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Afghanistan
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ZHARE DASHT CAMP, AFGHANISTAN. The family of Pashtuns — Gulzaman, his wife Bibi Marim, and their four young children—has recently arrived in this desert settlement from the south. They are tired, hungry, and in need of medical attention.
Tall and gaunt, Gulzaman lifts his brown shalwar kameez (long shirt and pantaloons) to reveal a leg infection. He says his wife, who remains inside the tent, huddled under a green burkha (the traditional dress that covers the body from head to foot, leaving only a narrow slit for the eyes), has tuberculosis.
They have not yet visited the camp’s health facility, but it is likely the children are afflicted with one of the many intestinal or respiratory infections common among Afghanistan’s four million refugees and internally displaced persons.
The refugees, categorized as those who return from another country, and internally displaced persons, those from another part of Afghanistan, are among the most vulnerable in a population, which already has the worst health status in Asia.
"Assistance is sorely needed: war has destroyed or damaged 70% of the country’s hospital and health centers"
One quarter of Afghan children do not reach the age of 5, falling casualty to infectious diseases such as respiratory infections, measles, diarrhea, and malnutrition, according to a United Nations Children’s Fund survey. One in three women in the poorest areas dies from a complication in pregnancy.
“The high mortality rates are largely due to appalling hygiene conditions and the lack of basic medicines,” says Vincent de Wit, an ADB Senior Health Specialist. “What is so sad is that these complications are easily preventable. They are generally caused by obstructions, bleeding, or hypertension.”
A $1.2 million ADB grant project is preparing to improve health services in the southern province of Kandahar through an international nongovernment organization (NGO). It will build five new health centers—and upgrade 13 existing facilities—with maternal and emergency services in areas with many displaced people.
“To reach isolated communities, we will train over 400 health workers, mainly women selected from communities of internally displaced persons, to provide basic health care and promote hygiene and immunization,” says Mr. de Wit. “We will also provide drugs.”
In addition, ADB has a $5 million grant project to provide health services through NGOs in five provinces, and is considering core sector financing for the Ministry of Health in 2003.
Administered by ADB, both grants are from the Japan Fund for Poverty Reduction, financed by the Government of Japan.
Such assistance is sorely needed: war has destroyed or damaged 70% of the country’s hospitals and health centers. While the Government focuses on rehabilitating hospitals, local and international NGOs are trying to provide basic health care.
“But their efforts, inadequately financed, fragmented and irregular, are reaching only a third of the population,” notes Mr. de Wit.
The financing gap for providing minimal health care to Afghans is $50 million a year, he adds. Because the Government lacks financing for the social sectors, basic health provision will continue to rely heavily on donor support.
The Zhare Dasht (Yellow Desert) settlement camp is 30 km west of Kandahar. It is accessible only by dusty track in an arid area, which, according to warning signs, has not yet been totally de-mined.
The United Nations High Commissioner for Refugees (UNHCR) opened the camp last August for people from the “waiting area” in Chaman, Pakistan.
Today, it provides basic social services in what Sheila Johnson, a UNHCR program officer, describes as “a life-sustaining operation” for 28,000 people.
As Gulzaman relates his experience, a small crowd, including children—some with sores on their faces—gathers to listen outside his tent.
“We had to leave our home in Faryab in the north because of tribal problems,” he says. “We lived for a year in Spin Boldak (across the border from Chaman) before deciding to come here.”
Some of the men sympathize with him, for half the people in the camp are Pashtuns, who had to leave the north or the west because of threats from other groups, which associated them with the Taliban.
The other half is made up of Kuchis, southern nomads, who have lost their herds of goats and cattle—their only means of subsistence—after a 4-year drought that showed no sign of easing.
“People arrive here in bad shape,” says Diderik van Halsema, a Dutch doctor with Médecins Sans Frontières, which provides health care at Zhare Dhast.
“A common complaint is body pain, which is caused by the trauma of having lost their homes and livelihoods and being on the move for months and years. It’s not a condition you can treat with a pill.”
In one of a row of medical tents, Wali Muhammad is examining the ear of a young girl brought in by her mother. A calm man in his 30s, Dr. Wali says, “These people lack pots and buckets to keep their food and water clean, and diarrhea is prevalent. Diarrhea can lead to malnutrition, and 20% of the camp suffers from malnutrition.”
Aside from attention to their physical requirements, Dr. van Halsema says camp residents need “to be treated with dignity. They want their voices to be heard, to give them some outlook. And in the longer term, they need self-sustainability.”
That may take time. Although some NGOs are conducting livelihood programs within the camp, what internally displaced persons need to encourage them to return to their homes and earn a living is a more stable political environment and a break from the drought.
Find out more about ADB's activities in Afghanistan
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