KABUL. REHABILITATION OF KHAIR KHANA HOSPITAL
Great commitment from Intersos, the Italian Cooperation and the United Nations Agencies
… but still expecting further undertaking from the Afghan Institutions

Intersos was involved in the rehabilitation and enlargement of the Khair Khana Hospital in Kabul between 2002 and 2003. It was a UNFPA promoted project funded by the Italian Cooperation. At the end of the works, the building was tested and handed over to the Afghan Ministry of Health for the purpose of management, care and maintenance. The municipality of Kabul was in charge of the connection to the urban sewage network.
Unfortunately this didn’t materialize. The mismanagement, the lack of any maintenance and the unauthorized modification of the original project have led to today’s highly precarious conditions of the hospital. Intersos finds the whole situation appalling and is trying to stimulate the Afghan Government to find a solution. However, some international media have brought up unfunded allegations on possible frauds between United Nations, Italian Cooperation and Intersos at the expense of the quality of the work done for the rehabilitation of the hospital.
Since Intersos has got the firm conviction to have operated correctly, and complied with all the commitments, our NGO has been providing, when requested, all information in detail with transparency and clarity. Part of this information, however, has been used either instrumentally or outside of the original context, thus giving a distorted view of the situation, with the clear intention to make up a scandal-provoking bad business.
Unfortunately when the media machine starts, especially on the Internet, it is impossible to track it, to defend oneself and to protect one’s image among the endlessly increasing sites and blogs blatantly reproducing the so called scoop. The comments are frequently accompanied by biased and insulting statements, conveying such a wave of violence and injustice, that it is almost impossible to dismantle. Indeed this is the scandal.
Therefore we have decided to use our own website to tell and document the truth
This is the true story of Khair Khana Hospital in Kabul.

In 2002 INTERSOS was selected to implement the rehabilitation and enlargement of the hospital “Khair Khana”, 52 beds, in a popular area of Kabul. The hospital was part of the UNFPA, United Nations Population Fund, programme in Afghanistan; the Italian Cooperation was the donor. The new building was realized under the supervision of  the UNFPA Senior Technical Advisor, monitored by UNOPS, United Nations Office for Project Services, whose Project Engineer realized several field visits. At the end of the works, in May 2003, the hospital was inspected by a commission coordinated by the director of the department of constructions of the Afghan Ministry of Health. A further inspection was performed in May 2004 at the end of the one year of responsibility foreseen by the contract.

INTERSOS guaranteed the planning, coordination and implementation of the works; purchase and transport of materials for the reconstruction; logistic and administrative support. Four Italian technicians were employed: a coordinator with consolidated experience in conflict areas and previous experience in Afghanistan; an architect with consolidated experience in Italy and abroad; an engineer with technical experience in building hospitals in the Italian region Trentino-Alto Adige; a surveyor with 35 years experience abroad in building companies, plus around ten Afghans charged with logistic and administrative tasks. Afghan companies realized the works, while the procurement of the material was partially done in Pakistan and partly in Italy, under the supervision of the UNFPA Senior Technical Advisor.

The Kabul Municipality and the Ministry of Public Health approved designs and drawings as they were agreed in the projects. Sometimes they requested adjustments and followed all the steps of the construction till the final hand over to the local institutions.

The intervention was mainly characterized as an emergency rehabilitation and enlargement; seven months of practical works had been planned, from 15th August 2002 to 15th of March 2003, but because of the harsh winter, religious holidays and some logistic delays, the works totally lasted almost 9 months.

UNOPS verified the accountability of the expenses, finalized the contracts and paid INTERSOS as soon as the works done were approved and verified, or as soon as the procurement and the related activities were approved and finalized. INTERSOS handed in to UNOPS five copies of the final technical documentation, made of several notebooks in A4 and A3 and comprehensive of drawings, construction works, purchased material, instructions of material purchased. The documentation was delivered as follows: 2 copies to the Afghan Ministry of Public Health, 1 copy to the hospital, 1 copy to UNFPA and 1 copy to UNOPS.

The hospital was handed over the 1st of May 2003 to UNFPA, that took its responsibility jointly with both Afghan and international authorities and it was officially inaugurated the 14 of July 2003 (http://www.unfpa.org/news/news.cfm?ID=359&Language=1). It was UNFPA duty, jointly with the Afghan Ministry of Health, to provide the hospital with medical equipment and to guarantee monitoring, training and support on the hospital management.

After one year, the trial period, in May 2004, an evaluating committee inspected the hospital. The committee was made of a representative from the Department of Building and Construction of the Ministry of Public Health; the Director of the new hospital; the Vice-Director of the hospital Operations; the UNFPA Program Officer; the UNOPS Program Officer and Project Engineer; INTERSOS Head of Mission, Engineer and Administrator. On behalf of the commission, UNOPS asked to INTERSOS some technical clarifications, which were promptly given.

Therefore, UNOPS released the Final Handing Over Certificate. The hospital has been visited by authorities and by several people, both Afghan and international (see as an example: http://www.unfpa.org/news/news.cfm?ID=482 ).

The Afghan Ministry of Public Health was in charge of introducing the new structure in the public service at local and national level; of recruiting and training the new personnel; and of the management, maintenance and control of the hospital. Kabul Municipality was charged of connecting the electricity and the sewage system, so following the agreement taken in 2002 when the land for the enlargement of the hospital and consequent enlargement of the sewage system was requested and granted.

As the structure was not completely new, but a rehabilitation and enlargement of a previous building, the actors thought the authorities, national and local, able to guarantee the functioning of the hospital. Unfortunately the Kabul Administration did not respect its duties and the Ministry of Public Health did not guarantee any support, training to the staff and assistance to the hospital that arrived to host 102 patients. Even more, in the spring of 2004 a heavy earthquake (6,8° Richter) caused some damages that should have been repaired to avoid the leaking of the rain water. As previously said, the technical assessment showed that the building was correctly built, so just ordinary maintenance was needed. But nobody ever took care of it and the management of the hospital let, along the years, the ice and the winter magnify the damages.

Mismanagement has led to serious and unauthorized modifications to the original project: medical equipment moved into unsuited and unguarded rooms; the originally planned usage of some premises modified; new windows inappropriately built in sterile rooms; inappropriate usage of the electrical system that ruined the system itself; the plumbing  was tampered causing seepages; the air cooling system
disappeared and replaced with electrical fans that damaged the roof, etc.

The consequences of the lack of management, care and maintenance have soon became evident: the hospital and its facilities have progressively deteriorated. In 2005-2006 the Afghan authorities, in the person of the Attorney General, began an investigation to verify the regularity of the project. INTERSOS received the following requests: analysis of the documentation and reports (already handed over to the Afghan authorities and to UNOPS in 2003, when the activities were completed), contracts, expenses for the construction, equipment and support costs. INTERSOS deemed its own duty to fully collaborate and provided the Attorney General with all the documentation requested.

In Afghanistan a campaign against INTERSOS, UNOPS and UNFPA was initiated. The news given was not supported by any evidence and the Italian Government, as main donor, was seriously affected. Several International newspaper and TV took the ‘news’ for granted, others further developed it. UNOPS and the Italian Embassy in Kabul released several statements to strongly support the regularity of the project implemented. The confusion so created has worsened the dialogue with the Afghan authorities for a quick overcoming of the difficulties.

Although very unpleasant and giving a negative image of the professional and committed work realized in such tough times (Afghanistan, in 2002), the news of the media is not the issue that INTERSOS believes of major concern. That an hospital in one of the most affected areas of Kabul is not working at its best, regardless of the money and the energies spent: that is the main concern.

1) Synthesis of the costs:

2)  Final report:  “Rehabilitation of Khair Khana 52-Bed Hospital in Kabul, Afghanistan” >>>>>

PHOTOS OF CONSTRUCTION WORKS>>>

MATERIALS >>>

STRUCTURAL CALCULATIONS >>>

PHOTOS OF INAUGURATION 12/6/2003 >>>