By the time the earthquake struck, flattening mud-brick homes across Afghanistan’s eastern mountains last week, many nearby health clinics had already been shuttered for months.

Mushtaq Khan, a senior advisor for the International Rescue Committee, felt his building jolt from all the way in the capital, Kabul, on Sunday night. He woke the next morning to a horrifying death toll slowly trickling in. First, 200 lives lost; then 500; 800; 1,000; and finally, by Thursday, there were over 2,200 confirmed deaths, with some rural villages still unreachable by rescuers.

As his team searched for survivors, he wondered what could have happened if the gutting of the US Agency for International Development hadn’t forced four of their clinics in the country’s hardest-hit province to close earlier thi

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