September 24, 2001
Following the tragic September 11 attacks on the United States, all humanitarian aid organizations, including MSF, were forced to withdraw their international staff from Taliban-controlled areas of Afghanistan due to rising insecurity in the region.
 
MSF has worked continuously in Afghanistan since 1979. Before the withdrawal of the majority of its international staff, MSF had 70 international and over 400 Afghan staff working on medical and nutritional programs throughout the country. At present, MSF teams continue to work in the Northern Alliance-controlled regions of northeastern Afghanistan. Additional MSF teams continue to provide assistance to Afghan refugees in neighboring Iran and Pakistan and are preparing for a possible influx of additional refugees, as are MSF teams working in neighboring Turkmenistan, Uzbekistan, and Tajikistan.
 
Over the past year, the humanitarian situation in Afghanistan has deteriorated sharply due to fighting and drought. In recent months, MSF teams have dealt with widespread malnutrition, outbreaks of scurvy, cholera, and measles, massive population displacement, and an increased flow of refugees into Iran and Pakistan. The drastic downscaling of aid programs is leaving millions without access to adequate food, clean drinking water, and health care. If food and medical assistance do not reach people in Afghanistan in the coming weeks, thousands could face starvation and epidemics this winter.
 
With the withdrawal of aid groups and the threat of a military response now focused on Afghanistan, MSF is extremely concerned for the humanitarian needs of the civilian population of the country. Large portions of the Afghan population rely on international aid for survival and MSF fears that, without this assistance, health and nutritional conditions will very rapidly deteriorate throughout the country.
 
Decades of war and political repression, devastating earthquakes, and years of drought have already pushed the civilian population of Afghanistan to the brink. Afghans now constitute the largest refugee population in the world, with estimates of up to 4 million living abroad and hundreds of thousands more displaced within their own country.
 
"Warfare, drought, and disease have ravaged the Afghan population for over two decades, and the situation has only worsened in recent months. Now, with tensions mounting, the withdrawal of international aid groups, and tightening of international borders, our concern for the fate of Afghan civilians is even more urgent," states Nicolas de Torrente, executive director of MSF-USA, who recently returned from a three-week mission in Afghanistan. "Afghan civilians, like civilians anywhere in the world, must be protected from conflict and ensured access to humanitarian assistance."
 

Fear of a Refugee Crisis

The tightening of international borders has worsened an already severe situation for those in need in Afghanistan. With conditions deteriorating inside Afghanistan, flight to neighboring countries remains one of the only means of survival for many Afghans.
 
In order to provide remote support to the Afghanistan operations and to prepare for the possible exodus of additional Afghan refugees, MSF is reinforcing its presence and capacity in the surrounding countries of Iran, Pakistan, Turkmenistan, and Tajikistan.
 
In Pakistan, where over 2 million Afghan refugees are already living, MSF continues to maintain a presence in Peshawar and Islamabad. MSF continues to work extensively in the Jalozai camp for Afghan refugees in Peshawar, home to 50,000 refugees (10,600 families) who have arrived within the last nine months.
 
In Iran, where approximately 400,000 Afghan refugees have arrived in the past 6 months and up to a total of 2.9 million are estimated to be living, MSF has teams in Mashhad and Teheran.
 

Current MSF Operations in Afghanistan and Central Asia

MSF is striving to maintain a full presence in Badakhshan, a region in northeastern Afghanistan under the control of the anti-Taliban group known as the Northern Alliance. MSF supports a referral hospital in Faizabad and clinics in Baharak, Iskashim, Skazar (Badakhshan province), and Khoja-Bahaudin (Takhar province). The programs are being conducted by a reduced team of international staff and assisted by Afghan staff.
 
Projects elsewhere in Afghanistan where MSF international staff have been withdrawn are still active. However without free access to them and the possibility to organize supplies from abroad, the future of these projects is in jeopardy.
 
In Bala Morghab, the measles vaccination campaign is continuing and the supplementary feeding center remains. In the Herat Mazhlakh/Shaday camps, the population is facing a rapid food shortage crisis due to halted food distribution. The hospital program continues with the Infectious Disease Ward still in operation as well as programs for cholera control.
 
In addition to extensive programs in Afghanistan, as well as presence in Pakistan, Iran, and Turkmenistan, MSF is also continuing its ongoing programs in the neighboring Central Asian countries of Uzbekistan and Tajikistan.

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