Afghanistan today suffers from one of the worst health crises in the world. Years of war and civil strife have left behind enormous poverty, a crumbling infrastructure, and a widespread landmine crisis. The country is among leading nations on every global index of suffering. Life expectancy at birth is estimated at around 46 years, and one out of four children die before their fifth birthday. The tragedy of the health emergency is that the most pervasive problems in Afghanistan have largely been controlled in other countries: chronic malnutrition and preventable diseases like diarrhea, respiratory infections, and measles. On top of these basic health threats Afghanistan is also saddled with an extensive network of landmines that kill or maim more civilians than in any other country.
These hazards have an exacerbated impact because much of the Afghan population lacks access to basic medical care. There is a critical shortage of health care workers. Estimates suggest there is only 1 doctor for every 50,000 people in Afghanistan, while the figure for the United States is approximately 1 doctor for every 350 people. Facilities are in urgent need of restoration, and there are inadequate supplies of medicines, vaccines, equipment and fuel. Prior to the fall of the Taliban and the ensuing disorder of early 2002, only three out of 133 hospitals, clinics, and TB centers in Kabul visited by the World Health Organization were deemed suitable. In the months since the fall of the Taliban, international aid organizations and the new Interim Government have been scrambling to rebuild Afghanistan's health care infrastructure.
Landmines are one of the most insidious threats to global health. Statistics on the number of active landmines in the world are hard to verify; experts estimate today that there are between 50 and 100 million landmines planted in minefields in over 70 countries.
Afghanistan is one of the world's most heavily mined nations. It has one of the highest proportions of disabled people, and this is largely due to the landmines planted extensively throughout the country. Only two of Afghanistan's twenty-nine provinces are believed to be free of unexploded battlefield detritus. Most mines were laid during the period of Soviet occupation and the subsequent communist regime between 1980-92, but they were used strategically even during recent strife between the Northern Alliance and the Taliban.
More than 90% of all those injured by landmines in Afghanistan are civilians. According to a survey done by the International Committee of the Red Cross, children represent half of all injuries and deaths from landmines in Afghanistan. They are the most vulnerable victims, affected while playing, tending animals, or scavenging. Growing numbers of returning populations are also at risk as they resettle across the country.
The U.S. bombing campaign has unintentionally contributed to the number of unexploded weapons strewn throughout Afghanistan. More than 10% of American bombs dropped did not explode, and demining teams do not yet have training to defuse them. *
Minefields continue to be discovered in Afghanistan at a rate of 12-14 million sq. meters per year. The new government of Afghanistan, however, recently acceded to the 1997 Mine Ban Treaty, previously opposed by the Taliban and Northern Alliance. The signing of the treaty gives hope that the production, trade and use of landmines in Afghanistan will stop, that stockpiles will be destroyed, and that decades of clearing efforts can finally begin to make an impact for Afghan civilians.
Learn more about the global landmine crisis in "The Horror of Landmines," an article by Emergency surgeon Gino Strada. Also check out an interview with Jody Williams, the founding coordinator of the International Campaign to Ban Landmines.
It is estimated that about one out of four children in Afghanistan die before their fifth birthday. These child mortality rates are among the worst in the world, surpassed only by Sierra Leone, Niger and Angola. As the most vulnerable of the Afghan population, children are disproportionately affected by all the major health hazards in their environment. They are particularly susceptible to landmine injuries because they often lack the experience to recognize mines as a danger. Rampant malnutrition acutely affects children's growth. According to the World Health Organization, about half of Aghan children under the age of five are stunted due to chronic malnutrition. More than 60% of all childhood deaths and disabilities are due to respiratory infections, diarrhea, and vaccine preventable deaths, especially measles. Diarrhea in particular kills an estimated 85,000 children a year in Afghanistan and is considered to be one of the country's major health risks. Immunization rates, while very low, are improving considerably. Less than half of Afghan children have been immunized for measles, but the figure is rising thanks to recent emergency vaccination efforts. More than eighty percent have now received some polio vaccine.
Under the Taliban's rule, women's physical and mental health suffered greatly. Women's access to health care decreased dramatically due to societal restrictions on gender relations and behavior. As a result, statistics on women's health are hard to determine.
When Physicians for Human Rights conducted a survey of women's health in 724 households in 2001, it found a high prevalence of poor mental health, suicidal ideation (65-77%) and suicide attempts (9-16%) among study participants. More than 70% of women exposed to Taliban policy made diagnostic criteria for current major depression. The majority of respondents (63-87%) described their physical health as "fair" or "poor."
Although women exposed to Taliban policies reported decreased access to health care services in Afghanistan in the years after the Taliban issued official edicts regarding women, they also reported improved access to and quality of health care over the past year.
It was found that cultural practices with regard to women had an effect on women's access to health care. Lack of female medical facilities and not having a male family member escort were listed as some of the most common reasons limiting health care access. Mental health services in Afghanistan were reported as "not available" by a majority of women exposed to Taliban policies. Forty-four percent of respondents in the non-Taliban-controlled area reported that mental health services were not available.
The maternal mortality rate in Afghanistan is generally calculated as one of the highest in the world; for every 1,000 live births, 17 mothers die. This number takes on significance when we consider that in the United States, less than .1 maternal deaths are reported for every 1,000 live births. In Afghanistan, a great number of these deaths are preventable. Over 90% of deliveries take place at home, most without a skilled attendant present. Only about a third of the country's 330 districts has a maternal or child health clinic.
More than half the women in the country suffer from anemia, with some estimates suggesting a much higher figure.
The diet of most Afghans today is limited mostly to starches like rice, gruels, bread and potatoes, and this deficiency is having devastating effects over time. By all reports there is a national nutritional crisis in Afghanistan, leading to stunted growth, poor concentration, reproductive health problems, blindness, and growth failure. The international community (through governmental agencies, the U.N. World Food Programme, and non-governmental organizations) continues to respond to the current crisis with food relief, but long-term solutions are still emerging. The effects of malnutrition are compounded by a lack of access to clean water. Only 19 percent of people living in urban areas have access to clean water. In rural areas, the figure is less than that, hovering around 11 percent.
*ABC World News Tonight (December 2, 2001)