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Salim Akbar O 2009 June MA.Pdf (434.2Kb) HEALTH EDUCATION IN THE PRACTICE OF DEVELOPMENT: Afghanistan, Child Participation and the Child-to-Child Approach by OMAR AKBAR SALIM A thesis submitted to the School of Kinesiology and Health Studies in conformity with the requirements for the degree of Master of Arts Queen’s University Kingston, Ontario, Canada June, 2009 Copyright © Omar Akbar Salim, 2009 ii Abstract For over thirty years Afghanistan has been challenged by war, political and civil instability, mass displacement, human rights abuses, drought, and famine. It is not surprising that health and quality of life of vulnerable groups in this region are among the worst in the world. In general, women and children have had especially limited access to education and healthcare. The situation in Afghanistan is difficult, but by no means impossible and renewed international focus combined with shifting internal dynamics provide a real opportunity to change the trajectory of the country and lives of millions of Afghans. With regard to internal dynamics, the health and education of children, I believe, provide one of the greatest opportunities for Afghanistan to build a new and peaceful path in the twenty first century. At the heart of a successful development strategy in Afghanistan will be stitching together local capabilities and resources and tailoring projects to context. Afghan children present an ideal starting ground. This thesis asks the question: how might children’s participation and the Child-to-Child approach to health education and community development be used effectively in Afghanistan? I analyze the possibilities and limitations of the Child-to-Child approach were it to be implemented in the traditional/Islamic context of Afghanistan. More broadly, I highlight external and internal forces that are affecting and will continue to shape future health intervention and development projects such as Child-to-Child in Afghanistan. I conclude that, at this time, Afghan children will receive adequate and long term health care (through initiatives such as Child-to-Child) only when essential and basic services/needs are met, geo-political conflicts between industrial nations over iii Afghanistan are resolved and future intervention programs are designed using culturally sensitive strategies not only to provide health services but also to address the underlying non-medical determinants of health related to Afghanistan’s development process. iv Acknowledgements This thesis project is dedicated to my parents Mumtaz and Salem, whom I am eternally grateful and deeply thank for their continued love, guidance, support and inspiration in completing this study. I am especially thankful to my supervisor Mary Louise Adams whom provided outstanding flexibility and encouragement to help me complete this project. I also wish to thank my family including Frishta, Zemar and Rebecca, whose ongoing support and unconditional love made this project possible. A special thanks to my dear friends Jonathan Hall, Nicky Potopsingh and Nike Ayo for their warm companionship during my tenure at Queen’s. I would also like to express my sincere appreciation to all my professors, my classmates and the staff at Queen’s University for making my graduate experience incredibly enriching and memorable. Above all I wish to express my deepest gratitude to God, The All Beneficent, The Most Merciful. v Table of Contents Abstract................................................................................................................................ i Acknowledgements............................................................................................................ iv Table of Contents................................................................................................................ v Chapter 1: Introduction ..................................................................................................... 1 Rational & Research Question................................................................................ 8 Chapter Organization............................................................................................ 15 Method .................................................................................................................. 16 Chapter 2: Afghanistan in Context.................................................................................. 21 A Brief History ..................................................................................................... 22 Afghanistan: Post Semptember 11, 2001.............................................................. 30 Afghan Culture: Meaning & Definitions .............................................................. 36 Ethnicity, Collective Society, Gender Seperation & Islam as Religion ............... 44 Ethnicity................................................................................................................ 45 Collective Identity................................................................................................. 47 Women & Gender Seperation............................................................................... 49 Islam as Religion................................................................................................... 54 Chapter 3: Afghanistan’s Children in Context................................................................ 63 Meaning & Dimensions of Children & Young People’s Participation................. 68 The Negative Consequences of Children & Young People’s Participation ......... 76 Support for Child-to-Child in Afghanistan........................................................... 79 The Case for Children’s & Young People’s Particiaption in Develoment Efforts........................................................................................... 81 The Child-to-Child Approach to Health & Community Development ................ 84 An Example: Child-to-Child in Nepal .................................................................. 89 Child-to-Child Limitations.................................................................................... 90 Chapter 4: Conclusion..................................................................................................... 95 Afghanistan & the Child-to-Child Approach........................................................ 97 Summary............................................................................................................. 110 References........................................................................................................... 113 1 Chapter 1 Introduction: The transformation of a traditional society could only be achieved extremely slowly, and certainly not by wrecking its existing structures and relationships (Ewans, 2002: 135). Less than a month after the terror attacks on September 11, 2001 on the World Trade Center and Pentagon, the United States and its allies declared a “war on terror” and subsequently began military campaigns in Afghanistan and then Iraq. Political leaders of western nations including the United States, the United Kingdom and Canada rushed to war on arguments of national security and moral responsibility. Canada fully entered the war in Afghanistan (sanctioned by the United Nations Security Council) and avoided the war in Iraq. Like other nations Canada addressed problems in Afghanistan “without understanding the whole, using atavistic, haphazard, fragmented, and short-term responses that sometimes exacerbate the collection of problems” (Ghani & Lockhart, 2008). The current conditions on the ground have demonstrated that the use of force has reached its limits and neither a “war of necessity in Afghanistan nor a war of choice in Iraq has yet succeeded” (Ghani & Lockhart, 2008:5). Following the removal of the oppressive Taliban regime in 2001, the new government and the international community had what Afghan-born development policy expert Dr. Ashraf Ghani (2008) calls an “open moment in Afghanistan”. This “open moment” presented a real opportunity for Afghan leaders and the international community to work towards a shared and functional development strategy (Ghani & Lockhart, 2008). Afghanistan’s citizens, traumatized by generations of foreign invasion, civil war and severe natural disasters had been desperately seeking improvements in 2 security, employment, health care, life expectancy, educational opportunities and better access to food, water and shelter. And initially some progress was achieved in the country (following the 2001 military intervention), including: relative peace and security around the country, 5 million refuges returning home, 80 percent of the population obtaining access to at least some health care and 6 million children returning to school (www.canada-afghanistan.gc.ca, 2008). However, since then and despite a heavy international presence (military and development), Afghanistan has become a perpetual nightmare of violence, corruption, criminality and humanitarian crises. What happened? According to Ghani and Lockhart (2008), Afghan political leaders during the “open moment” had a “chance to become the founding fathers and mothers of a new state building project” but instead most “opted for personal gain and compromise” (pg. 12). The international community, originally welcomed by most Afghans, has been increasingly perceived as having broken its promise to secure and rebuild the nation. Aid organizations and media outlets regularly report that innocent civilians are killed by military raids and air bombings conducted
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