Int J Emerg Med (2009) 2:77–82 DOI 10.1007/s12245-009-0106-y STATE OF INTERNATIONAL EM Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services John R. Acerra & Kara Iskyan & Zubair A. Qureshi & Rahul K. Sharma Received: 14 December 2008 / Accepted: 20 April 2009 / Published online: 5 June 2009 # Springer-Verlag London Ltd 2009 Abstract Developing nations have many challenges to the growth of emergency medical systems. This development in Afghanistan is also complicated by many factors that plague post-conflict countries including an unstable political system, poor economy, poor baseline health indices, and ongoing violence. Progress has been made in Afghanistan with the implementation of the Basic Package of Health Service (BPHS) by the Ministry of Public Health in an effort to provide healthcare that would The views expressed in this paper are those of the author(s) and not those of the editors, editorial board or publisher. J. R. Acerra (*) Department of Emergency Medicine, University of Pittsburgh, 230 McKee Place, Suite 500, Pittsburgh, PA 15213, USA e-mail: acerraj@upmc.edu e-mail: jracerra@yahoo.com K. Iskyan Departments of Emergency Medicine and Internal Medicine, Allegheny General Hospital, 320 E. North Avenue, Pittsburgh, PA 15212, USA e-mail: kmi5+@pitt.edu Z. A. Qureshi Department of Infectious Disease, University of Pittsburgh, Pittsburgh, PA, USA e-mail: zaq1@pitt.edu R. K. Sharma Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, A419 Crabtree Hall, 130 DeSoto St., Pittsburgh, PA 15261, USA e-mail: rks23@pitt.edu have the most cost-effective impact on common health problems. Trauma and trauma-related disability were both identified as priorities under the BPHS, and efforts have begun to address these problems. Most of the emergency care delivered in Afghanistan is provided by the military sector and non-governmental organizations. Security, lack of infrastructure, economic hardship, difficult access to healthcare facilities, poor healthcare facility conditions, and lack of trained healthcare providers, especially women, are all problems that need to be addressed. The long-term goal of quality healthcare for all Afghan citizens will only be met by a combination of specific goal- oriented projects, foreign aid, domestic responsibility, and time. Keywords Emergency medical services . Afghanistan . Emergency medicine . Health care Introduction Afghanistan faces a significant challenge to creating a functional medical system in a post-conflict setting (al- though Afghanistan may be considered an “intra”-conflict setting). A low-income country recovering from decades of strife, the health care system has been in disarray for many years. Rebuilding the health care system in Afghanistan is currently being undertaken by a number of groups, including the Afghan government, several nongovernmen- tal organizations (NGOs), and the US government. While some progress has been made, many hurdles remain. This article reviews the state of health care in Afghanistan, progress that has been made so far, and the challenges that