Afghanistan, 1997-1998

The Taliban movement remains in control of two-thirds of Afghanistan and only the northern provinces are held by the different factions of the Northern Alliance. Fighting continues to destabilise the area as the Taliban pushes for control over the whole country. Although most Taliban-held areas are relatively stable, the humanitarian situation is deteriorating. Women are denied equal access to health care. MSF targets women, children, minorities and victims of the conflict in Taliban and non-Taliban areas. The overall objectives are: preventive and curative primary health care with a complete minimal package of activities, essential drugs and quality-controlled prescriptions; a surveillance system and emergency preparedness enabling an adequate and timely response to the medical consequences of emergency humanitarian needs in the region; advocacy for equal access for women to quality medical assistance as well as their right to practise as medical professionals; to increase international awareness both in regard to this issue and to the estimated ten million landmines scattered throughout the countryside. In Oruzgan, one of the most isolated and traditional provinces in the south, MSF implements a primary health care programme focusing on women and children in partnership with a local NGO. MSF runs two comprehensive health centres (each averaging 80 female patients daily) and 12 basic health posts. As women's movements are culturally restricted in this remote area, MSF trains traditional birth attendants in hygiene and health education, and the clinics' staff is made up of Afghan women. To achieve this, the team has to negotiate constantly with Taliban leaders. In October 1997, public amputations were carried out on two men at Tarin Kowt bazaar by doctors sent by the MOH to set up a surgical programme. MSF deplores such activities. MSF continues to provide medical, and water and sanitation services to approximately 12,000 IDPs in Shaidai camp who fled the fighting in Badghis province. In Ghurian, a district west of Herat, MSF started a primary health care programme together with a local NGO. This includes a kitchen garden project showing how vegetables can be grown and used for nourishing meals. The high prevalence of malnutrition in Afghanistan is due more to lack of education than lack of food. In Kabul, MSF supports four clinics and the 50-bed Karte Se hospital in regard to consultations, in-patient care, mother-and-child health, vaccinations and a basic laboratory. The team fights to defend the right of local female doctors to work in the hospital. Support also continues in the 16-bed paediatric burns unit in Indira Ghandi hospital. MSF's work in Kabul is frequently complicated by Taliban interference, including threats to team members. Following a detailed analysis of nutritional activities in Ghazni, the team is introducing modifications to feeding programmes based in the hospital and a new strategy for mother-and-child health in areas surrounding the town. The TB treatment programme started in April 1997 can now treat 120 people. MSF supports a 10-bed unit in Sarab clinic, Hazaradjat province opened in November 1997, and another clinic opened near Gardan dewal in April 1998. Drugs were supplied to several clinics in Hazaradjat as the year-long Taliban blockade continues. In Taloqan, close to the frontline, MSF supports the 40-bed hospital with a medical and surgical programme and financial incentives for staff. An operating bloc has been built. The effectiveness of the training was proven not only when they assisted in Rostaq hospital in the earthquake emergency (see below), but also after an air attack on Taloqan caused several deaths and injured more than 60 civilians in May 1998. Taloqan serves as a base for support to a clinic in Pul I Khumbri, Baghlan province, serving IDPs from Kabul, and for four clinics and the emergency department of Kunduz hospital. When a measles epidemic broke out around Kunduz in April 1998, the team responded immediately with a mass vaccination of 100,000 people. In Maimana, Faryab province in the west, MSF is carrying out a preventive medicine programme including vaccinations in the clinics and a mass measles vaccination campaign. Training is provided for traditional birth attendants and support and drugs are supplied to four clinics. An earthquake and other emergencies At the beginning of February 1998, a powerful earthquake hit around 30 mountain villages in the province of Takhar, in Northeast Afghanistan, killing an estimated 4,000 people. MSF teams already present the area were the first outsiders to arrive on the scene. They helped the most urgent cases in the hospital in Rostaq, the centre of the stricken area, and then went into the mountains searching out and evacuating the wounded to hospitals. The terrain and heavy snowfalls combined to make an area already difficult of access almost impossible to reach. The emergency lasted for six weeks. A second and even more powerful earthquake struck the region at the end of May killing between 3,000 and 5,000. As it happened during the day, many lives were spared. An MSF team arrived the next day to coordinate the medical asstance to the wounded. Emergency aid was provided for war victims in Panjshir province and further north between August and November 1997. Two volunteers intervened to relaunch and support health structures in the area, but had to withdraw for security reasons throughout the winter. A team responded immediately to flooding in 15 villages in Northeast Afghanistan in April 1998 with distributions of plastic sheeting and covers for 6,500 homeless people, and followed up with measles vaccinations for 100,000 people. Such emergencies demonstrate the advantages of having MSF teams already in place to respond immediately. A less fortunate result of their proximity to the frontlines is that they are sometimes obliged to remain in their bunkers for days at a time, or even to make temporary withdrawals, and it can be extremely difficult, sometimes impossible, to get supplies through the fighting and winter snows. The team supporting four clinics in Mazar-i-Sharif distributed a three-month supply of drugs before having to withdraw in March because of the fighting. They returned six weeks later. Expatriate support can only be provided in summertime to a 20-bed clinic opened by MSF in Penjao (Hazaradjat).