SPIN BOLDAK, Afghanistan: At southern Afghanistan's largest hospital, a steady flow of patients caught in the crossfire in battles between Taliban and Nato forces leaves doctors scrambling to keep up and overwhelms the limited bed space. On some days, the floor is red with blood.

The overflow at Kandahar's Mirwais hospital has forced hundreds of sick and injured Afghans to cross the border into Pakistan every day to seek medical treatment, according to Afghans waiting at the Spin Boldak border crossing, some 70 miles east of Kandahar city.

Nato and Afghan troops have been pushing into the Taliban heartland in southern Afghanistan since July in an attempt to quell the insurgency. The fighting has pushed the province's already shaky medical services to the limit.

The central government's ability to provide services like medical care, education and infrastructure is crucial to weaning support away from the insurgency.

And yet, many Afghans are unable to get to basic health care.

Thirty years of conflict have left the country's health care system struggling to cope. Many clinics are wrestling with shortages of doctors and medicine, and Afghans living in rural areas often find it hard to get medical help because of the poor roads, lack of security and cost of transport. Aid groups like the Red Cross are trying to fill some of the gaps, but they say many Afghans are simply unable to reach hospitals for treatment.

Last month, the Red Cross said Mirwais hospital, which has 350 beds, was treating record highs of war-wounded — almost 1,000 a month, twice as many as last year. The Red Cross supplies medical personnel, equipment and drugs, but said many people were putting off seeking treatment until their condition was serious because they were afraid of getting caught in the fighting if they travelled.

That, however, was a risk 34-year-old Naimat Agha had to take after his two sons were burned by an explosive device they found. The young boys were wrapped in blankets on the pavement, their large, raw pink burns visible on their arms and torsos. Their father, unable to afford an expensive taxi, was stuck at the concrete walls and razor wire that marked the border crossing in Spin Boldak, searching for a cheaper car to take them to Pakistan.

"I am so angry because I am so helpless," Agha said. "I am just watching my child screaming with pain in front of me. I want to overthrow this useless government."

"I would like to appeal to the present government to build up the medical centre. Their promises do not mean anything until we can see the improvements," he said, after complaining the doctors at Kandahar hospital varied greatly in quality and the medicine prescribed was often fake or expensive.

The US Congress has allocated $56 billion for reconstruction projects in Afghanistan since 2001 — mostly for the security services but also for humanitarian aid. But Afghans say little of that money has trickled down to the Afghan people.

Provincial health director Qayum Pokhla defended the Mirwais hospital's record, saying it was doing its best under trying circumstances. He said he had appealed for extra doctors and specialists and additional funds to expand the hospital, and appealed to residents to have patience.

When the AP visited Mirwais, almost all the beds were full, and Pokhla acknowledged there was a severe shortage of space.

"Mirwais hospital is the only hospital available over here and to give everyone equal attention is impossible for us," he said. "I know the people complain but the main issue is that these impatient people want all their problems solved now. For us that's not possible — we just don't have enough resources."

And that has led Afghan's who can afford it to seek treatment instead in neighbouring Pakistan.

It takes nearly two hours by car to travel to the Pakistani border from Kandahar. A fare for a single passenger is about $5, roughly a day's wages for a farm labourer. Crossing the border is an extra $2, although guards don't ask for passports or visas. Hundreds of patients were lining up to cross, a process that can take between 30 minutes or several hours, depending on the time of day. Many said their biggest problems were finding money to pay the fare and the fear of getting caught in fighting.

The Red Cross does not track the number of Afghans travelling to Pakistan for medical treatment. Most of those interviewed by The Associated Press said they were going to the Pakistani city of Quetta to seek care.

Border guard Ali Islam Adozia says that hundreds of people seeking treatment pass his station at the Chaman border crossing every day. Sometimes lines of hundreds of people formed and no one was authorized to clear the sick through, he said. Police on both sides of the border harassed the travellers and the journey was expensive, adding to people's worries, he said.

"People are accompanied by sick babies or old people, who might be very ill," he said. "The taxi drivers charge fortunes because they waste hours waiting and later because the cars need repairs after travelling on these rough roads."

Zarghoon Baacha said he had been waiting for hours to cross the border to seek treatment for a kidney condition that doctors at Mirwais hospital could not diagnose. If the war didn't kill him, he said, the disease probably would.

"Many people in power like ministers and (President Hamid) Karzai himself said health issues would be sorted out soon," he said. "But soon never came."