Afghanistan: insufficient access to health care exacerbates humanitarian crisis

The summer fighting season is at its height, and civilians, above all, are paying the price – either directly, as victims of the violence, or indirectly, as they face massive difficulties obtaining health care.

The security situation is depriving a large part of the Afghan population of access to health-care facilities. Moreover, health personnel are also often unable to reach areas of the country where the need for care is high and the ability to provide it is low. Some health-care facilities have been directly attacked.

Over the past three months, discussions have intensified with detaining authorities on the transfer of detainees held by the international forces to Afghan custody to ensure that, both during and after transfer, conditions and treatment are in accordance with international humanitarian law, and that detainees are afforded adequate procedural safeguards and judicial guarantees.

Meanwhile, a two-month ICRC training programme for disabled basketball players culminated in a four-day wheelchair basketball tournament in Kabul on 15 June. The championship was won by the Maimana team, after a searing match against Herat. The two-month programme was part of the ICRC's efforts to promote sport for the disabled within its social reintegration programme, which also includes vocational training and micro-credit loans for patients, and home education for disabled children.

Visiting places of detention and restoring family links

The ICRC monitors 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 April to June, ICRC staff:

• carried out 89 visits in 57 places of detention;
• monitored 1,167 detainees individually and visited 421 of them for the first time;
• paid the transport costs for seven ex-detainees to return to their home villages;
• collected over 7,550 Red Cross messages and distributed nearly 6,700, mostly between detainees and their families, with the help of the Afghan Red Crescent Society;
• enabled families of people held in the Detention Facility in Parwan and in the Afghan National Detention Facility in Parwan to make 1,693 video telephone calls to their detained relatives;
• facilitated 1,132 family visits by providing transportation that enabled the families of detainees held in the Parwan facilities to visit their loved ones in person.

Providing health care

Supporting health facilities is a major part of the ICRC's work in Afghanistan. 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. In addition, it provides 47 Afghan Red Crescent clinics with technical and financial support, medicines and medical supplies. The ICRC also provides first-aid kits in front-line areas, and conducts first-aid training for combatants and civilians to enable them to treat the wounded.

Between April and June, Sheberghan Hospital admitted 4,683 inpatients and held 28,287 outpatient consultations. 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 665 fighters, Afghan National Security Forces, Afghan Local Police, Ministry of Public Health personnel, and taxi drivers;
• made monthly deliveries of drugs and other items to three ICRC-run local health posts in the south and east.

Providing limb-fitting and physical rehabilitation services

The ICRC runs seven prosthetic/orthotic centres throughout Afghanistan which provide rehabilitation services for amputees and others with disabilities. The centres support the social reintegration of disabled people by providing vocational training, micro-credit loans and home education for children. There is also a home-care service offering medical, economic and social support to paraplegics.

From April to June, the seven ICRC centres:

• registered nearly 2,370 new patients, including 340 amputees;
• assisted 21,983 patients;
• fitted almost 4,050 prostheses and orthotic devices;
• held more than 67,825 physiotherapy sessions;
• granted micro-credit loans to some 210 patients to help them start small business ventures;
• provided vocational training for 227 patients, 63 of whom completed their training during this period;
• conducted 1,926 home visits to treat patients with spinal cord injuries.

Distributing food and other aid

In cooperation with the Afghan Red Crescent Society, the ICRC distributes food and other items to people adversely affected by conflict or natural disaster. The ICRC also organizes food-for-work projects in different provinces to enable breadwinners to support their families, and runs training programmes for livestock owners to provide them with basic veterinary skills.

From April to June, the ICRC and the Afghan Red Crescent:

• distributed 172 metric tonnes of wheat, rice and beans to 1,954 families of participants in food-for-work projects;
• distributed one-month food rations and household items to 3,827 families displaced by conflict or natural disaster;
• distributed a total of 1,200 two-month-old chicks to 600 women in 20 villages in northern Afghanistan to help them support their families by raising chickens. The women also received 25 metric tonnes of chicken feed, and basic equipment such as water drinkers and feeders for their poultry;
• held 24 training sessions for a total of 400 livestock owners to help improve animal husbandry in the south and central regions. A total of 400 basic veterinary kits were given to the participants. Kits were also provided to 39 para-vets who supply farmers and livestock owners with medicines.

Improving water and sanitation services

The ICRC works closely with local water boards to help bring clean water to rural and urban communities by drilling wells, installing pipelines and training communities in hand-pump maintenance. The ICRC also helps prison authorities improve standards of hygiene and sanitation in places of detention.

Between April and June, the ICRC:

• installed pipelines and drilled wells as part of an effort to bring clean water to over 17,000 people in urban areas of Kandahar province;
• installed hand pumps and trained people to maintain them, and upgraded spring catchments as part of an effort to bring clean water to almost 230,000 people in rural areas of Kabul, Kapisa, Parwan, Bamyan, Paktia, Ghazni, Nangarhar, and Kunduz provinces;
• carried out hygiene-promotion sessions for some 8,000 people in Kabul, Herat, Farah, Laghman, Jalalabad, Kunduz and Balkh (Mazar-i-Sharif);
• helped improve water supplies and sanitary conditions for 1,619 detainees in three provincial prisons;
• continued renovation work at Mirwais Hospital in Kandahar.

Promoting compliance with international humanitarian law

Reminding warring parties of their obligation to protect civilians is a fundamental part of the ICRC's efforts to promote compliance with international humanitarian law worldwide. The ICRC also spreads knowledge of international humanitarian law among civil-society groups, government bodies and academics.

From April to June, the ICRC:

• gave presentations on international humanitarian law to over 325 members of the national army, the national police and local police units, and the National Directorate of Security;
• held briefings about the mandate and work of the ICRC for over 3,800 people, including community elders, religious scholars, members of provincial councils, political authorities, NGOs and beneficiaries of ICRC assistance programmes.

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.

Between April and June:

• with support from the ICRC, the Afghan Red Crescent Society distributed food, household items, seed, fertilizer and tools to families affected by the ongoing conflict in different regions.

Afghanistan is the ICRC's biggest operation in terms of committed resources. The organization has more than 1,630 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.