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IRIN - Afghanistan


Afghan healthcare under siege as escalating conflict cuts off access

Thu, 26 Oct 2017 14:30:06 +0000

The baby fell asleep clinging to his father, who perched on the edge of a hospital cot, cradling the child protectively.  Ihsanullah, 17 months, suffers from a virulent, drug-resistant strain of tuberculosis, which has alarmed his father and challenged the doctors. "There are injections and so many pills,” said his father, Bismillah. “The baby sees everyday the doctors with a white coat coming to inject him, so he is afraid." But despite the daily needles and pills, Ihsanullah is fortunate: his father left his job as a soldier in the north of Afghanistan so he could bring Ihsanullah to receive cutting-edge treatment at a specialised clinic in the southern province of Kandahar – the country's ethnic Pashtun heartland and a former Taliban stronghold. Throughout Afghanistan, however, an increasingly violent struggle for control is threatening access to vital healthcare. Pressure from a web of armed groups, including a resurgent Taliban, has seen medical workers targeted and health clinics commandeered or shut.  This has obstructed access to lifesaving care for hundreds of thousands of Afghans this year – and heightened the risk from deadly but treatable diseases like Ihsanullah’s tuberculosis. Ashley Hamer/IRIN Ihsanullah, 17 months, and his father wait while the baby receives treatment for drug-resistant tuberculosis at a clinic in Kandahar. The child has embarked on an intensive nine-month treatment regime. New treatments, limited reach For the past two months, Ihsanullah has been a patient with aid group Médecins Sans Frontières, which runs one of only two facilities in the entire country where his complex strain of drug-resistant TB can be treated. The baby's case is particularly troubling because tuberculosis is airborne and spread in close quarters, yet none of Ihsanullah's immediate family tested positive for the disease. He has nine months of heavy daily medication ahead of him. The clinic in Kandahar was launched a year ago – the first of its kind for MSF in an active conflict setting. There is limited clinic bed space and a small patient guesthouse, both designed for long-term treatment. New technology allows health workers to speed up the cumbersome diagnosis process and fast-track treatment. A state-of-the-art molecular testing machine brought in by MSF can now identify specific strains of TB on the spot. Previously, smear samples had to be sent to the capital, Kabul, or even to Europe.  Once diagnosed positive for a drug-resistant strain, the patient begins a newly-introduced treatment programme that lasts only nine months – the usual treatment for drug-resistant TB takes two years and requires close medical monitoring throughout. “It is essential that people complete the standard TB treatment regime, because if they stop halfway or take the wrong drugs – which they do – they build up resistance,” said Rod Miller, project coordinator for MSF in Kandahar.  If left untreated, the drug-resistant TB is passed onto others; sufferers face a prolonged, excruciating death. Ashley Hamer/IRIN Specialist equipment brought to Kandahar can now identify specific strains of tuberculosis on the spot. Previously, smear samples had to be sent to the capital, Kabul, or to Europe.  Afghanistan, a nation of 34 million people beset by decades of conflict, counts at least 60,000 ordinary TB cases annually. The disease kills some 12,000 people each year. Globally, the TB epidemic killed 1.4 million people in 2015. Only two new anti-TB drugs have been developed in the last 50 years, which means the same medicines have been in circulation for decades. Naturally, bacteria evolve to resist them. MSF calculates there are at least 2,000 new cases of multi drug-resistant TB across Afghanistan every year – driven by inadequate or incomplete treatment, misdiagnoses and a flood of smuggled or substandard drugs. But reaching Afghans to diagnose and t[...]

Afghan attacks, Raqqa redux, and plague in Madagascar: The Cheat Sheet

Fri, 20 Oct 2017 16:45:57 +0000

Every week, IRIN’s team of specialist editors scans the humanitarian horizon to curate a reading list on important and unfolding trends and events around the globe:   AU and EU: new BFFs?   African and European leaders are scheduled to meet in a summit in November at a time when relations have reached a turning point, the International Crisis Group says in a report released this week. The African Union has launched potentially transformative reforms that will shake up its peacekeeping operations and should increase its financial self-sufficiency. Because of Brexit, the EU is losing one of its most influential and internationally engaged members – with implications for Africa. One component critical to reshaping AU-EU relations is the Cotonou Agreement, a partnership between the EU and 79 countries from sub-Saharan Africa, the Caribbean, and the Pacific that expires in 2020 and will be renegotiated over the next two years. It’s unclear what shape the post-Cotonou settlement will take, and the future of the linked European Development Fund is equally uncertain. The AU’s reform of its peace and security architecture also has consequences for the EU – its chief funder. There are many points of friction: For the AU, the EU’s “paternalism” grates, while Brussels worries that it’s perceived as a “cash machine” – not to mention serious divergences over the migration issue. But there are deep-shared strategic interests. Both sides “must confront key areas of disagreement and frustration,” says the ICG. “In this context, the AU-EU summit comes at a particularly opportune moment.”   Biggest plague outbreak since 2008 (probably)   In Madagascar, 94 people have died in the worst outbreak of plague since 2008. Since 1 August, there have been 1,153 suspected cases, according to the WHO. This outbreak is nearly three times bigger than the typical seasonal outbreaks the island has every year, and it's reached the capital city, Antananarivo. Also bad: The pneumonic variant that can spread directly from human to human is responsible for two thirds of the cases. Speaking to reporters in Geneva, Ibrahima Soce Fall, the WHO’s emergency director for Africa, said the outbreak could be contained quickly and that all strains tested so far are treatable with standard antibiotics. The likelihood of international spread is minimal, he argued. However, the WHO's own literature admits the pneumonic form can produce "terrifying" outbreaks. The International Federation of the Red Cross and Red Crescent Societies has appealed for 5.5 million Swiss francs to support its work on the outbreak, which “involves illness, fear, stigma and discrimination”. Justifying the hefty investment, IFRC Secretary General Elhadj As Sy said: “we are adopting a ‘no regrets’ approach to this response”. In recent years, Madagascar has reported three quarters of the cases of human plague worldwide – a sign, according to a study, of the "deteriorating fabric” of the country’s health system. However, not all cases are reported to the WHO: Weak surveillance in northeastern Democratic Republic of Congo, another endemic country (it reported 1,962 cases in 2008), may hide continuing outbreaks there.    New lows in Afghanistan   It has been a deadly week in Afghanistan: Multiple attacks claimed by the Taliban have killed at least 100 people and injured hundreds more. Taliban militants targeted an Afghan Army base in Kandahar Province, killing 43 soldiers — the majority of the troops stationed there, according to media reports. Separate attacks in Paktya and Ghazni provinces killed at least 60 and injured at least another 200, according to the UN mission. These attacks are just the latest signs of Afghanistan’s deteriorating security situation. More than 8,000 civilians have been killed or injured in conflict through the first nine months of this year – a figure that has Afghanistan on a path to near record-high levels of casualties. The violence also underscores the Taliban’s mounting[...]

Six charts that show Afghanistan’s deepening insecurity

Wed, 18 Oct 2017 13:17:17 +0000

Civilian casualties in Afghanistan continue to soar as the country’s security situation deteriorates, according to the latest statistics released by the UN mission. The UN Assistance Mission in Afghanistan, or UNAMA, recorded more than 8,000 civilian casualties this year from January until the end of September, placing conflict-caused deaths and injuries at near record-high levels. The numbers have trended steadily upward over the last eight years even if the latest data represents a moderate drop from last year’s peak.   frameborder="0" height="450" name="Civilian deaths and injuries in Afghanistan" scrolling="no" src="" width="100%" id="Civilian deaths and injuries in Afghanistan"> UNAMA attributed roughly two thirds of the casualties to anti-government forces – mainly the Taliban and self-proclaimed Islamic State groups. Civilian casualties blamed on government-aligned forces dropped by 19 percent over the same time period a year ago. However, deaths and injuries caused by airstrikes continue to rise: the mission documented 466 casualties from aerial attacks — a 52 percent increase. The US has escalated airstrikes in Afghanistan under President Donald Trump; the US military launched 751 airstrikes on Taliban and IS targets in September, in what the US Air Force called “a record high month for weapons employed in Afghanistan since 2012”. But the UN has warned that less political oversight over airstrikes, and Trump’s strategy to increase troops in the country, could usher in “a more volatile landscape” in the months ahead. Airstrikes in late August killed at least 28 civilians in Herat and Logar provinces, according to the UN.   frameborder="0" height="500" name="Civilian casualties caused by air strikes" scrolling="no" src="" width="100%" id="Civilian casualties caused by air strikes"> The latest UNAMA figures also show that anti-government forces continue to deliberately target religious figures and places of worship — particularly minority Shia Muslims. Civilian casualties from such attacks have skyrocketed over the last five years. UNAMA said this amounts to “disturbing trends of intentional killings” targeting religious leaders and others seen as supporting the government. IRIN recently reported on how moderate imams preaching peace have become targets. Casualties caused by attacks against religious targets spiked in 2016; the 84 deaths recorded in the first nine months of 2017 are already nearing the mark set for the whole of last year.   frameborder="0" height="400" name="Civilian casualties from attacks targeting religious figures and places of worship" scrolling="no" src="" width="100%" id="Civilian casualties from attacks targeting religious figures and places of worship"> The enduringly high casualty numbers suggest the Afghan government may be paying a high price for its strategy to concentrate on defending areas with larger populations, while the Taliban makes gains in rural areas seen as less vital. “This change has led to an increasing number of clashes for control over lines of communication and vital infrastructure,” UN Secretary-General Antonio Guterres said in a September report to the Security Council. “In addition, the more secure hold of the Taliban over some rural areas has allowed them to undertake more frequent attacks in the north of Afghanistan.” The Afghan government’s physical control of its own territory has steadily eroded over the last two years. In a 30 July update, the Special Inspector General for Afghanistan Reconstruction, which reports to the US Congress on how American funding is spent, said that less than 60 percent of the country’s 407 districts were under government control or influence. The government had control or influence over 72 percent of its districts as recently as November 2015.   frameborder="0" height="550" name="District control in Afghanistan" scroll[...]

Evicting Kabila, rebuilding Dominica, and liberating Hawija: The Cheat Sheet

Fri, 18 Aug 2017 15:11:42 +0000

IRIN’s specialist editors have scanned the humanitarian horizon to keep you up to speed with this forward-looking weekly news digest:   Kabila unbowed   The Congolese opposition is adamant – no more talking: President Joseph Kabila must go by the end of the year, when the extension of his mandate brokered by the Catholic Church expires. But, asks the Congo Research Group, does the opposition really have the leverage? At the UN meeting this week on Congo’s delayed elections, “the sentiment expressed by African delegates was almost unanimous: Kabila has engaged in good-faith efforts to negotiate with the opposition, the electoral process should be given time.” There was no talk, even by Western donors, of Kabila stepping down at the end of 2017. According to CRG, donors think that sooner or later Kabila will be forced to hold elections, as was supposed to have happened at the end of his second term in December 2016. What the donors want to avoid is for Kabila to change the constitution and run for a third term, or rig the ballot. Those are big asks: in the meantime, Kabila appears to have the upper hand. Look out for IRIN’s upcoming report on the unfolding political crisis.   Liberating Hawija   Hawija is, in many ways, a forgotten siege. The city has been under control of so-called Islamic State since 2014, and while it was once thought to be ahead of Mosul in the queue for liberation, as IRIN pointed out back in July, the operation was complicated by competing but allied anti-IS forces laying siege to the city. It’s never garnered the headlines of a Mosul, even though 100,000 people are believed to have fled the city, but now Hawija will have its turn. Iraqi Prime Minister Haider al-Abadi announced on Thursday that an assault had begun, while the UN warned of an estimated 85,000 people still in Hawija and nearby east Shirqat – Save the Children pointed out this may include as many as 35,000 children. It is likely to be some time before Iraqi and coalition forces get to the city itself and we understand the fate of its civilians, which will be further complicated by Monday’s planned independence referendum in Iraqi Kurdistan. Oil-rich Kirkuk is one of the disputed territories claimed by both Baghdad and the Kurdish Regional Government. What does that really mean when a vote plus guns and political and battlefield rivalries are in the mix? We're about to find out.   Disaster follow-up   Back-to-back Cat-5 hurricanes Irma and Maria slammed the Caribbean, testing disaster management systems and human resilience to the limit. IRIN is covering the impact and response and, with a longer perspective, the context. Aboard the first fixed-wing aid flight into Dominica, today we bring you scenes of stunned survivors, aerial footage from overflights, and detailed reportage from the capital city relief operations centre. The prime minister said the country has to come back "from zero". Will the country be swamped by the wrong kind of "aid"? Will donors and the UN get behind a regionally-led response? Will the rest of the world pay attention? Can innovations and solutions such as disaster insurance offer any hope? From the deserted backyards of Barbuda to the operations centre in Roseau, Dominica's capital, we will continue coverage of operations as they unfold. Let us know what you think at Check our Facebook and Twitter feeds for additional photos and video clips.   Did you miss it?   Lessons learnt? Not in Afghanistan   Ill-prepared, understaffed, and poorly organised: A new report by the US government watchdog on reconstruction in Afghanistan offers a sobering summary of efforts to rebuild and train Afghanistan’s beleaguered security forces. The “lessons learned” report from the Special Inspector General for Afghanistan Reconstruction, which reports to Congress on how US reconstruction funds have been spent, details how the US failed to recognise Afghanistan’s complexities – including d[...]

Afghan refugees in Greek camp: “If you kept animals in this situation, they would die”

Fri, 02 Jun 2017 07:19:40 +0000

At its peak in the summer of 2016, the former Athens airport terminal at Elliniko was home to more than 3,000 refugees. A makeshift camp set up during Europe's refugee “crisis” the summer before, it is now home to fewer than 700 people, nearly all of them from Afghanistan. Over the last few weeks, the Greek government has been trying to persuade them to leave by removing vital services. On 20 May, the NGOs providing medical care, clothing, legal advice, translation, and cleaning were withdrawn. In the days that followed, WiFi, electricity, and water services were cut off and residents were told to accept transfers elsewhere or lose support. Most people agree Elliniko is unfit for human habitation, including Masood Qahar, a 40-year-old refugee from Kabul who has been living there since early 2016. Journalists are no longer allowed inside the camp, but Qahar showed IRIN photographs of people sleeping in the airport terminal corridors in tents or under sheets strung from the ceiling. When it rains, Qahar said, the water comes through the ceiling. He played a video of residents trying to sweep water away from their tents. Masood Qahar Inside the former airport terminal turned refugee camp, people sleep in tents divided by sheets Men, women, and children live together at Elliniko with little privacy. Human rights organisations including Amnesty International have repeatedly warned that women are at risk of sexual assault. “It’s not safe,” Qahar said. “I’ve been attacked three times with knives. Once, someone brought a gun into the camp.” So why stay? Despite this, Qahar and many of the remaining refugees are reluctant to leave on the uncertain terms they have been offered. When officials announced the closure earlier this month, they told the refugees they would be sent to a new, purpose-built camp at Thiva (Thebes), in central Greece. But the ministry of migration has not issued a formal plan for the transfer, and Qahar, for one, is suspicious. “It’s a small jail,” he said, showing photographs he had taken during a visit to Thiva. They show rows of shipping containers surrounded by a security fence on an industrial estate outside the town. The camp is to be managed by the International Organization for Migration, but the government has not yet specified what services will be provided. Masood Qahar The new camp at Thiva consists of rows of shipping containers surrounded by a security fence Kyriakos Giaglis, country director for the Danish Refugee Council (DRC) in Greece, which had been providing support services at Elliniko until it was asked to leave, told IRIN that his organisation is concerned about the apparent lack of consultation with the refugees. “Movement has to be well-informed, principled, and voluntary. This plan has not been properly communicated by the Greek authorities, despite our continuous requests.” Giaglis said it was unclear whether the camp at Thiva would be able to accommodate all the remaining residents at Elliniko or if adequate legal services would be provided to help refugees with their asylum claims in Greece or family reunion elsewhere in Europe. The DRC is asking that vulnerable people be moved to some of the 20,000 apartments in Athens provided by the UN’s refugee agency, UNHCR. But demand is high and there aren’t enough apartments to accommodate all the Elliniko refugees. According to UNHCR, around 100 people have been moved to apartments in recent weeks. Filling the information gap are rumours. Some refugees fear forced transfer to Thiva at short notice; others are concerned by the presence of IOM at the new camp because of the agency’s well-known voluntary return programmes for migrants. “They are trying to pressure people to go home,” said Qahar. There is no evidence to confirm such suspicions, and in a rec[...]

Pushed out of Pakistan into war-torn Afghanistan, refugees are told to be ‘patient’

Thu, 13 Apr 2017 10:14:04 +0000

Afghan refugees pressured by Pakistan to return to their volatile homeland where they face hunger and homelessness should be “patient”, according to an official who said his government plans to eventually offer more support.   The UN says more than 600,000 Afghans returned last year from Pakistan, where rights groups documented a campaign of harassment by the authorities. Pakistan suspended its repatriation plan in December, but resumed it on 3 April and returnees and advocates say the harassment has begun again.   A similar influx of returnees this year would further strain the capacity of the Afghan government, which is already unable to deal with those who came back in 2016. In addition, the UN says a record 400,000 people were displaced by war inside Afghanistan last year.   A recent UN survey found that 46 percent of returnees around the capital, Kabul, were severely food insecure. The figure was 30 percent in Nangarhar, a province bordering Pakistan. Of those surveyed in both locations, 63 percent listed employment as a “priority need”.    Another primary concern is that many returnees have no home to return to. Land would not only give them somewhere to build a house; it would also allow them to farm, which would cut down on hunger and unemployment.    Hafiz Ahmad Miakhel, a spokesman for the Ministry of Refugees and Repatriation, said the government is working on a land distribution programme. But he said it was a slow process due to factors including the need for various ministries to coordinate, and the time it takes to register all returnees and determine whether it’s safe for them to return to their homes districts.   “People have to be patient,” he told IRIN.   Little support   Patience is in short supply among those who are struggling to survive with little help.   “The government of Afghanistan keeps saying for people to come, but does nothing to support them,” said Amanullah, 19, who was deported from Pakistan in November and has been selling soup on the street since then in the town of Daronta, in Nangarhar.   The government gives each returnee $50, while the UN refugee agency, UNHCR, provides registered refugees with another $200.    That money disappears quickly, returnees said. Most have to rent houses at a cost of $75 to $100 a month.   “I wish we could say we spent it on a luxury, but it all went to rent and to feed our families,” said Akbar Khan, who has been unable to return to his home in Paktika Province because the security situation is so poor.   Humanitarian groups like the Norwegian Refugee Council [NRC] provide support to some returnees, including building shelters, but most receive little help. The $200 cash grant provided by UNHCR is half of what it was last year.   The government and humanitarian agencies asked for $550 million to fund programmes in 2017, of which only 21 percent has been committed or delivered so far.    “As aid agencies there is only so much we can do with the budgets and resources we’re given,” said Mohammad Nader Farhad, a spokesman for UNHCR. “There are some institutional matters that different ministries of the Afghan government will have to work on as well.”    The inability of ministries to coordinate and provide long-term solutions, such as land distribution, has bedeviled the government for years.   A year ago, Amnesty International reported that the government had failed to implement a national policy to provide basic living conditions for displaced people. Amnesty found many were living “on the brink of survival”.   SEE: Afghanistan’s failed promises to help people displaced by war   That situation is worse now, since 2016 saw record numbers of both returning refugees and people displaced by fighting. And it could get even more desperate as Pakistan ramps up its repatriation efforts, even as the war in Afghanistan intensifies.   Harassment again [...]

Attacks on Afghan hospitals hit children the hardest

Mon, 06 Mar 2017 13:09:20 +0000

An Afghan father recently described how his 15-year-old son lost both feet after stepping on a mine. He couldn’t get proper care in Kunduz City – the only trauma centre there had been destroyed – so he took a taxi more than 200 miles to Kabul. By the time his son received treatment, it was too late.  “Both of his legs had to be cut off from just below the waist, because the bones were ruined and he had a serious infection,” the boy’s father said. "For one week, he was ok, but then, from the infection, he went into a coma. Ten days later, he died in the hospital." This is one of the many brutal stories I heard during a trip to Afghanistan, where I travelled in November to research the impact that targeted attacks on medical facilities have on children’s health. Children and their parents, health workers and humanitarian staff repeatedly told my colleagues and I how these attacks have compromised access to critical healthcare and devastated children’s lives. In a country already among the world’s most dangerous for aid workers, clinics have become battlegrounds and medical professionals are on the front lines of the conflict. New report Over the last two years, the Taliban, Afghan government forces and other groups have committed more than 240 attacks on medical facilities. These violate humanitarian laws and erode an already extremely fragile health system. In a report released today, we show how these unlawful attacks have damaged or destroyed clinics and hospitals, and killed or injured many health professionals. Others have been forced to leave their jobs or flee, and many patients have been afraid to seek care. Children have suffered greatly: casualties have increased, along with rates of malnutrition, diarrhoeal disease and vaccine-preventable diseases such as measles and polio. Instead of places of healing, clinics and hospitals have become targets in Afghanistan’s escalating conflict. Attacks have been so frequent that one health director told us that many go unreported. Attacks have taken place in at least 20 of the country’s 34 provinces, making it difficult, if not impossible, to access healthcare in many areas. In one case, a 15-year-old girl suffering from meningitis took a week to reach a hospital. She died shortly after getting treatment. RELATED STORIES: Medical care cut off as Taliban assaults key Afghan city Prosecute those who bomb hospitals, or it will keep happening NATO probes raid on Afghan clinic, speaks to few, finds out little Will probe of “executions" at Afghan clinic bring justice? Can obscure commission bring justice for Kunduz? Hospitals and war crimes: a patchy record Warring parties have also closed medical facilities, and stolen medical supplies and ambulances. They have threatened, detained and killed medical personnel. A health vaccinator told us that when the Taliban caught him administering polio vaccines, they warned him they would kill him if he continued. He felt threatened again when fighters with the so-called Islamic State entered the area, and he later left his job. “I have seen with my own eyes, in an area of 100 metres there are three kinds of leaders: Taliban, IS and government,” he said. “Our clinic was in the middle of the conflict, so even though it is my job, I had to stop, otherwise I thought either the IS or Taliban would kill me.” Such cases of threats and extortions are far from unique. In February 2015, a group of unidentified men shot and killed a social mobiliser for a polio programme run by UNICEF. In August 2016, Taliban fighters abducted a staffer of a NGO overseeing a polio vaccination programme. Impact The impact of these systematic assaults on the healthcare system and health professionals has been profound. The World Health Organization reported 169 measles outbreaks in 2015 – a staggering 141 percent increase from 2014. More than one million of Afghan[...]