KABUL, Afghanistan At one of Afghanistans busiest hospitals, signs abound of one of the signature rebuilding successes of Americas longest war.

Afghans hobble into a spotless emergency room and are quickly seen by trauma specialists, including orthopedic surgeons. Modern equipment tracks heart rates, and health care professionals are careful to sterilize their equipment.

But everything is not as it appears at Wazir Akbar Khan Hospital.

A closer look at some of the heart-rate monitors reveals they arent working. Whats more, the X-ray technology here is outdated, there is a shortage of oxygen tanks and medicine, and doctors must work punishing hours to keep up with the steady stream of patients.

We dont have time to sleep, said Ahmad Tariq, an orthopedic surgeon.

In key areas, health care in Afghanistan has undeniably improved since the Taliban regime was toppled 13 years ago. But some highly touted gains may have been overstated, and others are at risk as international militaries pull out of the country and aid organizations scale back their efforts.

Improvements in health care are one of the main success stories the international military coalition and aid groups like the U.S. Agency for International Development point to in Afghanistan. Maternal mortality has been reduced by 80 percent and child mortality by 60 percent, according to USAID; life expectancy has risen, and more rural Afghans have access to health care, though the extent of that improvement is debated.

The Afghan Public Health Ministry estimates that there are now 2,286 health facilities across Afghanistan, compared with about 500 in 2002, and 60 percent of Afghans are within one hour of a health clinic. But some watchdogs have criticized such numbers as misleading, as facilities vary widely in quality and some cited by both U.S. and Afghan officials may not even be in operation.

It doesnt mean we dont have problems in health were a long way to go to provide quality health care for the people of Afghanistan, Qadir Qadir, director of policy and planning for the Public Health Ministry, said. In terms of quality, we have a lot to do.

Larry Sampler, the chief of Afghanistan and Pakistan operations for USAID, says he understands the concerns of health care professionals. But rather than diminishing support, his organizations biggest challenge may be the uncertainty during this transition period and the fact that the unity government headed by President Ashraf Ghani is still finding its footing. Still, he says he is cautiously optimistic USAID, the biggest aid donor in Afghanistan, can build on the health care gains it has made.

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Afghan health care at risk as international aid is scaled back