Afghans Face a Loss of Health Care

A 3-year-old Afghan boy, seriously injured in a fall in May, was brought to a base near Sangin, then flown to a field hospital for further care.
A 3-year-old Afghan boy, seriously injured in a fall in May, was brought to a base near Sangin, then flown to a field hospital for further care. (By Cpl. Jon Bevan -- British Defense Ministry Via Getty Images)
By Griff Witte
Washington Post Foreign Service
Friday, June 29, 2007

JALALABAD, Afghanistan -- This month, two Afghan medical workers drove off into the hazy blue mountains that rise above this dusty provincial capital. They have not been seen since.

No one knows who took them, but their disappearance has had far-reaching consequences. With security in doubt, other health-care workers have been ordered off the roads. Clinics are fast running out of medicine because supplies can't be delivered. Doctors are searching for safer places to work.

The problems here mirror a developing crisis across Afghanistan. Just as violence is heating up, with civilian casualties rapidly escalating, the health-care system is breaking down, according to Afghan and international medical experts.

The deterioration has been especially pronounced in rural areas, scene of some of the most intense fighting between Taliban and international forces. In those places, clinics are shutting their doors because the medical workers have become targets.

"Day by day it's becoming worse," said Nadera Hayat Burhani, a doctor and the government's deputy health minister. "In each country, it's a rule that you let the medical staff do their work. Unfortunately, in Afghanistan it is not that way. Here, they kill the medical staff."

Insurgents have been campaigning for years to prove to Afghans that their government has little to offer. Police officers, schoolteachers and local political leaders have been targets of violence. Now medical workers fear that they are in danger as well.

The International Committee of the Red Cross recently said it faces a more restrictive environment than it has in two decades of work in Afghanistan. "It's not a conflict where there are clear front lines," said Franz Rauchenstein, the agency's deputy chief in Kabul. "It's more complicated than in the good old days, when you had Party A controlling one area and Party B controlling another. Now that can change every day."

Rauchenstein said his organization has had to pull back from many areas because it has not been able to get security guarantees. Other groups have pulled back, too. The ones that remain in the most dangerous regions are reconsidering their operations with each new attack.

There has been a series of disturbing episodes in recent months. A nurse was beheaded by Taliban fighters, who blamed his death on the government's failure to turn over the body of their former commander. Six medical workers in the northeastern area of Nuristan have been taken hostage. Overall, 39 government medical workers have been killed in less than two years, according to Health Ministry statistics.

Mohammad Naseem, a doctor who manages health care in the Jalalabad area for HealthNet TPO, a Dutch nonprofit organization, hopes his two workers aren't added to the list.

The two -- 35-year-old Shiraz and 40-year-old Wali Jan -- were helping with an immunization drive in the remote district of Shirzad when they were abducted June 13. Since then, the kidnappers have periodically used Jan's cellphone to make demands and to threaten to kill their hostages if they don't get what they want.

HealthNet TPO has worked in this eastern Afghan province for 12 years, but this is the first time its workers here have been seized. Now the organization, which runs 54 health facilities in the province, is contemplating getting out.

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