference in mortality rates in the face of these challenges, they would need "three hospitals like MSF," she says.
Pashtunwali
In addition to war, poverty and a galloping population, medical staff faces another hurdle: the Pashtunwali, the patriarchal social honor code that dictates life in the Pashtun tribal area where lies Khost.
Under Pashtunwali, the sexes must be separated and a woman must never show her face to a stranger.
As such, the hospital's medical staff is exclusively female, with the exception of some anesthesiologists and the director of the neonatology department.
Even so, it has sometimes taken a bit of persuasion, says Salamat Khan Mandozai, a respected local figure who takes care of the hospital's safety and has also served as a liaison with the community.
"In this rural environment, some women still prefer to give birth at home," he notes.
Going to the hospital embarrasses them, recognizes Safia Khan – the birth is a private matter.
Dr. Khoury says the hospital is aware that many women do not come to them, but adds that families who do so do so "without hesitation".
For many, she adds, the obstacles are not about culture, but finance, namely transportation, or security, especially at night.
Women should also wait until a family man is available to accompany them, she says.
But once inside the hospital, the power goes to the mothers-in-law who escort the patients until they reach the doors of the delivery room.
"We are really reaching people on the margins of society in Afghanistan," said Dr. Khoury.
"It's a success story."
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