CRISIS PROFILE: Afghanistan still the ‘sick man’ of Asia

LONDON (AlertNet) - Devastated by decades of conflict and hard hit by natural disasters, Afghanistan is now the poorest country in Asia. Millions remain dependent on aid, even as insecurity and lawlessness put vast swathes of the country out of reach of humanitarian workers.

Millions of dollars have been pumped into Afghanistan since 2001 when U.S.-led forces toppled the extremist Taliban regime, but most Afghans still live in dire poverty. They face a daily reality of poor healthcare and sanitation, chronic hunger and the constant danger of landmines. Education remains a luxury for most children.

Meanwhile, Afghans remain the world’s largest refugee group after the Palestinians.

The World Food Programme estimates that at least 6.5 million people out of a population of between 21 and 26 million are dependent on food aid, and there is a very real risk of famine.

Poor living conditions, healthcare and diet mean that Afghanistan has one of the lowest life expectancies in the world - just 44.5 years. A fifth of children die before they reach the age of five.

The international community has promised Afghanistan nearly $13 billion in aid since 2002. Almost $3.1 billion has been set aside for humanitarian needs, including helping refugees return and resettle, while the government says most of the rest is being spent on security.

Refugees – how many are there and where are they?

About two million Afghans are now living abroad, most of them in Iran and Pakistan. Another 3.5 million have moved back to Afghanistan since 2001.

Some were able to return to their communities and rebuild their lives, but about 40 per cent ended up in Kabul where they have no roots or family.

Some 185,000 people are registered in camps run by the United Nations. Most are in Kabul and Zhare Dasht in the southeast.

No one knows exactly how many internally displaced people there are in Afghanistan, either living with friends and family or trying to survive in the open. In Kabul, an estimated 500,000 people are homeless or living in makeshift accommodation.

On the brink of a health crisis

Health statistics speak for themselves. Only 40 per cent of Afghan children are vaccinated against major diseases, and just 25 per cent of the population has access to safe drinking water and adequate sanitation. There is just one doctor per 6,000 people, and one nurse per 2,500 people.

Poor living conditions and little or no healthcare have led to some grim statistics:

• A fifth of children die before they reach the age of five.
• Some 72,000 new cases of tuberculosis are reported every year. Women account for most TB deaths.
• Epidemics are frequent, including cholera, Congo-Crimea haemorrhagic fever, measles, meningitis, pertussis and malaria.
• Outbreaks of scurvy have also been reported.

More optimistically, Afghanistan looks to be on the verge of eradicating polio, even as efforts to stamp out the disease worldwide suffer setbacks. Thanks to vaccination efforts, only one case of polio had been reported in 2005 as of mid-June, compared with 27 in 2000.

Landmines

Afghans live with the constant danger of landmines, the legacy of decades of conflict that began with an invasion by troops of the former Soviet Union in 1979.

Between five and seven million landmines and large quantities of unexploded ordnance exist throughout the countryside and alongside roads. Up to 100 people are killed or wounded by mines and unexploded ordnance every month, the United Nations says.

Efforts to demine swathes of the country have been hindered by constant security threats since Taliban rebels and other militants see aid workers – including deminers – as bolstering the U.S.-backed government.

The rural-urban divide

The humanitarian situation in the larger cities of Kabul, Muzar-e Sharif and Herat has improved since 2001 as foreign funds have poured in to rebuild vital infrastructure. In Kabul, where a lot of aid agencies have opened offices, businesses have sprung up to cater to the new expatriate community.

But in rural areas reconstruction is slow and the humanitarian situation remains dire. Few Afghans outside the cities have access to clean water, employment, healthcare or schools.

Work has been severely hampered by ongoing conflict. The government has little control beyond the capital and militant violence continues.

The worst of the fighting is in the south and east of the country where the Taliban and their allies continue to fight NATO-led troops. But even in the north and west of the country there is infighting between local commanders over power and land.

Aid is not reaching the most needy areas

Afghanistan is one of the most dangerous countries for aid agencies to work in, especially in the south and east. Aid workers not only have to avoid the fighting between the Taliban and NATO-led forces, but they are increasingly being targeted themselves.

The Taliban claims aid agencies are working for U.S. interests, and are therefore legitimate targets – a stance that has produced a catalogue of abductions and deadly attacks across the country.

In response, many international agencies have withdrawn from Afghanistan altogether. Médecins Sans Frontières (MSF), which had worked in Afghanistan since 1980, withdrew in 2004 after five of its staff were killed.

MSF has strongly criticised the U.S.-led coalition for using humanitarian aid to build support for its military and political aims, thereby making aid agencies a bigger target for militants.

In the south, aid agencies are only able to work in the city of Kandahar. Staff who do travel to the surrounding countryside are escorted by armed guards and avoid staying overnight.

Aid workers are also being targeted by groups that are disenchanted with the Western influence in the country and say progress is too slow.

President Hamid Karzai warned in June 2005 that violence would get worse in the run-up to parliamentary elections in September. He suggested that Taliban guerrillas and their allies would be behind the violence.

But it’s not just fighting that’s stopping aid

Most of Afghanistan’s roads have been destroyed. And many of the most vulnerable communities live in inaccessible mountain regions, which are often cut off by heavy snow during the winter.

The World Food Programme transports food as far as possible by truck, but it has to rely on camels, donkeys and people to carry it the remaining distance to remote villages. Regions on the Tajik and Chinese borders have been particularly difficult to reach, often requiring cross border operations.

Earthquakes, flood and drought are a problem too

Every year an estimated 400,000 Afghans are affected by natural disasters. And many farmers have still not recovered from a severe drought that killed 70 per cent of the country’s livestock three years ago.

Flash floods, landslides, earthquakes, extreme cold and locust attacks are also frequent and often cause widespread crop damage and food insecurity.

Heavy snows frequently isolate large areas of the country during the winter. Then between April and August every year, melting snow and the rainy season together cause major flooding in the central highlands.

Landless Afghans living in dry river basins can become victims of flash floods, and entire communities living on hillsides in the highlands are frequently swept downhill by landslides.

In June 2005, there were nine separate floods in just one week that caused extensive damage to people’s homes and crops.