More than 10,500 civilians were killed or wounded in the Afghanistan conflict in 2014, the United Nations reported Wednesday, the highest toll since the world body began counting casualties in 2009.
The U.N. Assistance Mission in Afghanistan documented 3,699 civilian deaths and 6,849 injuries, a 22% increase in total casualties from 2013 as Afghan security forces took full control of the country's security.
For the first time, U.N. figures showed that ground combat was the leading cause of deaths and injuries among noncombatants, surpassing casualties from bombs and underscoring the changing nature of the war as U.S.-led coalition forces reduce their presence.
The report also illustrated the conflict's growing toll on women and children. With 298 killed and 611 injured, female casualty rates increased 21%. Casualties among children rose 40%, with 714 killed and 1,760 injured, the U.N. said.
"The thousands of Afghan children, women and men killed and injured in 2014 attest to failures to protect civilians from harm," Nicholas Haysom, the top U.N. official in Kabul, said in a statement.
The 2014 data confirmed earlier U.N. projections that the final year of the U.S.-led international combat mission would probably be Afghanistan's deadliest. Coalition forces have been reduced to about 13,000 troops, including about 10,000 Americans, who are focused on training and advising Afghan soldiers and police officers, though U.S. forces are still authorized to conduct ground counter-terrorism operations and airstrikes.
As in years past, the vast majority of the casualties were attributed to the Taliban and other insurgent groups, who were found to be responsible for 72% of the documented cases.
The 54% increase in casualties from ground combat nationwide has led to overcrowding in health facilities, including the Nangarhar Regional Hospital in the eastern city of Jalalabad, which treats members of the Afghan National Security Forces and civilians, hospital officials said.
The hospital, which lacks a dedicated facility for treating security forces, has seen its thin resources further stretched by the constant arrivals of patients from neighboring provinces. Said Afandi, the hospital's head of training, said more than 60% of patients come from outside Nangarhar province.
"We're a regional hospital, but our facilities, even in terms of physical space, are not enough to meet the needs of so many people," Afandi said.
Eastern Afghanistan, along the border with Pakistan, saw the second highest number of civilian casualties -- 164 deaths and 606 injuries – while the highest toll was in southern Afghanistan.
The case of Qahar, 24, a member of the Afghan border police, illustrated how the changing nature of the war affects the patient load at the hospital. Qahar, who like many Afghans goes by one name, stepped on a land mine as he was on his way to his posting in Mihtarlam, the capital of the eastern province of Laghman.
Mihtarlam has long been one of Afghanistan's safer areas, and Qahar said he had not been worried about explosive devices.
"Mihtarlam is safe," Qahar said. "I would go to work in my uniform with no fear."
He was taken to the Nangarhar hospital by helicopter. In the intensive care unit, Qahar and an another Laghman police officer, who had been shot by the Taliban, occupied two of the 10 beds.
Since Afghan forces took full control of security responsibilities in January, there has been concern that civilian and security forces' casualties would continue to rise. More than 4,600 Afghan soldiers and police officers were killed in action from January to early November 2014, according to coalition statistics.
That prospect worried doctors in Jalalabad. Afandi said the hospital was understaffed and lacked funding due in part to outdated census figures.
"Nangarhar is fortunate, we have no shortage of qualified doctors and nurses. But we don't have the money to pay them," Afandi said. "This is merely a money issue."
Since 2009, the U.N. has documented a total of 47,745 civilian casualties among Afghan civilians: 17,774 killed and 29,971 wounded.