NZ nurse on what working in Afghanistan with Doctors Without Borders is really like

Former Wellington nurse Catherine Flanigan has just completed a nine-month assignment in Afghanistan for the humanitarian organisation Medecins Sans Frontieres.

From rescuing refugees in the Mediterranean to completing a nine-month tour of duty in Afghanistan, Kiwi nurse Catherine Flanigan, 37, tells Joanna Wane why she walked away from a secure, conventional life in New Zealand to care for people in desperate need across the other side of the world.

Almost 100,000 displaced people live in Bentiu camp, which sprawls across reclaimed swampland in South Sudan.

Conditions are so poor there were outbreaks of malaria and rabies when Wellington emergency and paediatric nurse Catherine Flanigan spent six months at the camp’s only hospital in 2018.

Since that first “challenging” posting, she’s completed nine more placements working with the medical humanitarian organisation MSF (Medecins Sans Frontieres/Doctors Without Borders) that have taken her from Syria to Belarus.

Four of those assignments involved living on a search and rescue boat in the Mediterranean, plucking shipwreck survivors from the water and providing emergency medical care to refugees and migrants attempting to make the dangerous sea crossing from Libya to Europe.

Now based in Sweden, the 37-year-old is studying for a master’s degree in humanitarian practice and has just spent nine months in southern Afghanistan as a nursing team leader at the 340-bed Boost Hospital in Helmand Province.

Co-managed by MSF and the Ministry of Public Health, the hospital provides free healthcare and takes referrals from across the entire province, handling an average of 840 patients each day. Peak occupancy rates of 150% to 200% mean children often share the same bed.

Afghanistan’s public health system is severely underfunded and under-resourced, lacking trained staff, medicines and equipment, and many of the patients cared for at Boost are in a serious condition by the time they arrive. In 2023, one in 10 pregnant or breastfeeding mothers was malnourished and the mortality rate for children in a dedicated Inpatient Therapeutic Feeding Centre was 7%.

A young mother with her newborn baby at Boost Hospital in southern Afghanistan, where Catherine Flanigan worked as a head nurse.

The only New Zealander in an international team that included people from Turkey, Ethiopia, the UK, Austria, and Tajikistan, Flanigan was in her final weeks in Afghanistan when she spoke to the Herald via Zoom.

“A friend once asked me, ‘When are you going to come back to your real life?’ At the time, I’d just finished an assignment on one of the search and rescue boats. When you work in these kinds of situations and see the difficulties people are facing, leaving horrific conditions in Libya and telling you their stories about sexual violence and torture, multiple attempts to cross the sea where they were scared they would drown … This is real life.

As a nurse, you just have this belief that people everywhere in the world deserve to have access to healthcare. And when you look at a baby or a child, they have absolutely no control over the situation they’ve been born into.

What’s most difficult, emotionally, is the contrast – seeing the level of care and attention we’re able to provide in New Zealand, compared to the situation facing mothers here. There’s an entire ward for children with malnutrition, a service that’s simply not necessary in New Zealand.

The hospital has more than 1000 staff and it’s pretty overcrowded, with a huge number of patients passing through. On average, about 75 babies are born here each day. It’s challenging but we have a triage system, as any hospital in New Zealand would, prioritising as best we can. You keep your supplies for the very unwell patients where it’s really needed.

Kiwi nurse Catherine Flanigan, at right, carries a patient on board an MSF search and rescue boat in the Mediterranean for treatment.

People assume we travel with armed guards and are surprised to hear that we don’t [MSF has a strict no-weapons policy]. What’s important is having that community acceptance. At the moment it’s quite safe here, which is partly why our numbers are relatively high, with patients coming from across the whole province, spending hours of travel by car or motorbike or bus.

One of the challenges is that women usually need to be accompanied by a mahram, a male chaperone, which can create more hurdles for them to access healthcare. By the time they arrive at the hospital, often they’re already in a more critical condition, which makes it more difficult to treat them as well.

It’s the same in maternity, where a lot of women who have delivered either at home or in other facilities further away are quite unwell because of some emergency or complication with the birth.

The unit is staffed almost entirely by women – gynaecologists, midwives and doctors. But the education system for women has some challenges, so there’s concern for the next generation because those unable to start their training now will leave a gap.

At the moment, we’re seeing a rise in measles patients; the vaccination rate here is not as high as it could be. There are contagious diseases we don’t have [in developed countries] and as the weather gets warmer, you usually see an increase in diarrhoea cases and dehydration.

Kiwi nurse Catherine Flanigan hugs one of 58 survivors rescued, along with a dog, from the Mediterranean in 2018 after fleeing Libya and attempting to cross the world’s deadliest maritime route. The group was taken by an MSF search and rescue boat to Malta for resettlement across Europe.

The first few times you come home [from an assignment] can be jarring. But you get used to it over time and MSF gives you a lot of support – you’re not just left to manage everything on your own.

I live in Sweden, on a small island just off Gothenburg that has something like a thousand people. After projects that have been quite intense, it’s good to be back somewhere so quiet and peaceful.

My partner, who’s Swedish, does similar work [with a different organisation]. I’m in Afghanistan for nine months, but there are shorter jobs as well, so it’s not always this long apart. How people did this in the 90s and early 2000s with no internet, I have no idea. We do have a shop or two here but it’s the small things you miss. Oh, my gosh, a good flat white!

The one thing I want to emphasise is that it’s not all international people coming in to ‘fix’ everything and then leave. The majority of my team are Afghans and they’re fantastic. When I was in Syria, the majority were Syrian. We learn from each other and they keep our projects running, which is so important and very motivating for me.

Meeting colleagues and patients in different places, particularly those who have gone through really difficult experiences, gives you a different perspective on what life can look like.

To me, it’s really important the people in Afghanistan are not forgotten. They have lived through decades of armed conflict, as well as natural disasters and an economic crisis. It’s true that the needs are enormous, as they are in many other countries where I’ve worked, but I know that providing medical care makes a difference because I have seen it, for each person and family we are supporting.”

• MSF works in 75 countries around the world, maintaining its independence by relying on private donations rather than government or agency funding. To find out more visit msf.org

Joanna Wane is an award-winning senior feature writer in the NZ Herald’s Lifestyle Premium team, with a special focus on social issues and the arts.