1. Analysis of Early Physical Rehabilitation ( EPR ) activities and Impact on local Rehabilitation system after the destruction of Kunduz Trauma Care Center in Afghanistan WEERTS Eric Technical Referent, Handicap International ( HI ) – Brussels – Belgium

2. Afghanistan – Kunduz

3. Before October 2015.

4. Profile of hospital September 2015 Hospital is expanding ( 84  92 by end of 2015); Growing number of national staff ( + 400 ) ER capacity 20.000 admissions per year 12 to 15 surgeries per day ICU : 8 beds – 80% of occupancy OPD average of 300 + admissions per month PT department : 9 PT, 30 OPD consultations/day and 50 – 70 treatments / day in IPD

5. October 2015 !!!! Human tragedy vs Public Health tragedy

6. START I project in Kunduz ER1: Reduce the negative impact of the Kunduz crisis on persons with injuries and/or disabilities by addressing urgent needs for physio-therapy and P&O care ( within a comprehensive approach ) at hospital. ER2: Improve the capacity of caregivers to better cope with the consequences of injuries and its recovery process through psychosocial support. ER3: Enhance inclusion of the most vulnerable populations including persons with disabilities in the humanitarian response in Kunduz.

7. General approach for emergencies

8. Activities /outcomes Human ressources set up : emergency coordination, field coordination, PT, PSS and MRE staff deployed : -Delivery of equipement to the hospital -Provision of PT sessions and PSS sessions for patient admitted at IPD and OPD -Training on inclusion for PWD among humanitarian stakeholders and goverment staff

9. Main results/data 197 patients got 438 PT and PSS sessions + 200 caregivers received advise / management skills 60 female and 137 male patients 30 patients under 17 years old 69 patients had fractures on limbs mainly 21 patients had Brain trauma 30 patients had serious pain issues 101 patients came from Kunduz, followed by Takhar and Badakshan provinces

10. 3. Provisional outcomes of project in Kunduz Concerns for future capacity in Kunduz: -Actual capacity is not adressing needs seen by MSF Trauma center ( 27 beds vs 92 ) -Range of services and rehabilitation management is not sufficient for ongoing patients load ( staffing / know how not sufficient ) -Types of beneficiairies seen at RGH need longer stays/sessions at care ( 5 day  21 days at MSF ) with PSS services

11. Recommendations Continue to support further comprehensive care ( PT, PSS, PandO ) at RGH by : -Raising awareness for health staff and caregivers at RGH -Extending services to longer sessions, PandO, mandatory PSS sessions -Increase capacity of RGH in beds and range of services to offer -Create response capacity within HI Afgha program

12. Thank You