14 World Health • 49th Year, No. 6, November-December 1996 Afghanistan: a nation beset by war Ashour Omar Gebreel

The children of Afghanistan became a "zone of peace" in November 1994, when hostilities were stopped for a week to allow an immuniza­ tion campaign to go ahead.

n Afghanistan during the past 16 years of war, the process of devel­ Iopment has been interrupted. The entire socioeconomic infrastructure Land mines take a heavy toll of civilians, like this 12-year-old in one of the hospitals still functioning has collapsed, and with it the health in Kabul . care system. Although most parts of Afghanistan are peaceful now vices, the Ministry of Public Health services and train personnel needs to (August 1996), except around Kabul, and WHO are encouraging decentral­ be strengthened; casualty and emer­ more than 16 million people are ization. The country has been divided gency services need to be expanded struggling to survive in an economy into eight regions and responsibility because of the large number of that has been shattered by years of for finances and management of injuries from landmines and contin­ prolonged war. Almost three million health services has been delegated to ued fighting; and communicable refugees have returned to try and the regional health authorities. WHO diseases (especially malaria, tuber­ cultivate their land but it has been is encouraging district health ser­ culosis, leishmaniasis and diarrhoeal sown with some 10 million mines. vices to promote better health and diseases) have to be kept under Another 3-4 million Afghan disease control. Discussions be­ control. Safe water and sanitation refugees remain outside the country tween WHO, other United Nations are urgently needed, as are supplies and are unlikely to return while the agencies and nongovernmental of essential drugs, vaccines and basic infrastructure and services are organizations have led to the forma­ basic equipment. still lacking. tion of a regional primary health care Many hospitals and health centres network based on community partic­ have been damaged or destroyed. In ipation and the local mobilization of Kabul, eight of the 14 hospitals are resources. not functioning either because of WHO has set up eight sub-offices structural damage or due to the lack in different parts of Afghanistan. of electricity, water, medical supplies The main WHO office in Kabul has and equipment. Many medical pro­ been moved temporarily to Jalalabad, fessionals and teachers have left the and there is also a WHO Supporting capital because their homes or work­ Office in Islamabad, in neighbouring places are destroyed, or simply Pakistan. These moves seem to be because they fear for their lives. the most logical, economical and practical way of maintaining a sus­ Strategic obiectives tainable health delivery system. There are three strategic objec­ Refrigerated vaccines were taken even to As part of a plan to rehabilitate and tives for the health system: the remote areas during the immunization develop Afghanistan's health ser- country's ability to manage health campaign in Afghanistan. World Health • 49th Year, No .6, November-December 1996 IS

Immunization of children is in Training and rehabilitation great demand. Whether people live in the cities or in remote corners of WHO is assisting the country's the rugged countryside they still medical schools at Herat, Jalalabad, want their children to be immunized. Kabul and Mazar. Fifth-year medical In 1994-95, a three stage mass students from Herat, Jalalabad, immunization campaign was carried Mazar and Peshawar whose educa­ out. In the first stage of the cam­ tion was interrupted by the outbreak paign, one million children were of the fighting, have completed their immunized in 120 districts. In view final years in Jalalabad and are ready of the difficulties that had to be to take up their responsibilities in the overcome at this stage, there were regional health system. WHO sup­ some concerns as to whether the ports health training institutions and personnel and the cold chain could in-service training courses in disease be doubled in time for the second and detection and control, health infor­ third stages of the campaign which mation, medical emergencies and the aimed to reach more than two million Part of a shipment of emergency medical supplies for hospitals in Ka bul. management of district health ser­ children in 220 districts. Through vices. A special training programme, the united efforts of everybody a certificate course on district health involved, and with the help of some children of Afghani stan became a practice, a training workshop on 13 000 health workers and volun­ "zone of peace" in November 1994 curriculum development and a teers,these goals were surpassed. when hostilities were stopped for a diploma course in mental health have Three thousand vaccination posts week to allow the immunization been arranged for students from all were set up throughout the country campaign to go ahead. Roads were parts of Afghanistan. and more than 2.3 million Afghan opened for medical supplies and WHO is helping to rehabilitate children under the age offive and equipment, and millions of mothers the water supply system in the city of about 740 000 women of childbear­ and children were able to travel Kandahar in order to bring safe water ing age were vaccinated during the safely to the vaccination posts. The to more than 250 000 people (20 000 second and third stages of the cam­ following year the "health ceasefire" families). The pumping station and paign. The mass immunization as it was called lasted for two water treatment laboratory have been campaign is to be repeated in order months. WHO believes that using restored, 97 kilometers of pipeline to consolidate this achievement. The health as a justification for a tempo­ repaired, and pressure installed, aim is to reach 265 districts, immu­ rary ceasefire may eventually lead to thanks to funding from several nizing at least 90% of children under a lasting peace. We are only too well United Nations agencies and the one year of age with one dose of aware of the scarce resources avail­ Qatar Charitable Society. This measles vaccine, at least 80% with able to the health services in project symbolizes efforts to bring two doses of combined diphtherial Afghanistan, which at present are in practical help to communities by pertussis/ tetanus vaccine, and pro­ total disarray. Yet ways must be promoting economic recovery in viding tetanus toxoid immunization found to meet the health needs of the peaceful areas of Afghanistan. Safe to all women of childbearing age. Afghan people in an equitable man­ water supplies are also being brought The vaccinations took place in a ner that will reduce disease and to Faizabad, Ghazni and Jalalabad. very difficult environment but the minimize the devastating effects of armed conflict on the country's socioeconomic recovery. •

Dr Ashour Omar Gebreel is WHO Representative to Afghanistan, based at the WHO Supporting Office, P 0. Box 1936, Islamabad, Pakistan .

New arrivals at a camp for the displaced in)alalabad. Health services are being decentralized to meet the needs of the many displaced persons.