International support remains critical in order to avoid the collapse of critical services – food aid, health, education, and other essential services.
The people of Afghanistan have been suffering from the cumulative effects of over 40 years of conflict and political turmoil. Today 18.4 million people, almost half of the total population, are in need of humanitarian assistance. Severe droughts are recurring in Afghanistan, resulting in nearly 14 million food insecure people, with over 3 million children facing severe malnourishment. The recent displacement of 550,000 people is adding to an estimated 2.9 million who remain internally displaced and in need of humanitarian assistance, while winter months are around the corner.
International support remains critical in order to avoid the collapse of critical services – food aid, health, education, and other essential services. Although humanitarian aid will not be able to address all the needs created by the freezing of development funding, international humanitarian assistance is needed now more than ever before in Afghanistan. Funding should prioritise urgent humanitarian needs, including winterisation and the response to the drought, while ensuring sufficient resources for managing increased access and security and safety-related costs for NGOs. Impediments to cash transfers and other operational restrictions, including those resulting from anti-terrorism legislation, must be lifted immediately and borders must remain open both for the movement of people and of essential supplies.
Although the recent turbulent changes push Afghanistan into a period of considerable uncertainty, placing our humanitarian activities under further pressure with increased challenges notably related to security and safety, Intersos continues to deliver life-saving activities today. While there are ongoing difficulties, Intersos has so far not experienced radical change in its operating environment, and we remain operational with no new restrictions, including with regards to the inclusion of our female staff in the projects.
The ongoing engagement with the current De facto Authorities in Afghanistan remains an important part of our strategy to obtain access to people we assist, as it was prior to the events of August. This engagement policy is conducted with all parties to the conflict, in accordance with core humanitarian principles and standards, and our code of conduct. Furthermore, Intersos is fully collaborating with local partners, based on principles of complementarity, and engaged with the aid community in order to respond to the growing crisis. We strongly believe that the aid community needs to speak with one voice to the new authorities, as well as to international community.
Our intervention in Afghanistan
Our projects in the Country are concentrated in the provinces of Kandahar and Zabul, where the conflict has been particularly acute since the last quarter of 2020. In these areas we guarantee support to several primary health centers in the districts of Spin Boldak, Maywand, Shawalikot , Zheray as well as to Qalat hospital and Kharwaryan and Shajoy health centers in Zabul province.
The health system in Afghanistan
After the collapse of the previous government and the subsequent stop of development funding, dozens of health facilities have been closed and more and more people are turning to our health centers. Especially in the more remote areas. In the Province of Kandahar, in the districts of Maywand and Panjwaye, we manage two Trauma Points, which are specialised health facilities, open 24 hours a day, able to provide first aid to injured people but also to the victims of road and domestic accidents. Two doctors, one of whom is a general practitioner, three nurses and a radiologist are involved in stabilising the most critical cases, reducing the risk of death and complications related to trauma, and providing diagnostic X-ray services in case of fractures and of orthopedic implants. Cases with severe injuries requiring advanced care – amputation and rehabilitation, skull fractures requiring further examination – are stabilised and referred to Mirways Regional Hospital in Kandahar. In addition, at Trauma Points we provide essential equipment, drugs and other medical supplies.
Twenty to thirty people a day are treated in our two Trauma Points.
In addition, we support the health system with two health centers and three mobile clinics, consisting of a doctor, a midwife and three nurses – one of whom is a nutrition expert and the other is in charge of carrying out routine vaccinations for communicable diseases. Our medical teams perform rapid diagnostic tests for specific diseases such as malaria and syphilis, provide pre and postnatal care and transfer women at risk to secondary health care. Finally, we support the Qalat hospital through staff training and the supply of medicines and medical supplies.
Maternal and child health in Afghanistan
In Afghanistan only 60% of births take place in the presence of health care professionals and 600 women out of 100,000 die in childbirth. This is a number 300 times higher than the figure for a country like Italy, where there are 2 cases of death for every 100,000 births. In the health centers we support we provide counseling, vaccinations and routine treatments; we refer HIV suspected cases for advice and further tests to the regional hospital of Kandahar, since services are not available locally and to mitigate the risk of stigmatisation of the assisted people; we guarantee safe births and provide health care to mothers and babies through neonatal and postnatal visits; we distribute kits for newborns.
We also deal with the therapeutic treatment of severe acute malnutrition for children aged 6-59 months, as part of the Outpatient Therapeutic Program (OTP), and continuous screening to identify cases of malnutrition. Cases of severe malnutrition, on the other hand, are referred to the reference structures in Spinboldak, Maywand, Zheray, the Provincial Hospital of Qalat and the Mirwais Regional Hospital in the city of Kandahar, where they receive the routine treatment required by the treatment protocols of systemic infections.
Since last year we have also been at the forefront in the fight against the Covid-19 pandemic, with the distribution of personal protective equipment, triage and training sessions for healthcare personnel and awareness of good hygiene practices. In addition to health interventions, our commitment in Afghanistan, further strengthened in recent weeks, also concerns psycho-social assistance and economic support for vulnerable people, in particular women – including women survivors of gender-based violence – children and the elderly.
We should remember that we have faced difficulties in the past, but as humanitarians, our presence and our response has always been guided by humanitarian needs, rather than nation-building agendas or changing political agendas. Responding to the needs in Afghanistan today is no exception.