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Afghanistan
HEALTH
Before the war, the health situation in Afghanistan was among
the worst in the world primarily because the health infrastructure
was grossly inadequate and mostly limited to urban centers. Protracted
conflict since 1978 worsened the inequitable distribution of health
manpower and services. The estimated infant mortality rate was
163 per 1000 live births (1993); the under five mortality rate
257 for every 1000 live births (1994); the maternal mortality
rate 1700 per 100,000 live births (1993); and life expectancy
at birth was 43.7.
Since infant and under five mortality rates are frequently used
as reliable overall indicators of community health and development,
these figures underscore the appalling state of the health sector
in Afghanistan. Most children die of a variety of infectious and
parasitic diseases, including acute diarrhoea, respiratory infections,
tuberculosis, diphtheria, poliomyelitis, malaria, measles and
malnutrition, in addition to disorders allied to pregnancy and
delivery.
The tragedy is that 80 to 85 percent of these diseases can be
avoided by preventive measures and by the provision of proper
health care, or cured at an affordable cost. However, currently
there is only one health center to care for every population group
of approximately 100,000. Only 12 percent of pregnant women have
access to maternal and emergency obstetric care; only 38 percent
of children under one year are fully immunized. These problems
are compounded by the fact that fully three-quarters of the nations
physicians have left the country resulting in a physician/patient
ratio of over 95,000/1. Because of the inadequacy of the health
delivery system, a majority of the population relies on indigenous
healers such as traditional midwives, herbalists, bone setters
and barbers who circumcise, let blood, pull teeth, and perform
other curative procedures. Mullahs, sayyids and other specialists
prepare curative and protective amulets.
The war and deteriorating economic, social, and physical conditions
in both rural and most urban areas, have impaired housing and
environmental sanitation facilities in general and added sinister
dimensions. By the end of 1996, it was estimated that 1.5 million
men women and children were physically disabled by war injuries,
including amputation, blindness and paralysis, as well as debilitating
infectious diseases, such as poliomyelitis and leprosy. Birth
complications causing disabilities such as cerebral palsy and
mental retardation also increased. Another 10 percent of the total
population representing families and associates of the disabled
are directly affected by these disabilities. They require information
and instruction not only regarding physical care, but also in
ways to integrate disabled persons into communities as respected
and productive members.
Sadly, the number of disabled increases daily because of an estimated
10 million landmines and unexploded ordnance (UXO) that contaminate
the landscape, the largest concentration in the world. A 1993
national survey revealed there were over 465 square kilometers
of minefield, of which 113 square kilometers were high priority
areas directly affecting residential areas, farm lands, grazing
pastures and canals; subsequently further high priority areas
totalling more than ninety square kilometers were identified;
and, as refugees return, new minefields continue to be uncovered
raising low priority areas to high priority. By the end of 1996
some 158.8 square kilometers were cleared and 300,000 mines destroyed.
The UN Mine Clearance Programme in cooperation with eight NGOs,
includes 50 demining teams and 10 mine dog groups, as well as
male and female mine awareness teams, staffed by some 3,000 Afghans.
Due to continuing hostilities, however, several de-mined areas
have been re-mined. It will be many years before Afghanistan will
be free of this menace.
Assistance to enhance the capacity and increase the accessibility
of health services, emphasizes basic preventive and curative primary
health services, with special attention to strengthening Mother
Child Health and health man power development at all levels, including
Traditional Birth Attendants and community health workers. Providing
safe potable water sources and sanitation facilities is also a
high priority since contaminated water sources are major causes
of high morbidity and mortality. Upwards of 60 NGOs, in addition
to the International Red Cross Committee and the International
Federation of Red Cross and Red Crescent Societies, WHO and UNICEF
have been active in the health sector over the years, assisting
everything from regional, provincial and district hospitals to
basic health clinics, as well as specialized services in physiotherapy,
drug detoxification, TB and malaria control.
The Mass Immunization Campaigns launched by WHO and UNICEF, in
partnership with the Ministry of Public Health, utilizing a cadre
of more than 15,000 vaccinators, health workers and volunteers
throughout the country, are singular successes accomplished with
the active cooperation of all parties to the conflict. In 1995,
2.6 million were vaccinated against DPT and measles; in 1996 2.3
million children under five received oral polio vaccine; during
1997, the nation-wide goal is to reach approximately four million
children under five, in addition to 60 percent of women of child
bearing age. The ultimate aim is to totally eradicate the polio
virus in Afghanistan.
As in the case with the education sector, however, the overall
results are generally spotty. New and refurbished buildings intended
to dispense medical care stand empty because of lack of personnel
or equipment; some have been commandeered by political groups
for offices. Of the thousands trained in various medical fields,
few find employment. Databases list increasing numbers of "discontinued"
projects and facilities. This is particularly disheartening because
the lack of medical facilities is a major deterrent to refugee
repatriation.
Data as of 1997
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