International Activity Report 2003
Afghanistan

International staff: 107 National staff: 1380 MSF has been in Afghanistan since 1980

A few scenes from Afghanistan today:

At the Arzan Quimat clinic in Kabul, Chazia, 12, comes for a psychiatric consultation with her mother. She is in pain; her head hurts. She can't sleep near windows; she is afraid of cows. Her mother asks for medicine that can return her daughter to what she was like before. This idea of being "like before" is brought up in nearly all the consultations. People want to be as they were before the war, before the trauma; they want to erase the traces of the war in themselves.

On a lonely road in Kandahar province, Red Cross worker Ricardo Munguia is executed in cold blood while traveling to Tirin Kot, where Munguia, an engineer, was working to improve the water supply. He was singled out as a foreigner from the group of people being ambushed.

Just outside the sports stadium near Kabul's historic center, an elderly man approaches an MSF staff memeber. He carefully unfolds a piece of paper issued to him by the UNHCR in Pakistan, where he used to be a refugee. The paper authorizes him to claim food aid on his return to Afghanistan. He had already received his ration three months earlier; still he clings to the document, crumpled by constant folding and unfolding, as if it were a sacred treasure. He solemnly holds out the paper, with its official seals of international organizations.... "I was told I'd get a house," he says. "[I was told] they'd give me land."

What they were promised was a chance for peace. On offer was some stability, an end to flight and terror and, for the millions of people who fled the country during two decades of brutal war, a chance to go home. But two years after the Taliban was overthrown, and a new government installed in Kabul by the US-led Coalition, the people of Afghanistan have received very little. The government lacks the administrative capacity and the finances to rebuild the country. People are not prospering. Many have returned only to find they lack even basic access to health care, shelter or economic opportunities. Others are just trying to cope with the aftereffects of many long years of war. "Afghanistan is currently stuck in a vicious cycle of violence and displacement," says Chantal de Montigny, an MSF field coordinator there. 'The promised reconstruction is not as widespread as hoped. Meanwhile, there are millions of refugees returning with no prospects."

At the same time, the politicization of aid, advocated by the international community (with the tacit acceptance of many NGOs) as a way to strengthen the new government and rebuild the country, has proven dangerous for humanitarian organizations and has undercut Afghans' access to assistance that is truly need-based.

Neither safe nor stable

Afghanistan is neither safe nor stable. There is a growing insecurity that is profoundly affecting Afghans and those trying to assist them. Armed clashes, whether between rival warlords or between Coalition forces and remnants of the Taliban, are becoming more frequent. The UN mandated International Security Assistance Force (ISAF) does not venture out of Kabul, and even there has come under attack; since ISAF was taken over by NATO in August 2003, there have been demands from many sides that it be extended outside of Kabul. As of today, the ISAF remains con. ned to the capital. Coalition forces control only a few cities. Elsewhere, especially in the south and southeast, banditry and violence are worsening.

Insecurity nearly everywhere is forcing aid organizations, including MSF, to periodically withdraw staff or reevaluate their presence in some areas. Aid workers are increasingly identified not only with the western military presence but also with the Afghan authorities through the reconstruction process; humanitarian agencies have had grenades lobbed at their compounds, cars held up and shot at, offices and warehouses robbed. At various times during the last year, MSF teams were forced to evacuate Kandahar, Spin Boldak, Chaman (in Pakistan), Ghazni and Maimana because of security concerns.

In March 2003, Ricardo Munguia, an engineer working for the International Committee of the Red Cross, was singled out as a Westerner and murdered in cold blood in a deliberate attack on a desolate road near Kandahar. He was the first international aid worker killed in the country in several years.

MSF calls on all actors and groups to respect the neutrality and impartiality of NGOs. At the same time, MSF has, with increasing urgency, been pushing both aid agencies and the military authorities in Afghanistan to ensure that there is no blurring of lines between the two. If aid agencies are seen as part of the Coalition's political and military efforts, MSF has warned, those agencies will continue to be "soft targets" for violent attacks. Yet this warning has fallen on many deaf – or at least unwilling – ears. "Humanitarian" teams of Coalitions soldiers have been sent to work on reconstruction in provincial cities. For their part, many aid organizations have taken lucrative contracts and stepped into spheres traditionally occupied by a government (eg, reestablishing health services in entire provinces).

However, if NGOs, trapped in the need for funding and visibility, accept to become the private contractors of states anxious to delegate political responsibilities, they shouldn't be surprised if they are seen as responsible for any possible failure of the reconstruction process, and they will also have to share responsibility for the loss of independent humanitarian space in the country. Judging by the growing number of attacks directly targeting the aid community, it may already be too late.

Disillusionment

Against this backdrop of increasing insecurity, the situation in Afghanistan has been dominated by another phenomenon: one of the largest and most rapid repatriation processes in modern memory. Close to 2 million people returned from Iran, Pakistan and other neighboring countries in 2002, with another million expected in 2003. But the repatriation process has not been smooth – for many people, it has been just one more trauma added to so many previous ones.

While many refugees are eager to return home at the first opportunity, the repatriation has been far from fully voluntary in many cases. In August 2002, MSF issued a warning after Afghan returnees had told of being forced to leave Iran against their wishes by the authorities there: cars with loudspeakers on their roofs had toured towns ordering the Afghans to leave and television and radio broadcasts had told them that if they didn't leave by the end of August, they faced arrest. At the time, MSF reiterated the necessity that any return be voluntary, and that refugees be given adequate information about the conditions in their place of return, both key requirement of refugee law. Many returnees reported being given at best scanty – and at worst false – information on the situation in Afghanistan.

Conditions in Afghanistan have not been, for the most part, conducive to rebuilding a life that had been on hold for one, five or even twenty years. The country has had difficulty providing its returning sons and daughters a proper welcome home. In 2002, Afghanistan was in the third year of drought, leading to food insecurity in large parts of the country, and particularly the north. MSF workers in the north and northeast were at one point in September 2002 feeding 3,500 children and 1,500 lactating women in 10 supplementary feeding centers. In November, MSF shipped more than 600 tons of food supplies to northern Afghanistan, to ensure communities had sufficient stocks over the harsh winter.

Many returnees have had to congregate in camps for the displaced. Outside Herat is one such camp, Mashlak, home to 29,000 people. People here are almost entirely dependent on outside assistance. MSF provides primary health care, vaccinations and nutritional programs, as well as a small program for people suffering from tuberculosis. Similar medical aid is given to displaced people in camps and nearby communities in Zhare Dasht and Spin Boldak (Kandahar province), Qadis and Jawand districts (Badghis province) Chaman (Pakistan), Sakhi and Camp 65 (Balkh province). In July 2003, Shaydee camp outside of Herat, where MSF was also working, was of. cially closed, although a few hundred people remained. Many people from Herat are going back north to Baghdis and Faryab provinces; MSF remains concerned about the ongoing con. ict reported in certain districts in these provinces, and about the returnees' access to land and services in these areas.

Welcome to Kabul

The priority is to not go back to Behsud [125 km west of Kabul, in Vardak province]. There we simply can't live, because there is no water. Our livestock was stolen by the Taliban. But here in Kabul, it is really tough: if we don't find a house, a roof, we'll be forced to go.... – Zahra, 25, who is living in one room with 25 other people in Kabul's Dashte-Barchi neighborhood

Many returnees, even those not originally from the capital, have found their way to Kabul. By mid-2003, close to one million returnees had settled there. Joy at getting back to their country can be quickly followed by disillusion. Rents in the capital – where the Coalition, international agencies and many NGOs have their base – have skyrocketed. And the city is 70% destroyed: many of those returning are forced to find shelter among the ruins. MSF provided some assistance to these squatters as they faced the winter – heating material, blankets, tents, and some medical care. But in a bombed-out city, with international funds for reconstruction scandalously slow in arriving, their futures don't look bright.

"What are they doing to us?"

Some Afghans are even now trying to flee the country again, having found there is so little for them in Afghanistan. On the border between Chaman (Pakistan) and Spin Boldak, in the country's south, until July 2003 MSF provided medical assistance to desperate refugees caught in the Waiting Area, a no-man's land between Pakistan and Afghanistan. Some were Kutchi nomads fleeing the drought, others were Pashtuns seeking refuge from ethnic persecution, but the Pakistani government wouldn't let them enter. "Many have simply exchanged one calamitous situation for another" said Diderik van Halsema, MSF field coordinator in Kandahar. "They are desperately searching for any means of survival." By July, Afghan authorities and the UN had shifted some people from this area to Mohammed Kheil refugee camp in Pakistan; others were moved to a camp in Zhare Dasht, in the desert near Kandahar, where the food and water situation is precarious: "Life is difficult here," says one man in Zhare Dasht. "Everything is full of dust. We don't have wood to build. Our tent is totally ripped. Sometimes people are fighting over a jerrycan of water. We are living in a desert here. Our government is letting us down. What are they doing to us?"

MSF has been working in Afghanistan since 1980, throughout the Soviet occupation, the civil war, and during the Taliban regime. MSF has projects in 16 of the country's 32 provinces. They include therapeutic and supplementary feeding centers, vaccination programs, basic health care projects, mother-and-child health care programs, mobile clinics in remote areas, water and sanitation provision, and specialized programs for diseases such as tuberculosis and leishmaniasis.