MSF-USA: MSF Programs in Afghanistan, Pakistan, and Iran

September 25, 2001
MSF Programs in Afghanistan, Pakistan, and Iran
AFGHANISTAN

Overview

Since 1979, MSF has worked on all sides of the conflict in Afghanistan. Currently, MSF is striving to maintain programs in both Taliban-contolled and Northern Alliance-controlled areas of the country. The main cities where the organization works are: Kabul, Mazar-I-Sharif, Faizabad, Herat, and Kandahar. MSF programs deliver basic health care, provide nutritional support through feeding programs, build latrines and deliver water and sanitation assistance, carry out mass vaccination campaigns, offer tuberculosis treatment, and assist in the control of outbreaks of cholera, malaria, and scurvy, as well as the distribution of medicines. A strong theme in all of our programs is access to health for women.

Before insecurity in the region following the September 11 attacks on the United States forced the evacuation of all international relief workers from Taliban-controlled areas of Afghanistan, MSF teams consisted of a total of 70 international and over 400 Afghan staff.

For the past four years, Afghanistan has been suffering from the worst drought in over 30 years. Year after year, crops are failing due to the lack of rain and melting snow in the spring. The ensuing food deficit is compounded by fighting in the northeast, northwest and central areas of Afghanistan, the traditional grain belt of the country, which is seriously undermining the traditional coping mechanisms of the Afghan population throughout the country. It is a slowly deteriorating process, which is worsening the living conditions of the Afghans each year and has led to the displacement of several hundreds of thousands of civilians. At the moment, MSF medical data does not indicate a famine as such, although there are disturbing figures. We fear for the worst if the coming harvest fails again.

The humanitarian situation in Afghanistan has been sharply deteriorating over the past year. Since early 2001, MSF has seen a rapid increase in displaced persons seeking refuge and food in camps around Herat and Mazar-I-Sharif, and throughout the north and western regions of the country. According to a survey carried out by MSF in July and August of 2001, the camp of Mazlakh, for example, witnessed an influx of 100 to 200 persons a day. The admission to our supplementary feeding centers in all sites in the western regions of the country also increased dramatically. Centers registered increased numbers of children under five-years-old with indications of severe acute malnutrition. MSF recently opened two therapeutic feeding centers for the severely malnourished and planned to open a third to address the increasing in patients in Herat.

MSF programs in Northern Alliance-Controlled Regions

In the remote region of the Northern Alliance-controlled region of

Badakhshan

, MSF maintains a coordination team based in Faizabad that provides support to three health structures in Badakhshan province and is regularly involved in emergency interventions in Badakhshan and Northern Takhar provinces. Working in Faizabad hospital, Baharak health center, and Skazar health center, MSF has helped to support surgical care, general health care, safe blood transfusions, mother and child health care, laboratory services, emergency preparedness planning, and nutritional assistance to target populations totalling more than one million. In addition, since the summer of 2000, the organization has provided emergency assistance to help care for the more than 100,000 displaced Afghans who have sought refuge in the Northern Alliance territory, including the Panjir Valley.

MSF programs in Taliban-Controlled Regions

In northern Afghanistan

, MSF manages and supports 18 public health clinics across five provinces, including in the city of Mazar-I-Sharif. Afghan doctors and nurses, both male and female, operate these clinics and are some of the only sources of quality, affordable health care in a region that is home to approximately three million people. Each month, the medical staff of the clinics conduct an average of 35,000 curative consultations and 45,000 preventive consultations. Since last year, the clinics have added five supplementary feeding centers for those at risk of malnutrition. In August, the caseload was 1,964 including 428 pregnant or lactating women.

MSF has also organized a large vitamin outreach distribution program to combat a resurgence of scurvy, a disease caused by vitamin C deficiency, in the northern region. In 2001, MSF staff visited 86 villages during two rounds, distributing vitamins to 6,204 families, and identifying and treating 443 cases of scurvy.

In the camps for internally displaced Afghans around

Mazar-I-Sharif

, MSF mobile clinics have provided basic health care, and water and sanitation support. Due to the poor conditions in these improvised camps, MSF together with UN agencies, prepared a large site north of Mazar-I-Sharif called Sakhi, with a maximum capacity of 20,000 persons. MSF opened a health clinic in the camp and runs additional nutritional, water, and sanitation programs. By August, 2,500 families had moved into the site and another site for 20,000 was being identified.

In the

central part of the country

, MSF works in the Kabul, Ghazni, and Hazarajat regions. In the capital city of

Kabul

, MSF has been supporting three clinics and one hospital, the Dashti Bashi, Arzan Quimat, and Khwadja Bora clinics and the “52-Bed Hospital” in Khair Khena. This is the only reference hospital in the Kabul area. MSF has maintained capacity to respond to emergencies such as outbreaks of cholera and other epidemics, new arrivals of internally displaced people, malnutrition, and natural disasters.

Ghazni

, MSF has supported the provincial hospital since 1995 and a tuberculosis center with 70 beds since 1998. In Ghazni hospital, MSF is involved in the internal medicine department (for both male and female patients), the pediatric ward, as well as hygiene and sanitation. MSF also supervises nutritional activities in the hospital. The opening of a new tuberculosis center is in the planning.

In the isolated central region of

Hazarajat

, home to many members of the Hazari minority, MSF supports two clinics, Sarab and Garden Dewal. One more clinic has been rehabilitated at Kanjab.

In the

western part of the country

, MSF is working in Herat, Badghis and Kandahar and several major camps for internally displaced persons, and has been providing extensive services throughout the region in response to the current nutritional emergency. In

Herat

, MSF helps to support three clinics as well as the pediatric ward and therapeutic feeding program of the Herat Hospital. In Badghis, the organization helps support a health clinic. In Kandahar, MSF has provided expertise in setting up an emergency preparedness program to detect early warning signs of epidemics and nutritional crises and establish a system of outreach response with a network of health clinics. MSF also provided hands-on support in the Infectious Disease Ward of the Kandahar hospital

In the Shayday and Mazlakh camps, where over 150,000 internally displaced persons live, MSF has acted as the lead medical agency, providing health care, supplementary feeding clinics, a referral system, and vaccinations. MSF has also undertaken a mass measles vaccination campaign and blanket supplementary feeding in Mushan/Talukon camp and Degobad camp

PAKISTAN

One of the only independent international aid groups operational in Pakistan, MSF works extensively in the Jalozai camp for Afghan refugees north of

Peshawar

. MSF provides basic health care, including services for mother and child health care), vaccinations, and operates a supplementary feeding center. The organization also distributes shelter materials, builds and maintains latrines, carries out camp-wide health and nutritional assessments, and provides water distribution of one million liters per day by truck. MSF has also carried out a mass measles vaccination campaign and health assessments in the New Shamshatoo camp.

IRAN

Iran hosts close to 2 million refugees—500,000 Iraqis and 1.5 million Afghans. In the past six months, approximately 400,000 new Afghan refugees have arrived in the country. Over the past years, the Iranian authorities have restricted their asylum policies towards refugees.

MSF activities in Iran, based in Mashad and Teheran, are focused on medical assistance to Afghan refugees. In Gulshar, a town of 80,000 that is hosting 40,000 Afghans, MSF works with the ministry of health clinic to provide basic health care, home visits, mobile clinics, and social support, particularly to newly arrived refugees. MSF is currently preparing a new programs in Zahedan, in southeastern Iran, to provide additional support to Afghan refugees.