The New York Times reports: [D]espite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.
Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.
Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.
One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.
Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.
Now, M.S.F. is planning to open five satellite clinics with intensive feeding programs in Lashkar Gah to take the pressure off the overcrowded hospital.
Despite the increase in the malnutrition caseload, doctors and health officials are not sure there has actually been a sharp rise in child malnutrition that can be attributed to any single factor.
“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.
In part, expansion of the hospital’s facilities has acted as a magnet, drawing more cases, Mr. Vandormael said. Unlike at other public hospitals in Afghanistan, patients and their caregivers do not have to pay for their own medicine and food at Bost. And M.S.F. has been able to ensure that it gets regular deliveries of Unicef-provided therapeutic foods used to treat malnutrition.
“Our treatment is better, so we get more patients as they hear about it,” said Dr. Yar Mohammad Nizar Khan, head of pediatrics at Bost Hospital.
Nonetheless, the numbers are still worrisome. Dr. Mohammad Dawood, a pediatrician at Bost Hospital, said there were seven or eight deaths a month there because of acute malnutrition from June through August, and five in September. Doctors around the country have reported similar rates.
Officials at Unicef and the Afghan Ministry of Public Health have declined to characterize child malnutrition here as an emergency, however. As defined internationally, that would mean severe acute malnutrition in more than 10 percent of children younger than 5; health officials in Afghanistan estimate the rate is more like 7 percent.
“Science-wise, the increase in number of children reporting to the hospitals is not an absolute evidence the situation is getting worse,” said Moazzem Hossain, head of nutrition for Unicef here. “It’s a good sign, the program is expanding, more are being screened, more are being found and treated.”
Another problem is unreliable statistics.
In January 2012, for instance, Unicef and the Afghan government’s Central Statistics Organization released a survey of more than 13,000 households showing that some provinces had reached or exceeded emergency levels, with more than 10 percent acute severe child malnutrition.
The survey caused an uproar, but Unicef and the Health Ministry repudiated it, saying it was based on faulty research. Unicef then financed a more thorough child nutrition survey, which was completed in November, but the government has yet to release the data, said Dr. Bashir Ahmed Hamid, head of nutrition for the Health Ministry. “Unfortunately, we faced some challenges with data analysis.”
Dr. Hamid said he expected the new data to show very high levels, probably more than 50 percent, of long-term or chronic malnutrition, which shows up as stunted growth in children. While acute malnutrition can be fatal, chronic malnutrition can cause multiple health and developmental problems. [Continue reading...]
The Associated Press reports: Afghanistan President Hamid Karzai lashed out at the United States, accusing it of making threats in the dispute over an agreement to keep U.S. troops in the country beyond 2014.
In an interview published Tuesday by the French daily Le Monde, Karzai says the U.S. is “absolutely” acting like a colonial power in its attempts to force him to sign the bilateral security agreement by the end of this year. The paper quoted him as saying: “The threats they are making, `We won’t pay salaries, we’ll drive you into a civil war.’ These are threats.”
Washington and NATO officials say the pact is critical to the plan to keep thousands of forces in Afghanistan after 2014 for a training and counterterrorism mission. [Continue reading...]
William Dalrymple writes: The Karzai family graveyard lies a few miles outside Kandahar, on the edge of the village of Karz. On the day I drove there, burned-out cars stood rusting by the sides of the road, children splashed through open drains and bullet holes riddled the mud walls opposite checkpoints. Amid all this, the graveyard stood out — gleaming, immaculate. Straggling bougainvillea and mulberry trees blossomed over the calligraphic tiles topping the cream-colored walls. Through the double gates were lines of cypresses. In the middle stood a domed enclosure containing the graves of the clan elders.
Hamid Karzai was entering the final lap of his presidency, and I had traveled to Karz with Mahmood, one of the president’s elder brothers, accompanied by a phalanx of his bodyguards. Afghanistan’s presidential election is set for April, and as the deadline for registering candidates approached, the country’s future seemed to hang in part on the fraught internal family politics of the Karzais. Hamid is ineligible to run for a third term, and it had been long rumored in Kabul that he would anoint his brother Qayum as his successor. Mahmood had made it clear that he wanted the presidency to stay in the family; he had even begun to raise campaign funds for Qayum, just as he once had for Hamid.
So far, however, the president had been publicly silent on the subject, and Qayum had yet to tip his hand. Mahmood’s business dealings — banking scandals and supposedly dodgy real estate deals — had long been perceived as Hamid’s Achilles’ heel, and it remained unclear whether family loyalty would trump the president’s growing preoccupation with his own legacy. All this, along with Karzai’s angry rhetoric against the alleged misdeeds of his American backers, had caused some tensions around the family table. “I don’t feel comfortable talking to Hamid these days,” Mahmood said as we rode in his armored Land Cruiser, sandwiched between pickup trucks full of troops. “These ridiculous conspiracy theories. And his cynical view of the West. These ideas aren’t helping Afghanistan. I don’t think he understands the importance of a good economic policy.”
On arrival, however, the sight of the massed Karzai dead quickly brought back Mahmood’s sense of dynastic solidarity. “See over there — the grave with the old carved headstone?” he said. “That was my grandfather, the real leader of the family. He migrated to Karz from the west of the province and bought this land.”
He then pointed to a poster of a mustached man on the guardhouse: “That’s my uncle, Khalil.” Khalil was killed in the 1980s. Some say he was murdered in a family dispute, but Mahmood told me he was assassinated during the war with the Soviets. “And over there,” he continued, “another uncle. Also assassinated.”
We walked into the domed mausoleum where two recumbent gravestones were covered with pink plastic flowers: “My father’s grave,” he said, lowering his voice to a whisper. “He was shot dead leaving a mosque. And that, by his side, is Ahmed Wali, my half brother.”
He didn’t bother saying what we both knew, that Ahmed Wali Karzai, the head of Kandahar’s provincial council, effectively governor of Kandahar and the man suspected by the West of controlling part of the Afghan heroin trade, but who also helped the C.I.A. operate an anti-Taliban paramilitary group, was himself killed by a trusted member of his inner circle. The shooting took place not far from where we were standing, two years earlier, almost to the day. I asked if anyone else in the family died violently. “Many!” Mahmood replied. He pointed to the different grave plots: “One, two, three . . . altogether about eight. Maybe more.”
From the graveyard, we headed on into Karz, where the brothers spent their childhood. Low mud-brick houses flanked the road. “Imagine having to live in these conditions!” Mahmood said. “If I had my way, I’d demolish the entire village, rehouse everyone in apartments and turn this space over to agriculture.” After decades in the United States, where he started an Afghan restaurant chain, it all seemed a bit of a surprise to him: “Imagine hanging up goat meat in the sun in this heat! So unhygienic. . . . And all these people just sitting there. Do they have nothing to do, for crying out loud? Just look how weak the retail community is here. Call these shops? What era are we in — the Roman Empire?”
I had asked to see the house where the brothers grew up, but after several false turns, we still couldn’t find the place. None of them had been back for years, not least because the village is now in the hands of a rival leader of the clan, their cousin Hashmat Karzai, and relations between the two factions of the family are not cordial.
“It’s changed beyond all recognition,” Mahmood said. “This mosque I remember: I used to play with Hamid over there. But the vineyards! Where have they gone?” Eventually his driver came to a stop. “This is it?” Mahmood asked. “It can’t be.” We got out in a field of dried mud, surrounded by mud houses with egg-carton domes. Mahmood summoned an old man in a turban wandering past and after conferring with him, announced: “The driver’s right. This is our home.” He gestured at the empty space around us.
“What happened?” I asked.
“The Russians.” He paused. “Any clan who were known to be prominent in the mujahedeen had their property seized or demolished.”
For the first time, Mahmood looked deflated: “Qayum and I were in the U.S., but Hamid and my father were prominent in the jihad. These houses here,” he said, pointing at the mud houses, “this was where my cousins lived. The same night the Soviet governor sent troops to demolish our house, they were all called out and lined up. Then they were shot. Every last one of them.” [Continue reading...]
The Washington Post reports: A growing number of Afghan interpreters who worked alongside American troops are being denied U.S. visas allotted by Congress because the State Department says there is no serious threat against their lives.
But the interpreters, many of whom served in Taliban havens for years, say U.S. officials are drastically underestimating the danger they face. Immigration attorneys and Afghan interpreters say the denials are occurring just as concerns about Taliban retribution are mounting due to the withdrawal of U.S. forces.
“There are tons of Talibs in my village, and they all know that I worked with the Americans,” said one interpreter, Mohammad, who asked that his last name not be published for security reasons. “If I can’t go to the States, my life is over. I swear to God, one day the Taliban will catch me.”
Mohammad received a U.S. form letter saying he had failed to establish that there was a “serious threat” against his life. He had explained in his application that the Taliban had spotted him on the job and spread word in his village that he was a wanted man. [Continue reading...]
Matthieu Aikins writes: In the fall of 2012, a team of American Special Forces arrived in Nerkh, a district of Wardak province, Afghanistan, which lies just west of Kabul and straddles a vital highway. The members installed themselves in the spacious quarters of Combat Outpost Nerkh, which overlooked the farming valley and had been vacated by more than 100 soldiers belonging to the regular infantry. They were U.S. Army Green Berets, trained to wage unconventional warfare, and their arrival was typical of what was happening all over Afghanistan; the big Army units, installed during the surge, were leaving, and in their place came small groups of quiet, bearded Americans, the elite operators who would stay behind to hunt the enemy and stiffen the resolve of government forces long after America’s 13-year war in Afghanistan officially comes to an end.
But six months after its arrival, the team would be forced out of Nerkh by the Afghan government, amid allegations of torture and murder against the local populace. If true, these accusations would amount to some of the gravest war crimes perpetrated by American forces since 2001. By February 2013, the locals claimed 10 civilians had been taken by U.S. Special Forces and had subsequently disappeared, while another eight had been killed by the team during their operations.
Officials at the American-led International Security Assistance Force, or ISAF, categorically denied these allegations, which came at an extremely delicate moment – as Afghan President Hamid Karzai and the American government were locked in still-unresolved negotiations over the future of American forces in Afghanistan. The sticking point has been the U.S.’s demand for continued legal immunity for its troops, which Karzai is reluctant to grant. Privately, some American officials have begun to grumble about a “zero option” – where, as in Iraq, the U.S. would rather withdraw all its forces than subject them to local law – but both sides understand that such an action could be suicidal for the beleaguered Afghan government and devastating for American power in the region. Yet a story like the one brewing in Nerkh has the potential to sabotage negotiations.
Last winter, tensions peaked and President Karzai ordered an investigation into the allegations. Then on February 16th, a student named Nasratullah was found under a bridge with his throat slit, two days, his family claimed, after he had been picked up by the Green Berets. Mass demonstrations erupted in Wardak, and Karzai demanded that the American Special Forces team leave, and by April, it did. That’s when the locals started finding bodies buried outside the American base in Nerkh, bodies they said belonged to the 10 missing men. In July, the Afghan government announced that it had arrested Zikria Kandahari, a translator who had been working for the American team, in connection with the murders, and that in turn Kandahari had fingered members of the Special Forces for the crimes. But the American military stuck to its denials. “After thorough investigation, there was no credible evidence to substantiate misconduct by ISAF or U.S. forces,” Col. Jane Crichton told The Wall Street Journal in July.
But over the past five months, Rolling Stone has interviewed more than two dozen eyewitnesses and victims’ families who’ve provided consistent and detailed allegations of the involvement of American forces in the disappearance of the 10 men, and has talked to Afghan and Western officials who were familiar with confidential Afghan-government, U.N. and Red Cross investigations that found the allegations credible. In July, a U.N. report on civilian casualties in Afghanistan warned: “The reported disappearances, arbitrary killings and torture – if proven to have been committed under the auspices of a party to the armed conflict – may amount to war crimes.” [Continue reading...]
The New York Times reports: Perhaps nowhere in Afghanistan presents a bleaker picture of addiction than Herat Province. Widely held up as a success story, the province enjoys a booming economy, a relatively progressive society and a vibrant capital free of the trash-strewn streets and waterways that choke most large Afghan cities.
But beneath the surface, Herat is contending with the country’s most serious drug addiction problem.
The head of the counternarcotics ministry in Herat says there are 60,000 to 70,000 addicts in the province, though some health officials figure the number is closer to 100,000. In the capital, roughly 8 percent of the population uses drugs, the new international report found.
The addiction crisis brings with it all manner of problems, including crime and public health concerns. A 2010 report by Johns Hopkins University found that about 18 percent of intravenous drug users in the provincial capital were infected with H.I.V., compared with just 3 percent in Kabul.
Long a staging area for men who work as day laborers in Iran, Islam Qala is now also a frequent waypoint for addicts returning to Herat. Most of the men say they picked up their habits while in Iran. The authorities there, struggling to deal with a widespread drug crisis of their own, are quick to banish Afghan addicts back across the border by the thousands, and the deported people stream back into Islam Qala six days a week.
In Herat’s capital, addicts fill the streets and parks, begging from pedestrians and motorists with relentless persistence. Pockets of the city have been transformed into junkie ghettos, like Kamar Kulagh, a roadside slum of sandbags, rocks and rags. [Continue reading...]
After thirteen years of war, a mission long described as an effort to win hearts and minds, for many Afghans for generations to come, the enduring memory of America will be of this nation’s grotesque wastefulness. America will have become synonymous with trash as the legacy of a pointless war will be precisely that: a pile of trash.
But as if to highlight America’s exceptional relationship with trash, in this instance in an orgy of destruction, items of value are first getting crushed before they get left behind.
The Washington Post reports: The armored trucks, televisions, ice cream scoops and nearly everything else shipped here for America’s war against the Taliban are now part of the world’s biggest garage sale. Every week, as the U.S. troop drawdown accelerates, the United States is selling 12 million to 14 million pounds of its equipment on the Afghan market.
Returning that gear to the United States from a landlocked country halfway around the world would be prohibitively expensive, according to U.S. officials. Instead, they’re leaving behind $7 billion worth of supplies, a would-be boon to the fragile Afghan economy.
But there’s one catch: The equipment is being destroyed before it’s offered to the Afghan people — to ensure that treadmills, air-conditioning units and other rudimentary appliances aren’t used to make roadside bombs.
“Many non-military items have timing equipment or other components in them that can pose a threat. For example, timers can be attached to explosives. Treadmills, stationary bikes, many household appliances and devices, et cetera, have timers,” said Michelle McCaskill, a spokeswoman for the Pentagon’s Defense Logistics Agency.
That policy has produced more scrap metal than Afghanistan has ever seen. It has also led to frustration among Afghans, who feel as if they are being robbed of items such as flat-panel televisions and armored vehicles that they could use or sell — no small thing in a country where the average annual income hovers at just over $500.
In Afghanistan, nicknamed the “graveyard of empires,” foreign forces are remembered for what they leave behind. In the 1840s, the British left forts that still stand today. In the 1980s, the Russians left tanks, trucks and aircraft strewn about the country. The United States is leaving heaps of mattresses, barbed wire and shipping containers in scrap yards near its shrinking bases.
“This is America’s dustbin,” said Sufi Khan, a trader standing in the middle of an immense scrap yard outside Bagram air base, the U.S. military’s sprawling headquarters for eastern Afghanistan. [Continue reading...]
Reuters reports: A U.S. bid to run unilateral counter-terrorism operations in Afghanistan after 2014 is threatening to derail a security pact between the two countries, an Afghan spokesman said, underlining Afghanistan’s tenuous ties with its main backer.
Most foreign combat troops are due to leave by the end of 2014, and the United States has been putting pressure on Afghanistan to finalize a bilateral security agreement by the end of this month.
The pact will set out the terms of a U.S. presence after 2014 and will be followed by similar deals with other countries such as Germany and Italy.
But two issues have emerged as potential “deal breakers”, President Hamid Karzai’s spokesman, Aimal Faizi, told reporters late on Tuesday. [Continue reading...]
Afghanistan is on the verge of momentous change as U.S. and NATO troops prepare to withdraw in 2014. Will this be the dawn of lasting stability or will the country slip back into war? What kind of commitment will be required to address the huge problems facing the country? “The Hard Places” is a new feature-length documentary that will examine these questions about the future by first looking back and chronicling the extraordinary journey of Dr. Tom Little, a man who chose to forsake a life of comfort and security in order to make a lasting difference.
American optician Dr. Tom Little arrived in Afghanistan just before the country entered a relentless series of conflicts that has lasted to the present day – from Soviet occupation, to civil war, to Taliban rule and the U.S. invasion following 9/11. Despite almost constant danger he, his wife and children decided to stay and live among the people they served. Little’s dream was to create a sustainable eye program that would train native Afghans to become eye doctors and to establish eye clinics throughout the country to treat the thousands of people suffering from vision problems in that unforgiving environment. Little believed it was his calling to help those who had no options, who were caught up in violent circumstances, but yet whom he also saw as fellow human beings in need of a healing touch. Today, in large part because of his perseverance and dedication, his organization, IAM, provides nearly 90% of all eye-care in the war torn nation.
In July of 2010, Tom and a team of fellow aid workers backpacked 120 miles into the remote province of Nuristan at the invitation of village elders to serve a population of nearly 50,000 people with no access to medical care. On August 5th, 2010, as he and his team were only a day trip away from solid roads returning to Kabul, they were ambushed and murdered in the wilderness. In 2011, in recognition of his life’s work and sacrifice, President Obama posthumously awarded Tom Little the Presidential Medal of Freedom, the highest honor bestowed upon any U.S. citizen.
We need a film that examines the real cost of lasting change and shines a light on those who take on the challenge. In recent days we have seen an increased incidence of aid workers being targeted by militants whose goal is to make bridge building between East and West impossible. The goal of “The Hard Places” is to reveal the lasting impact of Dr. Little’s work and use his story as a lens to investigate the challenges, dangers and successes of international aid work and highlight the continuing need for medical training, sustainable development and medical access for the Afghan people.
Please consider supporting this project by making a donation at Kickstarter — and to appreciate Lukas and Salome Augustin’s talent as filmmakers, watch Afghanistan – Touch Down in Flight:
Reza Mohammadi writes: When the Taliban’s poetry book was published in the UK this month, many found it very strange indeed, but someone who understands the culture and lifestyle of Afghans knows how important poetry is to Afghans. On a visit to Jalalabad during the orange flower blossom celebration, I have felt the power of poetry within the people. As each word was recited by poets, people would rise up, cheer, and then sit down. This is how Afghans live and breathe poetry and drown in an illusion and dream.
The Taliban are like other Afghans, humbled by poetry, and their connection to poetry is older than their connection to radical Islam, the Kalashnikov and grenades.
The history of poetry in Afghanistan dates back millennia. It flourished during the reign of Sultan Mahmud of Ghazni, who ruled from 998 to 1030, and was a man of literature and poetry, with more than 700 poets living in his palace. But 100 years before the Sultan of Ghazni, Persian literature was born in the court of the first Persian king, Yaqub, in Nimruz, a western province of Afghanistan. It is said that one day a poem was recited in Arabic to praise him, but as Yaqub didn’t understand Arabic he ordered that no poem should be recited in a language he did not know. So the literary men of the court were forced to compose poems in Farsi, the language of the king. And the rest is history.
Poetry is everything to Afghans, we hear and recite poetry from cradle to grave. Regardless of our ethnicity, whether we are Tajik, Hazara, Pashtun, Uzbek, Turkmen, Nuristani, Baluch, or any other of the hundreds of sub-ethnic groups, Afghans are threaded together by poetry.