Afghanistan: Civilians at Risk

A panel discussion co-sponsored by MSF and the 92nd St. Y

A panel discussion co-sponsored by MSF and the 92nd St. Y

Copyright Catherine Dumait-Harper/MSF


Salvatore Lombardo

, Senior Liaison Officer, UNHCR

Nicolas De Torrente

, Executive Director, MSF-USA

Sima Wali

, President and CEO, Refugee Women in Development

Moderated by:

Leonard Lopate

, Host of New York & Company, WNYC

Civilians in Afghanistan were at serious risk even before the US and British planes began dropping bombs. Since the mid-90's, they've endured the worst drought in 30 years—that after 20 years of war. The threat of famine was without precedent. Relief agencies were trying to cope with the natural disaster that has resulted in an agricultural deficit of 2 million tons, the destruction of livestock, and the massive displacement of people who've been forced to flee the food shortages, and now we have this problem.

With us tonight are three experts on the humanitarian crisis in Afghanistan: Nicolas de Torrente, Executive Director of Médecins Sans Fronti&eres;-USA or Doctors Without Borders as it's commonly known in the country, and winners of the 1999 Nobel Peace Prize; Sima Wali, the President and CEO of Refugee Women in Development Incorporated, a non-governmental international organization which helps women refugees from Afghanistan and other war-torn countries; and Salvatore Lombardo an attorney who specializes in international human rights issues and serves as the senior liasion officer in the United Nations High Commission for Refugees. I'm really pleased that this panel was put together with the three of you because I can't think of three people who know more other than perhaps people who are there right now, and all of you have been there within fairly recent times.

The situation was getting pretty dire prior to all of this. Just how much worse can it get? You've heard those jokes about how the military action has cost tens of dollars of damage in Afghanistan. Was it really in very bad shape before this whole thing started? Let's begin with you, Salvatore.


It has been bad for 25 years. The war certainly had a major consequence. The last three years with the drought, especially in the southern part of Afghanistan, has deteriorated the situation to a point where before September 11 we had more than 1 million displaced persons within Afghanistan. The rumors of the last few days are that we have in addition to that a few hundred thousand people more displaced. So, you had a situation of war where there were serious human rights violations, and you had three consecutive years of drought. So, when September 11 came, we were already in a very difficult situation. And now the point that I also think is very important is that the international community has forgotten about Afghanistan for many years. Together with our friends from MSF we have been struggling to get assistance to fund our programs inside Afghanistan and many of the appeals that we have launched in the last few years were neglected. There was no money for humanitarian assistance inside Afghanistan. Needless to say, there was no money for rehabilitation within Afghanistan before September 11.

Nicolas, you testified recently before a joint Congressional committee hearing on the impact of a military action on the civilian population. Did you find people in Congress very open to what you had to say?


I think that there is a very clear recognition that crosses across all contingencies—from the politicians to the general public to the humanitarians—that the civilians in Afghanistan are very much at risk, and I'd like to come back to a little bit to what Salvatore was saying in terms of describing the situation. The internal conflict has brought violence and persecution and fear to a great number of people inside the country even before September 11. This has caused people to move to safer areas. On top of that, with the drought, lots of people are subsistence farmers (Afghanistan is a very, very poor country) and people have reliance on livestock and on agriculture to live. After three years of repeated crop failure, ;you have a few assets, you share them among family members and kinship groups—there is a solidarity. People are resilient and have means of coping, but after three years, a lot of people are at the end and were leaving. You see this out migration due to fears of violence and due to droughts. They were going both inside the country to safer areas and places where they could find assistance—inside to major camps at Mazar-e-Sharif around Herat in the west—and were also leaving the country and becoming refugees even before September 11. So this is a very, very poor country where the central state has collapsed and a country where health indicators were at rock bottom and on top of that, you had war and drought. So I think it's very human to feel a connection to the people there and to want to help and I think that the politicians in Washington have that same feeling. The way that they want to achieve this of course—we perhaps have different takes on it. But we are all in agreement about this.

Sima, can we say that as bad as it is for the civilian population in general, that it is worse for women?


Definitely the situation for women over the past 22 years has been bad enough. Women have been subjected to sexual violence, they have been driven deeper and deeper into poverty and there is drug traffic and their children are sold so their situation was very dire to begin with and I do want to say that the problems of women neither began nor end with the Taliban. It began with the war situation early on. However, during the era of the Taliban, women were targeted the most and it seemed as though there was a special aggression targeting women. The edicts, for example, that were introduced that kept women subservient and oppressed were very unprecedented in Afghan history and culture.

People associated the period where women could walk around without the burka and could go to schools and all of that with the Soviet period so, after the victory of the mujaheddin, were women seen automatically as part of the problem?


That's sort of a myth because even during the Soviet era, women were subjected to torture and most of these women whose men were in the resistance were tortured and imprisoned. This was very unprecedented in Afghan history. During the Soviet era, the Afghan Marxists really did not put very much emphasis on women's issues so there was really no forced aggression on the women. But, with the arrival of the mujaheddin, women were initially kept from being employed from government positions. This was to free up government positions for political paybacks to the soldiers who had fought in the mujaheddin. But women resisted and the edict was lifted. During the advent of the Taliban, women were subjected to gross human rights violations.

You have been critical in the past about how US sanctions aimed at hurting the Taliban for harboring Osama bin Laden have hurt women the most because they have created a nation of beggars—of female beggars.


Unfortunately, right now, you are talking of at least 500,000 widowed women. And inside the city of Kabul, you are talking about 50,000 to 60,000 women who are in poverty and not allowed to work and most of the programs that we fund—we work with the women led community centers that are run clandestinely—these loosely held community groups have been driven deeper and deeper underground. Unfortunately, what has happened with the sanctions is that they have really affected the humanitarian situation more so for the women because it is the women who don't have access to society's resources.

All three of you have been in the area within the last year. Nicolas, you have been in the Northern Alliance area and Sima, you were in Peshawar and Salvatore, you have been in the Taliban held areas. How recently were you there?


I was there for a long period almost a year ago and since then I've been following the situation very closely from here. And also the neighboring countries—refugees are in Iran and Pakistan right now.

Because the real issue is the refugee issue, isn't it? Everyday it seems that tens of thousands of people are fleeing the country.


It hasn't been, with exception of the last three or four days, a major refugee crisis for a number of reasons. The last few days, we had three, four thousand people crossing a day illegally because the borders between Iran, Pakistan and Afghanistan have been closed and this has major consequences for the people. I think one of the major reasons that we haven't had a large influx of refugees is because the word is out in Afghanistan that the borders are closed. This has caused quite a lot of problems to people. Let me give you a few simple ones.

I think the most difficult one is that you have to understand that for an Afghan, to decide to leave is a very, very difficult decision. These are people, as you were saying, that are incredibly attached to their land. So, they don't want to do it; they do it because they are desperate. The second problem is that you need a lot of money. A lot of money for an Afghan is $50. That represents, for a lot of people, three or four months salary.

You have to pay someone to smuggle you out.


Exactly. Some of the people, according to the information that we have, they haven't made that decision yet because they are not sure that the border is closed. They could do it only if they can pay money and not many people will have that option.

Many people have now left because of forced conscription. Quite a lot of young Afghans—people of 11 and 12 years old—they have been conscribed by the Taliban forcibly to join what they call the jihad. But it hasn't happened yet. I think that we are calculating between 60,000 and 70,000 that have actually crossed the border to Pakistan. We continue to appeal to the Pakistan government to open the border but it hasn't happened yet.

Nicolas, MSF complained that the United States has actually returned some refugees and has been helping to keep those borders closed, which is against the UN charter. Has that eased up? Have the two of you discussed this?


We did not complain that the US returned refugees. We're concerned that, as Salvatore said, that the option for people to seek security is available, and that is the basic issue here. If you are in a country where you cannot find safe refuge, then you have to have the option to cross an international border to receive it in a neighboring country. That option has to be there. It really is part of international law—it's part of the system of states—so we are really urging the UNHCR and the Pakistani and Iranian governments to take the responsibility in the end. The UN can play a role in helping them find an acceptable solution. We would like these borders to be open for sure.

What are these refugee camps like? They must be very difficult to live in.


People are living in subhuman conditions and the majority of refugees who live in the camps are women and their children. There is no running water. The children that I saw were in scorpion-infested areas and suffering from treatable types of diseases. Diarrhea was rampant. Women were extremely depressed; they had very little shelter and no access to health care. The situations were dire last year and now I hear from my colleagues that it is even worse because the camps are overcrowded and also because the preferences of the Pakistani officials to give priority of settlement to those from the Pashtun ethnic tribes. If you are a Pashtun and you have allies over the border, you have a much better chance to enter the refugee camps because you are allied with the Taliban. But if you are a Tajik or a minority Shiite, you have a lesser chance of being that lucky.

So if you are a Tajik you have to try to get into Tajikistan and if you are a Shiite, you have to try to get into Iran?


Iran has also been returning a lot of refugees because refugees have lost their utility to be pawns in the game. Iran has actually, prior to this crisis, been forcibly returning refugees contrary to UN international human rights law. Also, prior to this event, the largest funded program by the US in collaboration with the UN was a repatriation program although it used the term "voluntary" a large amount of the funds went to repay humanitarian assistance and to repatriate refugees. Our concern was that it was not done on the guarantees for safety because we know that there is a crisis inside of Afghanistan. These are war zones and people are treated so badly in Iran and in Pakistan. In the refugee camps, women have been subjected to rape; girls have been sold into servitude into the Pakistani brothels and many of them have been sold out of the country. Because of these circumstances that Afghan women have told me, I would rather go home and die in my home country. It's just as bad here in the refugee camps; I'm not getting any protection.

Salvatore, I've heard the numbers—four and half million refugees. That's an incredible number and the responsibility for taking care of these people mostly falls on the Pakistanis and the Iranians? What's the UN's role in all of this? We're talking about something that must be costing millions and millions of dollars.


I don't want to defend the Pakistani government or the Iranian government.

They might have a certain amount of responsibility...


Yes, but I guess I have to play the United Nations tonight. Let me tell you one thing. Pakistan and Iran—and we have to be very honest about it—they have been very generous in accommodating millions and millions and millions of Afghans over the last 22 years. We cannot ignore that. The assistance by the international community—what we vulgarly call, bargain sharing, what Pakistan and Iran are advocating all the time which basically means that if I take four and a half million people then you have to pay some of the bargain—it has gone down and down and down. UNHCR, in the last years has just $10 million for the program in Pakistan, which is basically peanuts. So we were not in a capacity to respond to that because we didn't have money and I think that can be applied to other organizations.

This has developed a lot of fatigue inside Pakistan. I'm talking now [about] Pakistan where you have a very fragile ethnical balance. I think Pakistan now, let's be frank, it is divided between very serious, very serious security concerns. Pakistan, if things don't turn in one-way or another, it can collapse. This will have many dire consequences: militarily, politically and from a humanitarian point view. On the other hand, you have lots of "US"-friends, governments, pushing for the respect of a humanitarian principle. I don't have the perfect answer to that balance because it's a very, very difficult balance.

Well the Pashtun represent a major part of the Pakistani population, don't they? But they're not the dominant group. Can all of this activity against the government really bring down the government if the people from the Punjab, the dominant group, don't really want it to happen?


President Musharraf depends very much now on what I would call the silent majority from the Punjab. And the silent majority from Punjab for many, many years has been against the arrival of a large number of Afghans. It's a drain on the economy because if you have the Afghans, with all respect to the Pakistanis, in regards to the trade point of view, the Afghans are very smart and so on. The question is if you lose the support of the Punjab by not taking into account the security issue, then you eventually have a government collapsing. I'm speculating of course. But this is in the play.

Well, so much money has gone into this area to support the war effort... Are Islamic charities also helping out here? Do you know, Sima?


Some of the so-called Islamic charities really are going to support the madresses for the Afghan young boys who are being trained in these extremist Islamic schools and I met with some of the Arab funded "NGO's" and they are very anti-women and women's rights. They believe that the Afghan Muslims are not proper Muslims and they have to enforce their own form of Islam, which is the Wahhabi type, which is imported from Saudi Arabia, and the diobunde Islam that is again imposed on the Afghans by the Pakistanis.

Ramadan is coming just less than a month away isn't it, Nicolas?


Yes—middle of November.

And when it comes, winter comes, which is really harsh in Afghanistan. What does that mean for these refugee camps and what does it mean for the health of these people in these refugee camps?


The refugee camps in Pakistan are in low-lying areas so the risk of the harsh and bitter cold is not as severe as in other areas within Afghanistan. But, it certainly puts a kind of imperative on the humanitarian assistance actors to try to get in as much as possible in terms of supplies into the country and the closing of mountain passes, for example, to remote areas—the winter will have a very big impact on that.

Ramadan—we were discussing this a little bit earlier—whether Ramadan would have a very big impact in terms of the military confrontation itself. Will military activities lessen during Ramadan or not? Will this have an impact or not? Sensitivities are much stronger during Ramadan, and therefore, the reaction of the Muslim and Arab world to what is going on inside Afghanistan will be heightened during this period for sure.

Ramadan is a holy time and it's when people fast, at least during the day. It's a time when they don't normally think about war and in the past the United States has been sensitive to that. Didn't we hold off the Gulf War until after Ramadan?


I believe so, if my memory is accurate, that we did. The United States government did not go into war until Ramadan was over.

I know that none of you are privy to US policy but do you have any idea how Ramadan is going to play on the other side? People must have fought during the war with the Soviet Union during Ramadan, didn't they?


I think that Ramadan would have a regional psychological impact. This is a very important element in this conflict. It certainly would affect the sensibility of the Muslim population in the region. And I think that it's a very important element.

And there's pressure to get this thing over with. There's a lot of tension in Asia, anyway, to get it over with by November 16th.


I think, ironically I will say, that humanitarians and the military would have the same deadline because the deadline is winter. And I think that, as Nicolas was saying, the problem that we will face in the winter is access to areas that are inaccessible because of altitude and they are in the central part of Afghanistan. For example, right now, when you go to 2000 meters, it will be impassable. So, for us, we have four weeks to get as much food as possible inside Afghanistan. As Nicolas was saying, the major problem we have now is the distribution of assistance inside Afghanistan because the network of our local staff—because I think we have to be very clear about that—what the UN and the NGO community does inside Afghanistan is thanks to the Afghan people because our local staff do most of the work. They are there during this conflict and they are the ones taking care of the distribution right now.

There's pretty much no international staff in Afghanistan these days, is that right?


There's some international staff in the Northern Alliance controlled areas. It's a small pocket. In the Taliban controlled areas or in some areas we don't know if the Taliban is controlling them or not, but in that part of the country, the international staff had to leave a few days after the September 11 attacks in the US because of rising tensions in the area. MSF had 70 international staff in that area and they all left from those areas and we have a network of about 400 Afghan staff that are invaluable. They are the doctors, they are the nurses, and they are the logisticians, and have been working with us for 10 years. They are still there. Since the bombing started, things have become even more tense and we had major problems a few days ago with lootings of our compounds and with the UN compounds as well in different parts of the country—in Kandahar and in Mazar-e-Sharif. We're not clear if all of our operations had to stop or if things are still going on. We had reports that in our mobile clinics which are going to displaced camps—they are usually going with a nice white MSF Toyota jeep and now those were taken so the staff has improvised and is using local taxis and so on. So they are really trying to keep activities going and they are very, very committed. But, they are stressed to breaking point right now in the current situation.

But organizations like MSF have not been criticized in the way that that other one was where people were arrested for trying to convert people to Christianity. That was a special case?


There's been growing restrictions on humanitarian agencies in Afghanistan under the Taliban in the past year on the part of extreme elements in the Taliban. There are some that are a bit more moderate. For example, if we talk to the Ministry of Health, you negotiate with a doctor and doctor-to-doctor you can talk to each other. However, there are other much more extreme elements who look at the religious and the political aspect first and who want to restrict foreign influence in Afghanistan. They've made life for us much more difficult. They have put administrative hurdles before us-it is very difficult to get visas. It is difficult to do an assessment without getting a Taliban person to visit. It's against our rules, we want an independent assessment of needs, and we don't want to be accompanied. So there have been all of these and it's been a constant struggle to maintain what we call "humanitarian space" for our operations inside the country. And we felt that we were able to but we are almost reaching our limits. Some agencies were targeted because the Taliban perceived that they had ulterior motives-political, religious and so forth. It's quite unfortunate since they were delivering services to the population in Afghanistan. We still have no news of these people-I think that there are eight international staff people that were arrested in Kabul. It shows how important it is for humanitarian agencies to maintain a clear humanitarian agenda. Even the perception that there is something else behind or aside-we aren't fronting for anything else.

At least MSF was spared having its facilities bombed. The UN and the Red Cross have had to deal with that as well. Did the UN protest to the US? After all, Koffe Annan seems to be one the strongest supporters of this action.


First of all it wasn't a UN compound. It was an NGO compound working with the UN on probably the most important project that the UN has inside of Afghanistan, which is clearing the mines. There are 10,000 Afghans working that clear the mines inside Afghanistan. Afghanistan, by the way, has the largest amount of landmines in the world. This is along with drought and all the rest.

I think that in the last few years, we have had many crises with the Taliban. We have been very close to pulling out of Afghanistan.

Why do you think that they want to force these agencies out? After all, on some level, they still have to feel that you are doing a service to their people.


There is no doubt that together with the Afghans, the voluntary community and UN, etc. were running all of the social services inside of Afghanistan. There is no doubt of this. I think that the Taliban acknowledges that. I think that it was, and I agree with Nicolas here, it was when the humanitarian coincided with the political (that the Taliban reacted). You should not forget that the Taliban were isolated, you should not forget that there was a Security Council resolution two years ago and then there was another sanction resolution a year ago. The only way for the Taliban to draw the attention of the international community against their isolation was to make the lives of the humanitarian and Afghan people worse.

And to blow up statues of Buddha. Their argument was your ignoring us, you're not helping us, and we're going to blow up these statues.


I think that it's against the irony of the relationship between the humanitarian and the political. Things went wrong in Afghanistan because there was not a political solution for 22 years. I hope that we're not giving the impression that we have capacity to solve the problem in Afghanistan. Unless, there is a political solution and a solution to which gives stability to the people, there is no way that any of us-the best of us-can fix the problem in Afghanistan. Because we don't have that capacity.


In terms of the problems that the aid workers have been receiving inside of Afghanistan, the threats, etc. are really not coming from the Afghan people. These are members of the civil society who are because we've lacked a central government; they are picking up and really running the social services, providing health education and human rights services. So they are desperate for partnership with the international community. It really is coming from the Arab Afghans, these are the Arab mercenaries who are fighting along side the Taliban-almost thirty to forty percent of the Taliban forces are drawn from the Pakistani mercenaries who crossed the border (this also includes) the Arabs and the Pakistanis and the Kashmir's, and the Chechens, etc.

Which is what Nicolas said earlier, that it is not even sure if the Taliban is in control or not. You're saying that the non-Afghani Arabs in the country are really running the country these days? Not just Osama bin Laden but also many people who would be like him?


Right. They are trying to pick up. In fact, al-Rashid is one of the major trusts that is run by the terrorists groups as trying to get all foreigners out of Afghanistan. (They're doing this) because if you have anyone inside of Afghanistan, they will be bearing witness to the suffering. Particularly to the gender apartheid policies that have been carried out by the Taliban. So in that sense, if you drive all the foreigners and the journalists out, you can do what you really want to do which is to create a terrorist state and a war against women.

You said that you have reported that some of Osama bin Laden followers have taken Afghan wives and some of those wives have been forced to undergo female circumcision. That is not a tradition of Afghanistan.


No it's unheard of inside of Afghanistan and I know many of the Arabs and Pakistanis who are inside of Afghanistan have taken more than one Afghan wife so there are several Afghan women who are forced to marry into these Arab families and these kinds of enforcements-the very harsh restrictions-are alien to the Afghan people.

But it's been reported that this Arab contingent is pretty much who is pretty much the group that's running Afghanistan these days-they were responsible for the foreign policy because they were the only people who actually had any access to places outside of Afghanistan-that the sanctions had pretty much cut the Taliban off and that also the Taliban's approach to governing. So could there even be a Taliban government without these people there?


We don't know what's going on. I would like to join what ???-Koffe Annan's representative in Afghanistan said a few days ago-we don't know what's going on inside of Afghanistan. We don't know what kind of relationship is happening inside of the Taliban. The Taliban has always been a fragmented group and I think that there has always been friction between Kabul and Kandahar. You should also bear in mind that there are also a few thousand more realities inside of Afghanistan. What's happening in Kandahar and what's happening in Kabul does not always happen 10 km away from Kandahar where you might have a chief of a village who runs things a totally different way. That's the type of mosaic that you have.

So there is a real problem in that there infant and mortality rates are among the highest in the world probably because the health infrastructure has fallen apart. The United States says that it is trying to help by dropping these food packets. MSF has come out with a certain amount of criticism of that approach. What's wrong with giving this food to these people?


The issue is not really giving food to the people. The issue is that in order to really help people who are in need, you have to do a number of things. You have to find out who they are, you have to be able to deliver the aid directly to them and make sure that they receive it. The needs are enormous and therefore it's clear that there is an intention to try to help through food drops. However, food drops are not a means to reach people in an effective way and to actually make sure that the most vulnerable groups receive the food. Sima spoke earlier about the widows in Kabul. There is an incredible program in Kabul where about 40,000 widows in Kabul are receiving food through a bakery system, for example. The World Food Program provides the wheat and the local and international NGOs and Afghans bake the bread or run the bakery system and then these women get tokens and can come and receive this. This is really a lifeline for survival for very vulnerable groups. These are the people who really need food right now. There are other vulnerable groups throughout the country. Scattering food in remote areas where you're not really sure who is going to receive it is not the best way of reaching those people.

Hasn't MSF also said that it is inappropriate for any military to deliver aid-if aid is not perceived as being entirely neutral or independent of the political objectives, then aid workers become targets of war?


This is really where we have to take into account the very difficult environment that we operate in-environments of conflicts-where it is very politically charged-where humanitarians are unarmed and we rely on the consent of those on the ground to allow us to go in and help the people most in need. When there is a blurring of agendas-whether it is a political agenda or a military agenda-then we really cannot say that aid is humanitarian: that it is purely based on need that it is delivered impartially-- therefore our credibility and the credibility of all humanitarian actors who are trying to do this is really jeopardized. Aid becomes part of-partisan aid becomes part of the war effort and therefore can be targets in the war. Insecurity rises, etc. So this is the reason we came out so strongly about this because of the programs that we had in Afghanistan; 400 national staff still there, we really wanted to make sure that in the eyes of the population and the authorities there that there is a clear distinction. The US is doing something, they have a military or a political objective-we're humanitarian workers, we want to be separate from it.

What about the other side? Sima, you're from Afghanistan. These packages have beans and potatoes and peanut butter, among other things. Peanut butter strikes me….


We don't know what peanut butter is. We have never seen it An Afghan is not familiar with the smell of peanut butter. That's part of the problem in addition to the politicization of the humanitarian food drops, the mechanism in which the food is dropped is the very-Afghans cannot distinguish between a plane that is dropping food and a plane that is dropping bombs.

Or whether it's poison.


The Taliban has used this mechanism to actually spread propaganda that the food is poison. Women are unable to go to the areas where the food is being dropped so it is the young children. You are talking about a country that has close to 7 million people on the brink of starvation and the food drops although a step in the right direction, are totally inadequate. You are also talking about the packages-there is nothing written in Farsi on the packages. Yes, leaflets are being dropped that we are your friends and we are dropping food but many of the population cannot read or write. Also, at the height that the food is being dropped; it becomes a weapon in and of itself. These are the kind of things that we need to take into consideration.

You said 7 million people and there are four and half million people in exile-that's a shocking number.


It's a very large number-we're talking about recent CIA statistics, which might be inflated, but that there are 24 million Afghans and 12 million of this group is women. And we're talking about a very large part of this population who has sought refuge in other countries. And many of have amassed at the borders only to find that the borders are closed.


Just to give you an example of what can happen to these food drops. We don't really know what's going on in the Taliban controlled areas-we have no observers-no witnesses there-this is a major problem.

In the Northern Alliance part we have people on the ground and we see what goes on. One group of food parcels was dropped in the Northern Alliance area. A local commander there quickly expelled all the civilians from the area, cordoned it off, gathered up all the supplies and took it off for himself and his men and went to sell it at the market. We know this because we're there-I don't want to speculate about what goes on in the Taliban controlled areas. This is where aid does not reach those who are in need.

Is it possible to get aid in there any other way? I heard that the UN got a convoy of 45 trucks with 1000 tons of food into Kabul. That seems like just a drop in the ocean here.


The needs for??? is 52,000 metric tons and so far we've been able to bring in, depending on the circumstances, 1000 tons sometimes, 1500-so we will never be able to reach our target. Particularly before the winter when it will become more difficult. I think at one point it depends very much what will be the picture of Afghanistan in the next few weeks. Problem number one is access. Access is subject to security.

Won't there be more access if this military campaign has some kind of success? Right now it seems that American troops have been able to roam around in Afghanistan…. the Taliban are on the run, aren't they?


First of all, as Nicolas said, it's a characteristic of humanitarian work that, we work with everybody. We don't work on the basis of a political agenda. We work based on the needs of the people. So we need to have access to the Taliban area. So far, we haven't had that. What happens is dependent upon if that area continues to be controlled by the Taliban and who is there, etc. So access and security will be the main problem.

I think, that at one point, we will certainly have to use civilian airdrops with basically what we've been criticizing of the military airdrops. This will need to be with an effective distribution system on the ground because without an effective distribution system, the airdrops have very little meaning. We have to come to a point where we have such a huge capacity to bring in food; otherwise we will have people dying of starvation.

Sima, do you think that the Pashtun women are looking forward to the time when the Taliban will leave?


All Afghan women are war weary. They are sick and tired of war. The women that I talk to represent all ethnicities and represent a broad spectrum of the Afghan society. Unfortunately, they are the silent majority-their voices are not heard. They are saying that we are tired of the war. We want to continue our lives and be able to rebuild our own shattered lives and those of the society. Women have not sat by idly over all of these years. They have set up and are running the centers that provide education and are running the orphanages. They are providing secret schools for the children-this is at grave risk for themselves and for their families. No thanks to the international community-they are getting no help. There are very powerful Afghan women that I have talked to and right now, I am compiling a list of Afghan women who are very strong and powerful. What is disconcerting to me is that yes, this is a very complex and a very dire humanitarian crisis which is unprecedented in the world. People are in need yet we sometimes forget that the Afghans are highly skilled. They are telling me that they don't need charity. For 22 years, no one has paid attention to the skills and the resources that Afghan women, and their male counterparts, bring to the table. Afghan women are willing and able to sit at the table to discuss peace and to discuss a format and program to rebuild Afghanistan. Yet these women are not brought to the table for these discussions.

In today's NYT magazine, there are several pages on Pashtun women who are living in Pakistan but who are very committed to this whole cause. One 36 year old mother who has a number of sons said that she would be very happy to have explosives attached to her body and become a suicide bomber for the cause of Kashmir and she would happily send her kids into jihad against the Americans. Is it because they live in Pakistan and are spared the kinds of things that you talk about that they can think that way?


Again, we're talking about very extremes and I doubt very much if this is an Afghan woman who has suffered 22 years of poverty and war and gender violence. The Afghan women that I have talked to-Pashtun and non-Pashtun-do not express that sentiment. There are minority extremes in all societies and you talk about some women who initially supported the Taliban because they thought that they would be bringing peace and security. Over time, they got fed up with their policies. I believe that this must be a Pakistani question.

Here are some questions from this audience: Oxfam has called for a cessation of bombing in order to get food into Afghanistan before winter. What is the MSF and UN position on US military action and its effects on refugee relief?


We've been discussing this issue and have come to the conclusion that we would not support right now, the call for a ceasefire in the current military situation. This is for two reasons. One is an issue of principle. We're a humanitarian organization. We deal with war. War is the central part of our lives and what we try to do in a war is to preserve a space for humanity really. That's what humanitarianism is all about. We fear that if we get into the debate about who is right and who is wrong or who should go on and who should stop, we are overstepping our bounds a little bit. We might be playing into the military or political strategies of whoever is fighting. Who would benefit right now from a stop in military operations? Maybe the humanitarians would because we would be able to bring in supplies better although that is still a question mark. Clearly there is one side in the conflict that would benefit from a ceasefire. So for not wanting humanitarian concerns to be used in a political way, we would not go into that call.

Second, for medical operations, a limited ceasefire is not really what we're looking for. We're looking for a much longer term and sustained solution. We would have to be able to be there and to deliver services on a continual basis. Just to re-supply during a ceasefire would not solve all the problems. We can understand why agencies call for this but after a lot of soul searching within ourselves, we have decided that we would not support it right now.


I would agree with many of the point that Nicolas made. I think that the main concern is that we reach a solution where there is a possibility for everybody. Where there is a possibility to do our work. I would also say that it's not just the military side; there is also the Taliban side. I think that is where we do have a lot of concern because I don't know for how long we will have access to the southern part of Afghanistan. The accounts that we receive from refugees that are coming across the border are frightening.

What's happening in Kandahar and what's happening in neighboring villages is really frightening. This is why a lot of people are leaving.

What can we do to help Afghan women and which aid organizations should we be talking to?


With regards to assistance to Afghan women, it's very important that whatever campaign is being waged here in the US to save Afghan women's lives must really convert to action on the ground. Afghan women are saying that the rhetoric is really not enough. We need to work in solidarity that many of the groups that I work with, these are community based groups that provide the critical human services and provide human rights work and are doing so with very little funding-these are courageous men and women community based leaders and we are hoping to extend and expand these efforts to other women both in Afghanistan and inside Iran. Women that I talked to, and this was prior to September 11, said that there lives were very complicated and that it's very difficult to live under the Taliban and they were urging the international community, especially the United States to bring sustained international pressure.

Afghan people in general really feel that they need to be empowered. The Afghan people have lost their voices and it has become very silent. The country is overrun with foreign mercenaries. Afghanistan has to be declared a neutral state. And its constitution has to be recognized. The foreign mercenaries, the Arabs and Pakistanis who are fighting next to the Taliban have to get out of Afghanistan. The Afghan people need to regain their own country so that they can build and reconstruct their shattered economy.

There have been so many different coalitions proposed, do any of those look like they would be any better for women? None of them look like they would change that situation very much.


Unfortunately, none of these coalitions pay very high regard to the status of women. When you're talking about the Afghan society, as in most war torn societies, you are talking about a very changed demographic where a very high proportion of the population are women and their orphaned and handicapped children. These women are supposed to be bearing the daunting task of reconstructing their countries and taking care of the family and of the elderly. Right now, all these processes are taking place with the support from the UN and from the US government and right now, Afghan women are concerned that they do not have a prominent place at the table that are being negotiated for peace. We recently had a dialogue in Switzerland with Afghan women from all ethnicities and they were saying that we have not been invited and they were demanding to sit at these tables. So I hope that this message gets across.

Are MSF doctors allowed to treat Afghan women?


Yes and that's a condition for us to stay in the country. One of our prime objectives is to treat people who are most in need. Sima has explained very eloquently that in Afghan it is really the women and the children. We have female international staff and Afghan national staff who work with us, or worked with us, even in the Taliban areas. The Taliban did have an exception for the employment of women, health was the only exception. Because in their view, an Afghan woman can only be treated by a woman, therefore they had to allow female doctors and nurses-otherwise, their own women would not be treated. The real problem that we've had is that there are very, very few Afghan women doctors left and Afghan medical staff such as engineers and highly educated people-they've left the country. So we've had very few Afghan doctors left in the country and then women doctors, even fewer. The ones that are left are mainly in big cities like Kabul and others so that in the rural countryside and in smaller towns, access to health care in practical terms, to find a female Afghan doctor who will treat someone is very remote. There is a big gender disparity in terms of living conditions between men and women in terms of health care just because of that simple fact.

To return to the refugee question, why isn't the international community asking for access to countries on the north such as Uzbekistan, Tajikistan or even China?


We have asked countries like Turkmenistan, Tajikistan and Uzbekistan to open the borders and in fact, we made a contingency plan for a number of refugees in all three countries. But all three countries maintain the same policy of closed borders. That is one reason. I think that main reason that we don't expect a large influx in the central Asia republics is at the moment, and this is probably how a lot of people will proceed, I think the main problem will be the southern and central parts of Afghanistan. These are Pashtun areas that traditionally fled to Pakistan. The second reason is that many of the people that will flee, unless it becomes a nightmarish type of exodus which can happen, but unless that happens, I would say most of the people will go with their relatives. That's what we have seen in the last few weeks. You have the money to bribe a border guard, you buy a truck, you cross the border and stay with your relatives and you go to areas where you can have reasonable living conditions. (So because of these reasons) we don't expect a major influx in the central Asia countries. I think Pakistan and Iran are the countries where we should concentrate our efforts.

Sima and Salvatore have suggested a political solution such as empowering certain politically active political leaders. One, are there any suggestions to specific leaders and two, if the US supports or empowers certain people, would they be accepted by native Afghans and would the US be criticized as paternalistic at best or coordinators of a puppet regime?


These are difficult questions; if I had the answer to these questions, I would probably not be here tonight! But anyway, what I will say is that I don't have the answer to that but I think, as many of us could suggest, will make a few methodological suggestions.

The first one is the solution is an Afghan solution. Don't ever dare, don't ever think—I don't know what my colleagues think of that—but don't ever think that you're ever going to impose a solution on Afghanistan. Keep that in mind all the time.

The second point is that this is 22 years or more of conflict, so you don't have the leadership. The leadership that you have at the moment is a lot of factions; there are a lot of problems.

Let me back up, you say that you can't impose it on Afghanistan but we have seen what happens when the people who have any power try to resolve it for themselves. Mostly they have been trying to kill each other. Can we really trust these warlords to come up with any solution?


The alternative then is to come up with a solution

Bring in people that we believe to be the moderates...


You know much better than me about the loria jura you should explain that. It probably is the most fascinating solution because it comes directly from the Afghan. All other solutions will probably go through a number of individuals who do not have a clean human rights record in the last 20 years. I probably have said too much.


I concur what Salvatore said about the solution coming from the Afghan people themselves. Afghans are very worried about a comment that Tony Blair made about the role of Pakistan in creating the future government of Afghanistan. The Afghans see the Pakistanis forces-and the Taliban actually created by Pakistan-and Pakistan is seen as another invading force. The kinds of negotiations that are taking place right now are with the major political leaders. The members of the civil society, women in particular, are not at this table and therefore, their viewpoints are not taken into consideration. I'm hoping that the mechanism that you mentioned earlier, the loria jura process which is an Afghan judicial process which is a council of elders in which women played a role in the past and we have proof of that, that this is a solution that is coming from the Afghan people themselves. What Afghans want is not a quick fix measure but to look at the situation from a long term prospective. The fact that this country has been totally devastated-- we really are calling for a Marshall Plan.

Where is the moderate Arab world in all of this? Why aren't other Arab Muslim countries helping in the humanitarian effort?


This has been going on in the last 10 years. Saudi Arabia and the United Emirates are the only countries that recognize the Taliban. They have been "helping" from a humanitarian point of view, the Taliban over the last years. We have had some offer from Saudi Arabia to finance our programs.

They did give the most money to the war effort-more than the CIA gave.


Yes but there is a slow evolution, particularly in Saudi Arabia, to create some form of Islamic NGOs. I would very much welcome to see that sort of civic society developing. I think that it's wrong that most of the NGOs come from the " Western World". That's wrong and I think one of the mistakes is not to have developed that kind of capacity and to have some kind of-this is one of the points of divisions with the international NGOs. I think that there are a lot of local resources, lots of local NGOs-born within the Afghan diaspora. I think that it's their job and it's their turn and that we should help them.

Nicolas, what would you suggest as an alternative to the food drops?


It's to support some of the efforts that Salvatore mentioned; it's to organize international groups such as World Food Program, the International Committee of the Red Cross, international NGOs who have the channels of supply and have the distribution. When Salvatore mentioned earlier on the possibility for civilian air drops-we are not against air drops as such-they are a logistical means and if you drop food and there is a system to retrieve it and to distribute it to those who need it, that's fine and I think that there are agencies on the ground who can do this job and have been there for many years and have identified the right people who should be receiving the food.

The problem with these food drops is that this food was gathered before we even knew that we were going to Afghanistan. This is what was available in huge quantities; is that why we have this strange mix of foods?


In fairness, there has been progress. In 1991, when the US dropped food on the Kurdish refugees between Iran and Turkey, they were dropping meals ready to eat and they had pork products so I'm saying that there has been an effort to think through and to find foods that are more palatable and acceptable.

This person asks a question about oil and government politics, where do we stand? Afghanistan doesn't have oil reserves but there were plans with the Taliban to set up a major oil pipeline. The Wall St. Journal welcomed the Taliban, as I remember, because they thought that we're finally going to get that major oil pipeline.


The Afghans welcomed the Taliban when they came because of the security problems in the country. There has been quite a lot of background speculation about the oil. I think that in that part of the world, whenever you talk about politics, people will say that there is a hidden agenda and that the hidden agenda is the pipeline. Is basically using Afghanistan as a place where this pipeline will go, otherwise he would have to go to the central Asia republics. If we take that theory, we can go very far but I don't think that we're prepared to go there.

We're not policy makers and some of these other questions are really fascinating but they would be more appropriate for people in Washington or people in perhaps the Northern Alliance. I'm sure that people in Afghanistan think a lot about oil and that pipeline or is that beyond the normal person's concern that they wouldn't even be aware of it?


People inside of Afghanistan aren't aware of it except the Taliban who are in negotiations with the US oil companies. From another perspective, there are vast resources that Afghan will once again serve as a transit route for Pakistan and this will serve the US economic interests. So for that reason and for US national security reasons it makes so much more sense to have a stable Afghanistan-to rid Afghanistan of terrorism and we all know that it has replaced the Golden Triangle with regards to narcotics and drug trafficking. This is how most of the war effort is funded so it makes more sense to have a stable Afghanistan and to pressure Afghanistan's neighbors to stop interfering in the internal affairs of Afghanistan and to declare Afghanistan an independent nation. And to ensure that what the Taliban has done, which has negated the Afghanistan constitution that gives rights to women, that this constitution be restored so that the Afghan people can reconstruct the country. It's in the interest regionally as well as in US national interests. It makes more sense to provide long-term development assistance to Afghanistan not just the short-term quick fixes.

Does it bother you that Benizar Bhutto, a woman who went to Oxford and Harvard I think, was such a strong early supporter of the Taliban? Their ideas were well known even then.


We were very concerned and when I go to Pakistan, I talk to many Pakistani human rights lawyers and women who don't think that Mrs. Bhutto did much for women. Again, unfortunately, the issue of gender is being used for political posturing by many women as well as by men.

I'm going to close with this question: should it have to take war to ignite global interest in civilian humanitarian concerns?


It's the silver lining but it shouldn't have to take war—obviously not. We've been trying to attract attention to forgotten conflicts, civilian that are trapped in cycles of violence that people have forgotten and who are really not even on the radar screens.

This is really one of our concerns right now is as the world focuses on Afghanistan right now, as it should, that some of these forgotten conflicts will become even more forgotten. We're talking about situations as the ongoing war in the Congo where in pure medical humanitarian terms, it's even worse than Afghanistan right now, in terms of the number of deaths and the mortality rates and the effects of disease and malnutrition and so on. There's Sierra Leone, there's Angola, and so on. I think that we are concerned that the shift in attention is obviously necessary. There has to be a big effort and focus on Afghanistan right now but it shouldn't be at the detriment of all of the other people who are suffering in other parts of the world. It's logical but I think that we should remember that.

Are you shocked at the amount and number of people who are dying of AIDS around the world-especially in Africa-that we are so obsessed with anthrax-where one person that has died and with the NY Post receiving a couple of envelopes.


Let me point out another silver lining there, which we hope might come about. We heard about Canada a couple of days ago, declaring a compulsory license on the manufacture, to use the generic version of the patented drug, Cipro because it was facing an unprecedented health emergency and it felt that the health and well-being of its citizens was at such risk that it had to take this measure. Not a single case of anthrax has been declared in Canada so far and that's good-I'd like for it to remain that way. But this is the type of measure that has been opposed by Canada and the US. In international trade agreements, there has been this possibility to do this and the US and Canada has opposed this. Canada is on record as one of the four states going into the world trade agreements negotiations as opposing patents being waived in cases of acute health crisis. They've done it. Maybe they will change their minds and maybe the US will change their minds. Maybe health will become more important than patents in cases of severe crisis in Africa.

Sima, you have said more than once this evening that people in Afghanistan have felt totally ignored until this happened. I get the feeling that you don't feel all that sure that after everything is resolved, that your concerns will be addressed at all.


I certainly don't see the signs and I'm distressed about that. I hope that will change and I'm also-well we as an organization and trying to get the voices of women and their men counterparts across. We've struggled for 20 years to get this message across and unfortunately, the pleas of the Afghan women were not heard until the unfortunate events of September 11. You've realized that through this unfortunate event that what really happens in Kabul impacts upon you and you in NY here. It's unfortunate that this has happened but it has brought Afghanistan to light. Unfortunately, the long-term solution that is aimed at solving the humanitarian crisis and the development crisis is really not taking place and I hope that there will be signs towards that. I think that as an Afghan and as a woman, I've had difficulty trying to convey the horror of the Afghan people. I think that what I leave you with is that to get an understanding of what the Afghan women have been through over the last 22 years under the Taliban, if you intensify the September 11 attacks and multiply it in terms of intensity and in terms of longevity, then the horror of the Afghan women will begin to penetrate your psyche-and the Afghan people in particular. It's been a very difficult struggle that we've been waging and I hope that this time around, the US will not walk away.

Salvatore, many people in this country cannot understand why there is so much resentment towards the US in Afghanistan. After all, we sent four or five billions dollars in arms for the fight against the Soviet Union. People from Afghanistan have said, yes and the Soviets left and the US lost all interest in us. Do you see any kind of a silver lining in all of this? Do you think Washington will recognize that there are long-term effects to US policies?


I'm going to pass!

Does the UN ever say, well, you did this and then you walked away and this may cause some trouble?


We have been saying this for a very long time and as you know, very often the United Nations is not heard. I think that going back to what Sima was saying is very true. This is a time for opportunities and also a time for concerns. It certainly is a time for opportunities because the reason why we didn't manage to get peace in Afghanistan for a very long time was because the major players were not interested: the major players over here and the major players in the region. But it's also a time for concern and I think for all of those who have been associated with this crisis for a very long time we do have a lot of concerns. The first one is the quick fix. The fact that everyone will get tired and will want to fix this problem very quickly-they jump on the first person that can offer a solution. That's a problem-the quick fix.

The second one is the short memory, which is linked to the first one. It's like everybody wakes up one day and says what is Afghanistan? There have been a lot of problems in that part of the world and we have often forgotten what we have experienced in the past.

The third concern is that we forget about people and that's what a politician does very often. They come up with solutions that serve their self-interests and they don't realize that at the end of the day, any political situation has to go through people. If it doesn't respond to the needs of the people, that's not politics. And I'm afraid that what we might see is not politics but we'll see realism, which is what we have seen in Afghanistan for a very long time. So our work is to look out for people but I'd say let the Afghans, finally after 22 years, to have the possibility to look after themselves and we haven't allowed them to do that.