Improving Neurosurgical Care in Afghanistan: Milestones, Challenges, and the Road Ahead.

BACKGROUND

Neurosurgical services are often lacking or nonexistent in low- and middle-income countries. Although there are limited data available on the current state of neurosurgery in Afghanistan, the existing data paint a dismal picture of inadequate clinical and research infrastructure. There are an estimated 74 neurosurgeons in the country (0.2 neurosurgeons per 100,000 people) working in 16 hospitals concentrated in urban centers, despite the fact that about 70% of the population live in rural areas. Technology seems to be a promising tool with which to enhance neurosurgical health systems in Afghanistan. Telemedicine can take a variety of forms, but the unifying benefit is its ability to minimize the influence of distance as a limiting factor in healthcare and education. This paper reports the most recent milestones and challenges in the field of neurosurgery in Afghanistan.

METHODS

This historical report and contextual analysis describe the recent Afghan-led and internationally supported efforts to strengthen neurosurgical capacity through a structured change-management approach.

RESULTS

Major milestones include a national capacity assessment, installation of stable internet and power support at 9 hospitals; procurement and distribution of cranial, spinal, and drill sets to public hospitals; short- and long-term training pathways for neurosurgeons and nurses; smart-glasses-enabled telemedicine and intraoperative mentoring; reactivation of the Afghan Neurosurgical Society; national neurosurgical conferences; and diaspora-supported fundraising. Persistent challenges include geographic barriers to care, out-of-pocket costs, limited neurosurgical epidemiologic data, border closures, customs and sanctions-related logistical barriers, restricted travel and visa access, unstable internet connectivity, and gender-related constraints on medical education and professional mobility.

DISCUSSION: The Afghan experience highlights both the fragility and possibility of neurosurgical capacity-building in conflict-affected settings. Locally led partnerships, diaspora engagement, practical infrastructure investments, remote mentorship, and flexible logistics can create meaningful progress even when conventional global health pathways are disrupted.

CONCLUSIONS

Surgical complications impose a substantial multidimensional burden on neurosurgeons, encompassing emotional distress, confidence erosion, and financial strain. The near-universal absence of formal support represents a critical institutional gap. Structured peer support, reflective debriefing, and financial protection mechanisms should be systematically integrated into neurosurgical practice.