Afghanistan: outlook remains bleak despite progress in some areas

Ten years of war-driven economic change has resulted in better infrastructure, and access to global markets, services and communications, especially in urban areas. But the lack of security is still a major problem in many rural areas, and communities in conflict-affected regions remain highly vulnerable.

The proliferation of pro- and anti-government armed groups makes for a very unstable security environment. In addition, roads blocked by checkpoints, or sown with improvised explosive devices, as well as harassment and intimidation by the different warring parties, are part of the daily life of many Afghans living in villages.

Efforts have been made to recruit and train Afghan army and police forces over the past year, and the transfer of responsibility for security from international to Afghan control is well under way. However, Afghanistan is facing a very uncertain future, with humanitarian needs still growing and donor interest likely to fade over time as the international forces withdraw.

"One of the most pressing issues of concern for the ICRC is the difficulties faced by rural communities trying to obtain safe access to local medical services in areas where conflict is raging," said Reto Stocker, who heads the ICRC delegation in Afghanistan.

"A slow-onset drought is making life precarious for people in dozens of districts in the north and west of Afghanistan," he added. "Simple poverty is as much a factor as anything else contributing to people's sense of vulnerability."

The ICRC continues to work closely with both the international and Afghan detaining authorities to ensure that they understand and live up to their responsibilities with respect to conditions, treatment, procedural safeguards and judicial guarantees for detainees under their care. Challenges remain, but an open dialogue exists with the different authorities and the ICRC has regular access to places of detention countrywide.

In accordance with its mandate, the ICRC reached out to the warring parties throughout 2011, to promote awareness of, and respect for, the rules of war, and simple humanity. The delegation also maintained a dialogue with all sides, including the armed opposition, to ensure acceptance and respect for the humanitarian work of the ICRC. Despite this, access to the field became increasingly difficult owing to poor security. Innovation and stronger working relations with partners were required to remain close to people in need.

Visiting places of detention and restoring family links

The ICRC is mandated to monitor the conditions in which people are held and the treatment they receive in places of detention worldwide. In Afghanistan, ICRC delegates regularly visit prisons run by nations contributing to the NATO-led International Security Assistance Force (ISAF), by US forces and by the Afghan authorities. The ICRC also helps family members separated by conflict to stay in touch with one another, and endeavours to trace missing persons.

From January to December 2011 ICRC staff:

• carried out 336 visits to 112 places of detention;
• monitored 3,271 detainees individually and visited 2,309 of them for the first time;
• paid the transport costs for 29 ex-detainees to return to their home villages;
• collected 15,837 Red Cross messages and distributed 12,562, mostly between detainees and their families, with the help of the Afghan Red Crescent Society;
• facilitated 3,077 video telephone calls between families and their relatives held in the US-run Parwan detention facility at Bagram airfield;
• facilitated 1,136 family visits by providing transportation that enabled the families of detainees held in the Parwan facility to visit their loved ones in person.

Providing health care

The ICRC provides medicines and medical support to Sheberghan Hospital in the north and Mirwais Regional Hospital in the south, both of which are run by the Ministry of Public Health. Over 20 expatriate doctors, nurses and administrative personnel are supporting the staff at Mirwais. The ICRC also provides technical and financial support and medicines to 47 Afghan Red Crescent clinics, and to community-based first-aid volunteers who deliver health care to people in conflict-affected areas. In addition, the ICRC runs four first-aid posts, one in the west and three in the south.

During 2011, Mirwais and Sheberghan Hospitals admitted almost 61,530 inpatients and held nearly 204,200 outpatient consultations between them. More than 13,560 surgical operations were performed in the two hospitals.

In addition, during the same period, the ICRC:

• delivered medical supplies to the front lines to treat people injured in the fighting;
• provided first-aid training for 1,183 combatants, doctors, police and community-based first-aid volunteers;
• made monthly deliveries of drugs and other items to three health-care clinics in the south and east.

Providing limb-fitting and physical rehabilitation services

The ICRC runs seven prosthetic/orthotic centres which provide rehabilitation services for amputees and others with disabilities. The centres support the social reintegration of disabled people, ranging from landmine victims to those with spinal cord injuries. They also run a home-care service offering medical, economic and social support for paraplegics. The ICRC has been providing these services in Afghanistan for over 20 years.

In 2011, the seven ICRC centres:

• registered nearly 7,480 new patients, including 1,224 amputees;
• assisted 73,552 patients;
• fitted almost 14,400 prostheses and orthotic devices;
• held more than 201,850 physiotherapy sessions;
• granted micro-credit loans to approximately 720 patients to help them start small business ventures;
• provided vocational training for 248 patients, 244 of whom completed their training during this period;
• conducted 6,856 home visits to treat patients with spinal cord injuries.

Distributing food and other aid

This remains one of the ICRC's major activities in Afghanistan. The service comprises emergency food distribution, "food-for-work" projects and support for agriculture and livestock programmes. The ICRC provides this aid to communities displaced by conflict or natural disaster in close cooperation with the Afghan Red Crescent.

During the year 2011, ICRC staff, together with Afghan Red Crescent staff and volunteers:

• distributed nearly 920 metric tonnes of wheat, 524 metric tonnes of rice, and 410 metric tonnes of bean to over 12,070 participants in food-for-work projects;
• distributed one-month food rations and household essentials to over 19,110 families displaced by the conflict or floods;
• trained farmers in basic veterinary skills, and supported the de-worming of nearly 227,000 and the vaccination of more than 42,400 animals;
• distributed one-off food rations to help 2,177 farmers to meet their immediate food needs, in addition to providing farmers with seed, tools and fertilizer to help them increase almond and pistachio production, and also providing them with oil-press machines and micro-credit loans for income-generating projects;
• helped hundreds of men and women in the north to vaccinate their poultry.

Improving water and sanitation services

ICRC water engineers are working closely with local water boards on urban and rural projects. The organization promotes hygiene awareness in religious schools and detention centres, and with families in their homes.

In 2011, the ICRC:

• installed pipelines and drilled wells as part of an effort to bring clean water to nearly 230,000 people in urban areas of Kabul, Farah, Nangarhar, Laghman, Kunar, Kandahar, and Kunduz;
• installed hand pumps and trained people to maintain them, and upgraded spring catchments as part of an effort to bring clean water to over 182,000 people in rural areas of Kabul, Kapisa, Bamyan, Herat, Farah, Badghis, Laghman, Jalalabad, Kandahar, Helmand, Balkh, and Kunduz provinces
• carried out hygiene-promotion sessions for some 56,870 people in Kabul, Herat, Farah, Laghman, Jalalabad, Kunduz and Balkh (Mazar);
• continued to improve the water supply and sanitary conditions for nearly 11,875 detainees in 13 provincial prisons;
• continued renovation work at Mirwais Hospital in Kandahar.

Promoting compliance with international humanitarian law

Reminding parties to a conflict of their obligation to protect civilians is a fundamental part of the ICRC's efforts to promote compliance with international humanitarian law worldwide. The organization also spreads knowledge of international humanitarian law within civil society, government bodies and the armed forces.

Throughout 2011, the ICRC:

• gave presentations on international humanitarian law to over 3,120 members of the Afghan national army, the Afghan national police, the armed opposition, and the National Directorate of Security;
• held briefings for over 20,000 people, including community elders, members of religious circles, provincial councils, NGOs and people receiving aid from the ICRC.

Working in partnership with the Afghan Red Crescent Society

The ICRC provides the Afghan Red Crescent Society with technical and financial assistance to help it deliver services to the community and to implement a range of programmes.

In 2011, the ICRC:

• provided support for a training-of-trainers workshop on volunteer management for 49 Afghan Red Crescent supervisors and volunteers;
• distributed food and household items, seeds fertilizer and tools to beneficiaries in close cooperation with the Afghan Red Crescent (see assistance section above)

Afghanistan is the ICRC's biggest operation in terms of resources committed. The organization has more than 1,600 national staff and 146 expatriates based in its main delegation in Kabul and in five sub-delegations and 11 offices countrywide. In addition, it operates seven prosthetic/orthotic centres.