Earlier a pregnant woman who was injured in an explosion finally made it to Lashkargah 48 hours later. Her unborn baby was also wounded in the blast. The mother survived the delivery although her uterus had been perforated. But her baby died from sepsis. Had she been able to reach a hospital faster, perhaps both lives could have been saved.

After nearly five years of absence, following the murders of five of our colleagues in 2004, the return of MSF is cautious, balancing risks against needs. Our sole objective is to assist those most in medical need, to help as many people as possible to survive the conflict. In order to be accepted by all parties involved in a conflict, a private medical-humanitarian organisation should demonstrate, and clearly communicate, complete impartiality, and independence. For MSF this means, for instance, that we choose not to accept any funds from any governments for our work in Afghanistan or Pakistan and we reject any attempt from other forces to control or direct us.

The once clear distinction between armies, reconstruction and development activities and humanitarians has become very confused; at present all assistance actions, including hearts and minds initiatives implemented by armed forces, are labelled "humanitarian". The key difference is that strictly humanitarian organisations such as MSF work to provide immediate life-saving care on the basis of medical needs alone, with no other objectives. There is a practical need for clear distinctions to be made. Why? Because humanitarian organisations such as MSF should seek to help populations in need no matter where in the country they live or what battles are being fought there. An organisation (of whatever political complexion) that aligns itself with one side through funding or otherwise, simply will not and cannot do this. Second, choosing sides often requires relying on armed protection and that can make the organisation or the structure they support a military target.

Currently, there are many medical facilities in Helmand that have been physically rehabilitated by ISAF and which are patrolled by NATO and Afghan troops. They are viewed as military targets by armed opposition groups. Meanwhile, clinics run by local independent NGOs, which are often intentionally left in a state of disrepair to avoid association with ISAF-supported health facilities, have come under attack by ISAF forces mistaking them for opposition hideouts. The result is that clinics themselves have become a battleground, putting patients in danger and making them more reluctant to seek healthcare.

Central to restarting our work in Afghanistan has been the demilitarisation of hospitals through the enforcement of a strict no-gun policy in the health structures where we work. We are asking all parties – the police, the coalition forces, and the armed opposition – to leave their guns at the gate.