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Monthly Humanitarian Bulletin Humanitarian Bulletin Afghanistan Issue 65 | 1 – 30 June 2017 In this issue SG Guterres meets IDPs in Kabul P.1 Humanitarians fill trauma care void P.2 HIGHLIGHTS Difficult return after four decades P.4 UN Secretary-General António Guterres met with Lower wheat harvest forecasted P.5 displaced families in A man is being lifted into an ambulance in Helmand. Photo: WHO Kabul. Humanitarian organizations provide Guterres: Solidarity with displaced people trauma care that is not During the month of Ramadan, on 14 June, UN Secretary-General António Guterres paid funded by the public Afghanistan a one-day visit. In the morning, he visited displaced families in an informal system. settlement behind the Arzan Qeemat fruit market in an eastern outskirt of Kabul. In a mud house where one of the displaced families lives he met separately with elders and a Darzab District Hospital group of women from a displaced community from Tagab district, Kapisa. damaged in an airstrike on “The women and men I met the first day of fighting. spoke of their houses destroyed Families returning from and members of their families Pakistan after decades being killed, but they also spoke about the will to rebuild their life, face a difficult future. the will to have their children in The country faces an school and the will to go back home as soon as peace and import requirement of 1.4 security are re-established,” million tons of wheat but Secretary-General Guterres told no substantial rise of the journalists the same day. market price of flour. The lives of the 85 families living in the informal settlement CHF-Afghanistan funded are representative for the lives Secretary-General António Guterres meets Mr. Agha Shireen and another with one third of its target of approximately 70,000 elder from a displaced community in Kabul. Photo: Kirk Kroeker/UNAMA. halfway through the year. displaced people currently living in similar settlements in Kabul. Some of the families from Tagab arrived one year, others only three months ago. “The first families to flee were those whose houses were destroyed by the fighting,” Mr. Agha Shireen, one of the elders of the displaced community, explained. “Most of us were farmers. We grew corn, wheat and pomegranates on our fields.” Only a few children can go to school, many are sent to collect garbage or beg HUMANITARIAN When they were forced to leave their homes, they decided to come to the capital Kabul, in search of security and livelihoods. “We came here for work, but there are no jobs for RESPONSE us,” he adds. The fathers and sons try to find work as day labourers, earning at the most PLAN FUNDING AFN300 (US$4.40) a day if they get hired, at all. 27% FUNDED “We do not want to be beggars,” one of the elders declared. Rather, they would hope to receive small cash grants to kick-start small businesses, as some returnees have done, 550 million benefiting from UNHCR cash grants. The reality, however, is that displaced families requested (US$) across the country receive humanitarian assistance for two months upon arrival in an urban centre and not much else. With protracted displacement, many of them join the 149.7 million ranks of the urban poor, struggling every day to buy food. Received (US$) Displaced girls and boys are even more vulnerable than adults. Often, they get sent to sift through garbage or to beg. “Living here is dangerous for our children,” one of the women http://fts.unocha.org told Guterres. “We live next to a big road and two or three of our children have already by 7 July 2017 Afghanistan Humanitarian Bulletin | 2 been killed in road accidents.” Only very few girls and boys can continue their education, as most of them lack the school achievement certificates to be admitted to public schools in the city. “In our village, everything is One older women pointed out the difficulties to access health care services. “There never green and our life was good. seems to be place for us when we go to a Government hospital and we cannot afford to We want to go back. The pay for a private clinic,” she explained. Pregnant women mostly deliver their babies in the moment the security allows camp, with assistance by some of the grandmothers. “We have done that many times, but us to return, we go back to sometimes the mothers die and there is nothing we can do.” our village and to our fields.” None of the displaced women in the informal site wants to stay in the city, instead they dream to go back to their homes. “In our village, everything is green and our life was good,” one of the women said in the exchange with Guterres. “We want to go back. The moment the security allows us to return, we go back to our village and to our fields.” A country in conflict lacking public trauma care In a country where conflict causes a record high of casualties, typical war surgery like extracting shrapnel or amputating severed extremities is in high demand. A demand, that in Afghanistan has to be met most often by humanitarian health delivery partners, as trauma care is not part of the basic public health service. This fact is grounded in how the modern Afghan health system was conceived 15 years ago: Faced with severe underfunding and a weak network of health facilities, key donors decided to provide health services by contracting NGOs. These NGOs were and are required to provide all the services defined by the Ministry of Public Health (MoPH) in the so-called Basic Package of Health Services (BPHS). The BPHS was later complemented by the Essential Package of Hospital services (EPHS). Together, these two documents are the framework of the public health system in the whole country from a health post or basic health centre in rural areas to district and provincial hospitals in the urban centres. The Basic Package of The BPHS covers maternal and new-born health, Health Services (BPHS). immunization, childhood illnesses, malnutrition, covers maternal and new- communicable diseases, mental health and disabilities. born health, immunization, Emergency trauma care was never part of these basic NGOs implement the BPHS under the childhood illnesses, services catalogued by the BPHS. aegis of the Government. Source: MoPH malnutrition, communicable The expectation at the time was that mostly road diseases, mental health and accidents would cause trauma injuries which would be dealt with in hospitals after a swift disabilities. Emergency referral. Therefore, the focus was laid on improving some of the world’s worst public trauma care was never part health indicators. of the BPHS. BHPS was successful in improving some of the worst public health indicators The model of delivering the BPHS via NGOs under the aegis of the MoPH proved to be a big success: Within two years, three quarters of the population had access to health care, according to the Ministry. To date, under-five child mortality dropped by 30 per cent and maternal mortality by 75 per cent since 2003. At the Presidential Summit on Health Care on 1 June President Ashraf Ghani emphasized that the partnership between the MoPH and NGOs had come a long way in improving health conditions of millions of Afghans. He also remarked that this system had proven remarkably resilient at reaching patients despite the many operational and security-related challenges the NGOs face. Rolling out a health system by contracting NGOs has even become a model for other countries, like Rwanda or Uganda, too, and it continues strongly in Afghanistan: Currently, a total of 19 NGOs are contracted by the Government as implementers of the BPHS-services, funded notably by the European Union, USAID and the World Bank with an estimated $200 million every year. unocha.org/afghanistan | www.unocha.org United Nations Office for the Coordination of Humanitarian Affairs (OCHA) • Coordination Saves Lives Afghanistan Humanitarian Bulletin | 3 Humanitarians increasingly fill a void For years, humanitarian health partners have worked with their own funding alongside the BPHS-implementing NGOs to provide supplementary health services or reaching patients In the last twelve months, in underserved, uncovered or hard to access areas. Last year, the Afghan Red Crescent humanitarian partners have Society (ARCS), 22 national and 14 international NGOs were active in addition to the treated more than 38,000 government’s (BPHS) health partners across the country. patients with significant With intensified conflict, the number trauma injures. of patients in need of life-saving treatment is increasing. The majority of these patients seek assistance in health facilities run by partners providing trauma care and are not paid by the MoPH. In the last twelve months, humanitarian partners have treated more than 38,000 patients with significant trauma injuries. Humanitarian partners also have helped the hospitals run by the MoPH to better deal with this type of arrivals Source: Health Cluster Afghanistan in the emergency rooms: In six provincial hospitals they trained doctors and staff how to provide effective trauma care or how to deal with mass casualty incidents. But capacities of humanitarian partners are limited. Some health NGOs providing trauma care in conflict areas had to curtail their services and only still treat conflict-casualties, focusing on life-saving war surgery. $30 million for the health sector from the CHF-Afghanistan in three years Faced with the current intensity of conflict the lack of trauma care provided via the public health care system has become a veritable structural gap that humanitarian partners struggle to fill. The growing pressure on life-saving health services is also reflected in the 2017 Humanitarian Response Plan (HRP) in which the Health Cluster requested more than $52 million, up from $40 million the previous year.
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