To help build trust with local communities in Afghanistan, Albert van Hal spends most of his time talking to local leaders — something that has proved fundamental to his work aiming to support stronger health systems in the country.

“I think that’s crucial in a fragile state. It requires enormous amounts of time and talking to build trust because it’s broken. It’s all gone after so many years of conflict,” said van Hal, advocacy coordinator and program manager for fragile states for Cordaid, an organization for relief and development aid.

The Dutch organization has been providing health care services and working with local organizations since 2003. In addition, it trains midwives, nurses, and laboratory — and pharmacy technicians to help support the health system.

Despite decades of conflict, Afghanistan’s health system has made considerable progress.

Since the beginning of the war in 2001, Afghanistan has seen a devastating impact on its population with at least 32,000 civilians killed and another 60,000 wounded in the last decade alone. And the situation isn’t improving: in the first half of 2019, there were 3,812 civilian casualties.

But a closer look at the country’s health indicators reveals considerable progress in the provision of health care, against the backdrop of continuous conflict. Between 2003 and 2015, under-5 child mortality dropped by 34% from 137 to 91 deaths per 1,000 births, and rates of childhood stunting declined at a rate of 2% per year, faster than the global average of 1.3%. The maternal mortality rate has drastically declined, falling from 1,600 to 396 maternal deaths per 100,000 live births between 2002 and 2015. However, it remains considerably higher than the global average.