The Humanitarian Crisis in Afghanistan

A Congressional Briefing Delivered in Washington, D.C. by Nicolas de Torrente, Executive Director, MSF-USA to a Joint Hearing of the U.S. Congressional Near Eastern and South Asian Affairs Subcommittee and International Operations and Terrorism Subcommittee of Senate Foreign Relations Committee
October 10, 2001

Ladies and Gentleman,

I am grateful to Senators Wellstone and Boxer and their staff for convening this hearing today and for giving me the opportunity to present Doctors Without Borders/Médecins Sans Frontières (MSF)'s perspective on the humanitarian situation in Afghanistan.

First of all, I would like to express the deep shock that all MSF staff and volunteers around the world felt following the September 11 attacks on the United States and extend our condolences to the friends and families of the victims. These deliberate attacks, which indiscriminately targeted civilians, were an all-out assault on the fundamental values and principles that we as a humanitarian organization hold so dear. We have been extremely impressed by the rescue and recovery operations in New York, and, in a modest way, were able to contribute to this effort by providing an MSF mental health team experienced in mass trauma to support New York's own excellent mental health professionals.

I would also like to take this opportunity to clarify, up front, some confusion regarding MSF's stance on the US actions taken since Sunday. As a humanitarian organization, our concern with any military actions, including those undertaken by US forces in Afghanistan, is with their impact on the civilian population. Our intention is also to raise concerns regarding the blurring of lines between military and aid activities - such a mixing of roles has the potential to undermine the provision of larger-scale humanitarian assistance by independent, non-governmental actors to the most vulnerable populations in Afghanistan, as I would like to explain, below.

First, please allow me to briefly share with you the salient features of the severe humanitarian crisis currently facing Afghanistan.

The Severe Humanitarian Crisis in Afghanistan

MSF has been working in Afghanistan for over 20 years. In fact, I just returned from Faizabad, in the Northern Alliance-held territory, in late August. At that time, MSF had over 70 international volunteers and over 400 Afghan staff present in all areas of Afghanistan. MSF volunteers were running hospitals, clinics, providing essential health care services and responding to emergencies, particularly epidemics, and health problems resulting from population displacement and malnutrition.

Over 20 years of war and three years of uninterrupted drought have combined to force hundreds of thousands of Afghans from their homes, exposing them to increasing insecurity, disease and hunger.

Today, due to internal conflict and regional tensions, civilians are trapped within the cycle of violence, and are suffering from persecution, repression and other violations of international humanitarian law from different sides.

The drought has compounded the effects of the ongoing conflict by gradually depleting people's coping mechanisms. Our surveys show a consistent deterioration of the nutritional situation in all areas, now reaching emergency levels for millions of people (more than 10% of children under 5 were measured as being acutely malnourished). There have recently been outbreaks of scurvy (vitamin C deficiency) and epidemics of diseases (cholera, measles, diarrhea) that easily kill malnourished children. We are concerned that with high levels of malnutrition, these people face a long winter before there is even the chance of a new harvest.

Throughout Afghanistan, war and drought has resulted in massive displacement. In recent months, hundreds of thousands of people have been leaving their lands, homes and families out of fear or hunger or both, and fleeing to vast makeshift camps around the major cities or to neighboring countries.

For MSF, carrying out effective humanitarian action requires the constant presence of our teams on the ground so they can assess the needs of the civilians, provide assistance to the most vulnerable, and evaluate the impact of our programs on the target population. In Afghanistan, it has been difficult to gain the necessary conditions for access and appropriate delivery of humanitarian assistance, especially to women, but it has been possible. Throughout our 20 years in Afghanistan, maintaining direct contact with the population and dialogue with the different actors, as well as demonstrating focused and clear humanitarian goals has been critical to our operations. This has become more difficult in recent years for several reasons, including the increasing restrictions on NGO operations by the Taliban regime.

Since September 11, rising tensions, and grave uncertainty about the security situation led to the withdrawal of MSF and other international humanitarian staff. This is jeopardizing the programs that provide a lifeline to the vulnerable Afghan population, and also makes it difficult to really know what is happening inside the country.

Today, our main goal is to bring our teams back up to full capacity. To do this, we require that all parties to the conflict guarantee safe and unhindered access to the Afghan civilians in need. Up until the air strikes, convoys of food and medical supplies were re-supplying our programs in Mazar-I-Sharif, Herat and Kabul. Our Afghan staff remains in the country, very committed and able, and we are able to monitor the situation somewhat through communication with some of them. Although the supplies and the size of the teams are currently insufficient, these programs remain important sources of medical and nutritional assistance to the Afghan population. These efforts are currently suspended due to the military operation.

A main point I would like to raise today is our concern regarding the impact that military actions have on humanitarian actions inside Afghanistan, and why we in MSF feel it is so important to maintain a clear distinction between these two endeavors. Allow me to elaborate more on this latter point.

Concerns Regarding Integrating Humanitarian Operations within a Military Strategy

The US has stated clearly that the delivery of aid is an integral component of its comprehensive anti-terrorism strategy. President Bush's recently announced $320 million aid package is a reflection of this approach, building on the longstanding generosity of the US government for assistance programs towards Afghanistan. One of the key objectives of this strategy is to win over public support in Afghanistan and elsewhere for the US's comprehensive assault on terrorism, by conveying the message that the US strikes at the Taliban leadership and Osama-bin-Laden network, but reaches out to Afghan civilians. Clearly, there is an enormous need for assistance, especially as winter approaches. However, we have a number of concerns about the blurring of lines between the current military and humanitarian actions.

First, I would like to make a quick point on the airdrops themselves. As has already been stated by administration officials, air drops of food by the US military, even if well-intentioned, are not the most effective means of meeting the enormous humanitarian needs of the Afghan people. Air drops should include the clear identification of beneficiaries, careful monitoring of the distribution of assistance, and transparency in implementation of the operation. Our experience has taught us that delivering untargeted and unmonitored relief is generally ineffective and can even be potentially harmful. For instance, medicines need to be delivered through health structures and administered by qualified health staff if they are to be effective, and not risk causing more harm than good. Malnourished persons require specialized food and care. By packaging individual rations, the US military's intention is to limit diversion of aid into the hands of military forces. However, this still does not ensure that the aid benefits those who need it most. Aid agencies on the ground have done extensive work to identify and target those most in need, whether they are displaced persons in camps or widow-headed household in major cities. Without independent assessments and monitoring on the ground, it will be very difficult to be convinced that airdrops have reached these people.

Most importantly, however, we believe that the military and humanitarian agendas and activities should be clearly separated. This is not about semantics or abstract principles, this has very direct implications in terms of security of humanitarian staff and access to populations in need.

The Geneva Conventions defines humanitarian action as neutral, independent and impartial. This means that humanitarian actors should not take sides and should be free from political influence so they can go after their objectives single-mindedly - to impartially help people based solely on criteria of need. If aid is not perceived to be entirely neutral and independent of political objectives it can be claimed by one or both sides as a part of the war effort. Aid and aid workers can then become targets of war.

Gaining access and providing assistance to vulnerable populations under the sway of armed factions in a politically charged climate is always very difficult. Ultimately, it rests on demonstrating that the motives for helping the civilians are purely humanitarian. By making aid delivery an essential means of reaching its political and military objectives, the US-led effort could well taint those independent and impartial humanitarian actors whose programs have provided the bulk of the assistance to Afghans for many years, and whose efforts will be needed for years more.

In the aftermath of the current events, it will be increasingly difficult to convince armed factions of the impartial objectives of western humanitarian organizations in very volatile and politically charged environments. Recent attacks on UN offices in Quetta, Pakistan, are a reflection of this problem. And it is not a new one: in Somalia, the confusion of roles and agendas of the political and military actors with those of humanitarian organizations resulted in neither side being able to reach their objectives, with dramatic consequences for both.

What is needed now is a large-scale independent humanitarian relief effort aimed directly at reaching those most in need in Afghanistan and neighboring countries. This response could be provided by independent humanitarian organizations and UN agencies. All parties to the conflict, including the Taliban, must allow for the delivery of large-scale convoys of basic foodstuffs and medicines by humanitarian actors who can ensure that it is delivered to those who need it.

Afghan Refugees

In recent months, in addition to the approximately 4 million refugees in neighboring countries, hundreds of thousands of Afghans have fled their country in search of security and assistance abroad: over 400,000 to Iran, and some 200,000 to Pakistan. Our work with a large number of these refugees has shown that fear, violence and persecution have been a key factor in this population's decision to leave the country. Many also seek to escape the ravages of the drought.

Knowing the dire medical and nutritional consequences of massive displacement, we understand why one important reason to inject food aid into Afghanistan may be to prevent further displacement. But it is important to remember that these necessary aid efforts, even if they are successful, cannot provide a guarantee of protection for the civilian population. The right of the Afghans to seek safe asylum must be respected. MSF is extremely concerned with the closing of all international borders with Afghanistan and the containment of the population. Non-refoulement, or the right not to be forcibly returned to an insecure area must also be upheld.

Currently, we have not witnessed the expected mass influx of Afghans across international borders. There is much speculation as to the reasons for this: have Afghans abandoned the more exposed, larger towns and taken shelter in the countryside? Have they been blocked along the roads? We don't know for sure, but what is certain is that borders remain officially closed, with even tighter controls than before. Only those who can afford the high price of smugglers can flee, leaving the poorest and most vulnerable behind.

We are also very concerned that, despite the ongoing preparations of aid agencies, led by UNHCR and including MSF, were refugees to arrive in big numbers today, they would not be adequately protected and assisted in host countries. For a number of years, Pakistan and Iran have been increasingly reluctant to accept newcomers, and our ongoing experience working in Jalozai camp in Peshawar shows how difficult it is to assist Afghan refugees in Pakistan. New sites that have been identified for refugee camps in Pakistan are situated in insecure and inaccessible areas close to the border. In these locations, the safety of the refugees, and of the aid workers who would try to assist them, is far from assured. Moreover, these are desolate areas, where water and shade are in very scarce supply.

The borders must be opened to allow refugees to flee warfare and persecution. The internationally recognized right to seek protection and receive asylum in neighboring countries must be upheld. Adequate steps to receive refugees in safe and appropriate conditions must be taken.


To conclude, what is critical for MSF is that, in the midst of conflict, the fundamental needs of protection and relief for the Afghan people are met.

Therefore MSF would like to underline the following points:

  • The rights of the Afghan civilian population to safety and humanitarian assistance should be assured by all parties to the conflict,
  • By maintaining a clear distinction between military actions and aid operations, the US government will contribute to the future involvement of independent and impartial humanitarian actors in Afghanistan,
  • The US Government should insist on the opening of the borders of neighboring countries to Afghan refugees,
  • A large-scale independent humanitarian relief operation led by international and non-governmental organizations is needed inside and outside Afghanistan to provide effective assistance and protection to the civilian population, solely on the basis of assessed needs and in an impartial fashion. In neighboring countries, the conditions for refugees - current and future - must be substantially improved.

Mr. Chairman, we are grateful for the opportunity to express our concerns today in front of the Senate Committee on Foreign Relations.

This testimony was delivered to the Committee on Foreign Relations' Subcommittee on Near Eastern and South Asian Affairs (Chairman Wellstone, D-Minn.) and its Subcommittee on International Operations and Terrorism (Chairman Boxer, D-Calif.), with Senators Wellstone Boxer presiding. Witnesses presenting testimony included:

  • Mr. Andrew S. Natsios

    , Administrator, US Agency for International Development (Department of State)
  • Ms. Christina Rocca

    , Asst. Secretary of State for South Asia
  • Mr. Alan Kreczko

    , Acting Asst. Secretary of State, Bureau of Population, Refugees and Migration
  • Mr. Ken Bacon

    , President, Refugees International
  • Ms. Eleanor Smeal

    , President, Feminist Majority