Afghanistan’s Health-Care System In ‘Free Fall’ As Punishing Winter Looms
By Michael Scollon
RFE/RL’s Radio Azadi
November 3, 2021
A punishing winter looms for many Afghans who are already dealing with the effects of a devastating humanitarian crisis and an economic crunch brought on by the Taliban takeover, the withdrawal of foreign forces, and suspension of international funding.
The state health-care system, propped up by foreign aid for two decades, was hurting even before the Taliban seized power in mid-August, with many health-care workers going unpaid for months. Now the system is trying to stave off total collapse.
“The situation is dire,” Khan, a resident of the eastern province of Kunar, told RFE/RL’s Radio Azadi. “We are on the eve of winter and disease is spreading.”
Like many both at home and abroad, Khan called on foreign countries and aid groups not to abandon the country.
The main problem affecting Afghanistan’s health-care sector is the loss of financial aid, according to Patricia Gossman, associate director for Human Rights Watch’s Asia Division.
“There is no money to pay health-care workers. There is no money to buy medicines,” said Gossman, who added that the system was “already weak” under the previous government. “With former donors blocking aid — not humanitarian aid, but actual cash to pay salaries — the health-care situation is in a free fall like the rest of the economy.”
Hundreds of health facilities have been shuttered in Afghanistan since the Taliban toppled the internationally recognized government in Kabul.
Abdul Bari Omari, the Taliban’s caretaker deputy director of public health, told RFE/RL in October that nearly 90 percent of the sector was dependent on foreign aid, which led to the closure of 2,300 health centers when that aid was cut off.
Urgent appeals for more funds by NGOs and the United Nations have resulted in pledges of more than $1 billion, and outside states and aid groups have delivered much-needed medical supplies. But there is no clear path for the distribution of the funds and supplies, and billions of dollars held by Afghanistan’s previous government remain frozen in the United States.
Many have turned to outside organizations that continue to provide health services in Afghanistan, such as the United Nations Children’s Fund (UNICEF), which has worked in the country for 70 years, and Doctors Without Borders (MSF).
Representatives of both organizations say they saw the departure of some staff and an uptick in patients following the Taliban takeover, and cite malnutrition as a deadly concern.
Christophe Garnier, a MSF project coordinator, said the organization’s therapeutic feeding centers in the western city of Herat and the southern city of Lashkar Gah were operating at twice their capacity and maternity units were helping more than 55 women a month deliver babies in the eastern city of Khost and more than 60 per day in Lashkar Gah.
“There are several factors that explain why we are seeing so many patients but perhaps the biggest problem is that other health facilities aren’t functioning, so people have few other places to seek health care,” Garnier said in e-mailed comments from Afghanistan. “Now the situation has slightly stabilized, many organizations have returned, but the health system is still struggling.”
Garnier singled out financial measures taken against the Taliban’s acting government, including the freezing of nearly $9 billion in Afghan assets held in the United States, as having “paralyzed the country’s banking system and pushed the country toward economic and institutional collapse.”
Sam Mort, chief of communication, advocacy, and civic engagement for UNICEF Afghanistan, said that the organization is urgently scaling up its humanitarian response to the crisis in Afghanistan. Mort said in e-mailed comments from Afghanistan that most of UNICEF’s team is physically back at work in the country, including women, and that new staffers are being hired.
Mort said that the organization was well equipped to deal with the challenges experienced in Afghanistan in recent months and was able to distribute supplies to Afghans displaced by fighting, water to areas heavily hit by drought, therapeutic food to combat malnutrition, and mobile health teams to provide health services.
But the challenges remain immense and complex, Mort said.
“More than 600,000 people are displaced; there is drought; winter is approaching; there are outbreaks of measles and acute watery diarrhea, food and fuel prices are rising, and around 20 million people will face acute food insecurity this month,” Mort said.
“And when food insecurity spikes, so too does severe acute malnutrition,” which he said could lead to the deaths of 1 million children under the age of 5.
Following a visit to Kabul in mid-October, UNICEF deputy executive director Omar Abdi, expressed shock at the conditions he saw.
Abdi based some of his observations on his visit to the capital’s 360-bed Indira Gandhi Children’s Hospital, which is dealing with staff shortages after many medical workers fled the country or took other work due to a lack of payment.
“I visited the children’s hospital and was shocked to see how packed it was with malnourished children, some of them babies,” Abdi said.
Abdi noted that even before the Taliban takeover at least 10 million children in Afghanistan were in need of humanitarian assistance, and listed polio and measles as sources of concern in addition to acute malnutrition.
RFE/RL has documented many complaints from citizens about the state of public health care, including at Indira Gandhi Hospital.
Shirin Gul said her granddaughter recently died after the hospital was unprepared to treat her heart condition.
“There were no services or supplies at the hospital,” Gul said, adding that she had to go elsewhere just to obtain medicine.
Meanwhile, officials at the state-run Afghan-Japan Hospital in Kabul — the only active hospital for the treatment of COVID-19 patients in Afghanistan — told RFE/RL that employees had not been paid in three months.
As fears mount of a fourth wave of coronavirus infections, chief physician Tariq Ahmad Akbari said that the facility was short of funds to buy medicine, oxygen, and even food for patients.
Akbari said the hospital was sending requests for financial assistance to authorities and institutions both within and outside the country, and that if the pleas are not answered the hospital might be forced to close.
UNICEF’S Mort said that finding a way to pay health workers stands among the biggest challenges in Afghanistan because such professionals could be forced to look for other work to support themselves.
“To ensure delivery of essential medical aid, we urgently need the health system operational, health workers paid, and facilities open and well stocked,” Mort said.
MSF’s Garnier said that during a recent visit to a displaced persons camp near Herat, community leaders expressed concerns about the upcoming winter.
“This community has no work, no income, no land, no home, and no food,” Garnier said. “They are very worried about what will happen in the winter, when they already don’t know what they will eat today.”
Copyright (c) 2021. RFE/RL, Inc. Reprinted with the permission of Radio Free Europe/Radio Liberty, 1201 Connecticut Ave NW, Ste 400, Washington DC 20036.
Related
Taliban Bans Use Of Foreign Currencies In Afghanistan
Radio Free Europe/Radio Liberty
November 2, 2021
The Taliban has announced a ban on the use of foreign currencies in Afghanistan, threatening further disruption to an economy pushed to the brink of collapse following the hard-line Islamic group’s takeover in August.
From now on, anyone using foreign currency for domestic business will be prosecuted, the Taliban said in a statement shared with journalists on November 2.
“The economic situation and national interests in the country require that all Afghans use the afghani currency in every transaction,” the statement said.
The national currency, the afghani, has dramatically depreciated since the Taliban overthrew the internationally backed government in mid-August.
Many transactions inside the war-torn, drought-stricken country are conducted in U.S. dollars, while border areas use the currency of neighboring countries such as Pakistan for trade.
With Afghanistan’s economy in a parlous state with most aid cut off as winter nears, food prices rising, and unemployment spiking, the Taliban is seeking international recognition and is pressing for the release of billions of dollars of frozen Afghan assets parked abroad.
Afghanistan was heavily dependent on international funding for the last 20 years, with three-quarters of the entire public spending budget coming from aid.
In an effort to try and contain the spiraling humanitarian crisis, the international community has announced support packages for Afghanistan and its neighbors.
With reporting by AFP and Reuters
Copyright (c) 2021. RFE/RL, Inc. Reprinted with the permission of Radio Free Europe/Radio Liberty, 1201 Connecticut Ave NW, Ste 400, Washington DC 20036.
Turkmenistan Talks TAPI Pipeline With Taliban, But Should Ashgabat Instead Be Looking To Send Gas To Europe?
Bruce Pannier
Radio Free Europe/Radio Liberty
November 2, 2021
Building a natural-gas pipeline through Afghanistan and Pakistan to India (TAPI) was the main topic of conversation when Turkmen Foreign Minister Rashid Meredov went to Kabul to meet with the Taliban’s interim government on October 30-31.
Since coming to power 15 years ago, Turkmen President Gurbanguly Berdymukhammedov has been fixated on completing TAPI. But the authoritarian ruler’s attention might be better turned to the Trans-Caspian Pipeline (TCP), which looks more attractive to its European market than ever before.
Due to a lack of pipelines connecting Turkmenistan to other markets, this period of record gas prices on world markets is quietly passing the Central Asian country by — a shame for cash-strapped Ashgabat and its destitute citizens since it holds the fourth-largest proven reserves of natural gas on the planet.
A Salesman In Kabul
Meredov met with Taliban acting Foreign Minister Amir Khan Muttaqi, acting Deputy Prime Minister Abdul Salam Hanafi, and acting Defense Minister Mawlawi Muhammad Yaqoob, the son of deceased Taliban leader Mullah Omar.
Atop the agenda of their meetings was — as Muttaqi said of his meeting with Meredov — “Important issues such as TAPI, railroads, and electricity.”
Yaqoob tweeted: “I am directly responsible for overseeing the security of the TAPI project…[and] we will not hesitate to make any sacrifices for the implementation of this national project.”
TAPI was an important issue when Turkmen officials met with former Afghan President Ashraf Ghani’s government as well as that of his predecessor, Hamid Karzai, and with representatives of the Taliban when it ruled the country in the late 1990s.
The Afghan government has been promising since 2010 to create a special force of some 7,000 troops to guard the TAPI pipeline.
The Taliban even promised to guard TAPI in 2018 when they were battling government forces.
The pipeline aims to carry some 33 billion cubic meters (bcm) of gas from fields in Turkmenistan more than 1,800 kilometers through Afghanistan to Pakistan and India.
Pakistan and India would each receive 14 bcm and Afghanistan would receive 5 bcm, which would be a huge increase for Afghanistan compared to the country’s recent annual use of less than 200 million cubic meters.
Additionally, it was reported during Meredov’s recent meeting with Taliban representatives that Afghanistan could earn some $500 million in transit fees annually, though Meredov said in November 2017 that Afghanistan would earn some $1 billion from transit fees.
When the price of gas briefly shot to more than $1,000 per 1,000 cubic meters in October this year, officials in Turkmenistan must have broken out in a sweat.
Twenty-five years ago, Turkmen officials were trying to get their only gas customer at that time — Russia — to pay $40 per 1,000 cubic meters instead of $32.
But even if the security situation in Afghanistan becomes more stable under the Taliban, there are still significant problems with financing the approximately 775-kilometer stretch of TAPI through Afghanistan.
The estimated cost of the total project is some $10 billion, though that estimate is a decade old.
In a recent article for the Atlantic Council, former U.S. Ambassador to Turkmenistan Steve Mann wrote that even with an improvement in security inside Afghanistan, “the ascent of the Taliban will do nothing to address the project’s dire flaws, including financing, bankability, and pipeline ownership and operation.”
He added that “On top of that, the severe [economic] sanctions on the Taliban introduce a new deal-breaker.”
Pakistan has sought to renegotiate the price of Turkmen gas from TAPI several times in recent years and Turkmenistan reportedly agreed in 2020 to consider lowering prices.
India might now be out of the project entirely as New Delhi’s relations with Islamabad have never been good and are even worse with the Taliban.
The Kazakh and Uzbek foreign ministers have also visited Kabul since the Taliban took control of Afghanistan in mid-August, and Meredov’s visit may have also been aimed at firming Turkmenistan’s ties with the new Afghan authorities.
Pivot To The TCP?
But it is odd that Turkmenistan is making an effort to revive TAPI while the possibilities of constructing the TCP seem to have improved significantly.
The TCP aims to carry some 30 bcm from Turkmenistan across the bottom of the Caspian Sea to the pipeline network in Azerbaijan and eventually to Europe.
The European Union has been hoping for years to see the project realized as part of its Southern Gas Corridor (SGC).
With the record gas prices at the moment and fears that the EU is becoming too dependent on Russia as Nord Stream 2 reaches completion, a boost in gas volumes from a different supplier should be seen by the EU and Turkmenistan as a golden opportunity — especially as some of the key obstacles to the TCP’s construction have been removed.
One was the dispute between Turkmenistan, on the east side of the Caspian, and Azerbaijan, on the west side, over three oil and gas fields located halfway between the two countries in the middle of the sea.
That decades-old dispute was resolved in January.
There was also the problem of needing a pipeline that stretched from Azerbaijan to Europe, but the 1,841-kilometer Trans-Anatolian Natural Gas Pipeline (TANAP) that runs through Turkey was completed in 2018.
The TANAP project foresees expanding pipeline capacity to some 60 bcm annually.
But Azerbaijan does not have enough gas to provide such a volume, so TANAP would have to include Turkmen gas to reach that level.
The SGC pipeline network was completed at the end of 2020, and gas from Azerbaijan’s Caspian field Shah Deniz 2 is already being supplied through the SGC and TANAP to Greece, Albania, and — via the Trans-Adriatic Pipeline — to Italy.
All that is needed is to build the roughly 300-kilometer TCP at an estimated cost that ranges from $5 billion to $8 billion.
A U.S. company called Trans Caspian Resources just proposed an option that would carry smaller volumes of gas but be operational within two years.
Former U.S. Ambassador to Turkmenistan Alan Mustard attended the recent Oil and Gas of Turkmenistan International Conference and suggested an alternative: the Caspian Connector. It could carry some 10-12 bcm of gas annually and, using existing infrastructure, be built for $500-$800 million.
But one major obstacle remains.
Russia and Iran have raised environmental concerns over the construction of a pipeline along the bottom of the Caspian Sea, despite the fact that Kazakhstan has already done so in the northern part of the Caspian. And Russia has constructed longer and deeper pipelines across the bottom of the Black Sea to Turkey and, in the case of Nord Stream 1 and 2, across the bottom of the Baltic Sea (some 1,222 kilometers), making the two lines the longest underwater pipelines in the world.
There was little, however, that Azerbaijan and Turkmenistan could do in the face of Russian and Iranian resistance.
Turkey is a rising power in the world again with its influential roles in the conflicts in Libya and Syria, not to mention the military support it gave Azerbaijan during the recent conflict with Armenia in Nagorno-Karabakh. It has even recently supplied armed drones to Ukraine, one of which Kyiv recently used to destroy some artillery of the Russia-backed separatist forces in eastern Ukraine.
Ankara has shown its willingness to stand up to Moscow and Tehran, and if Turkey increases its public support for the TCP that could convince Turkmenistan and Azerbaijan to move forward with the project.
But obtaining Ankara’s support might be the problem for Turkmenistan.
Turkmen officials are urging Turkish authorities to shut down protests in Turkey against the Turkmen government that are led by migrant laborers. It is also seeking to have the activists deported to Turkmenistan.
Ankara was apparently upset when one Turkmen protester was forced into the Turkmen Consulate in Istanbul and beaten in early August.
The Turkish government has been sensitive to such incidents since Saudi journalist and activist Jamal Khashoggi was killed inside the Saudi Consulate in Istanbul in October 2018.
There is speculation that Turkey’s reluctance to shut down anti-Turkmen government protests on Turkish territory has led to Ashgabat’s hesitancy in accepting Ankara’s offer to join the Turkic Council, which comprises Turkey, Azerbaijan, Kazakhstan, Kyrgyzstan, and Uzbekistan.
But Turkmenistan needs to move on its proposed gas pipelines if the country is ever going to cash in on its extensive gas reserves.
While TAPI seems no closer to being realized than it was 25 years ago, the TCP or some form of it — with a guaranteed market of paying customers — could be completed in the near future.
RFE/RL’s Turkmen Service, known locally as Azatlyk, contributed to this report.
Copyright (c) 2021. RFE/RL, Inc. Reprinted with the permission of Radio Free Europe/Radio Liberty, 1201 Connecticut Ave NW, Ste 400, Washington DC 20036.
Winter Relief Flight for Thousands of Afghans Lands in Kabul
Lisa Schlein
VOA News
November 2, 2021
GENEVA — A plane chartered by the U.N. refugee agency carrying desperately needed winter relief for thousands of displaced people landed in the Afghan capital, Kabul, Tuesday.
This is the first of three mercy flights scheduled to take off from UNHCR’s warehouse in Dubai for Kabul this week. The planeload of 33 tons of winterization kits will be distributed to thousands of families living under precarious conditions.
Conflict and insecurity have displaced 3.5 million Afghans inside the country, including some 700,000 newly displaced this year. U.N. refugee agency spokeswoman Shabia Mantoo says her agency aims to aid half a million of this large number of displaced.
She says aid is prioritized based on needs and vulnerabilities. She says the UNHCR is rushing to provide critical aid to the Afghans before the rigors of winter set in and access is cut off.
“Already, they are feeling the onset of the cold, with temperatures dipping to even zero degrees Celsius overnight,” Mantoo said. “So, quite cold. People have very rudimentary or basic setup, especially those that have just been displaced. It is quite critical, and that is why there is an urgency to get this winter assistance in. In the highlands and the upper parts of the country, we are expecting even more temperatures to zip even more.”
Mantoo says the winter relief supplies include emergency shelter kits, items to improve tent insulation against the cold and heat resistant protection to enable the installation of a stove. She says humanitarian aid, including food rations, blankets, kitchen sets and solar panels, also are being distributed.
“We are using land, sea and air routes to bring humanitarian relief into Afghanistan and other countries in the region so we can respond to increasing needs,” Mantoo said. “Further relief supplies have also been prepositioned in Termez, Uzbekistan, ready to be trucked into Afghanistan as needed.”
The UNHCR is appealing for greater international support. It says more resources are urgently needed as it scales up its humanitarian response to reach all who will need help to survive the harsh winter ahead.
So far, the agency’s $388 million appeal remains 42% underfunded.
Taliban Say Islamic State Gunmen Stormed Kabul Military Hospital
Ayaz Gul
VOA News
November 2, 2021
ISLAMABAD — Afghanistan’s Taliban say militants linked to a regional affiliate of Islamic State, known as Islamic State-Khorasan Province, carried out Tuesday’s assault on the country’s main military hospital in Kabul.
Taliban spokesman Zabihullah Mujahid said the raid on the capital’s Sardar Mohammad Dawood Khan hospital in Wazir Akbar Khan area had killed at least seven people and wounded five others. Among the dead were a child, three women and three Taliban security guards, he added.
Witnesses and security guards reported the attack began with a powerful explosion at the entrance to the 400-bed hospital before a second bomb exploded inside the sprawling facility.
Mujahid said five assailants then tried to storm the main building apparently to target doctors and patients but Taliban special forces swiftly engaged them and thwarted the attempt.
The ensuing gunfight lasted “15-minutes and killed all Daesh militants,” Mujahid said, using a local name for IS-Khorasan. “No one was hurt inside the hospital.”
The terrorist group did not immediately respond to accusations that it was behind the attack.
IS-Khorasan has intensified attacks in Afghanistan since the Taliban took control of the country in mid-August. The violence has mainly targeted Taliban fighters and members of the minority Shi’ite community, killing and injuring hundreds of people.
Islamic State militants stormed the military hospital in 2017 and killed more than two dozen people. The Taliban also had targeted the facility while waging a deadly insurgency against the Western-backed Afghan government and U.S.-led foreign troops.
The Taliban is trying to win over Afghanistan’s Shiites with a 33-year-old Hazara emissary. But many question the group’s sincerity
Maulavi Mahdi
The Washington Post: As a military commander, Maulavi Mahdi never captured territory or killed Americans in battle. Yet the Taliban considers the 33-year-old ethnic Hazara a godsend. Click here to read more (external link).
The US did more to radicalise Afghanistan than Osama bin Laden
Osama bin Laden
Al Jazeera: Today, the conditions in Afghanistan check every box on the radicalisation checklist: Afghans have suffered trauma and violence. They feel betrayed by an external force that allegedly came to “help” them, but ended up leaving them worse off. They live in economic deprivation with one million children at risk of starvation. They also have very limited educational opportunities – millions of Afghan children are unable to go to school and have little hope for the future. Click here to read more (external link).
Tolo News in Dari – November 2, 2021
Pentagon removes more than 130,000 Afghanistan War photos and videos
Kirby
Ariana: Pentagon Press Secretary John Kirby said on Monday that he made the decision to temporarily archive any images and videos that could put Afghans in danger. Click here to read more (external link).