A full-scale attack on war- and drought-ravaged Afghanistan will result in “devastation of biblical proportions,” says a Canadian Médecins sans Frontières /Doctors without Borders worker who recently fled Afghanistan.
“They're going to have to move [to another country] or they're going to die,” Dave Michalski, a MSF logistician told CMAJ. “They're tough and resilient but worn down. It will be a difficult winter.”
The fear of war comes after the Sept. 11 terrorist attacks in the United States. The US government has linked these attacks to Osama bin Laden, an exiled Saudi Arabian living in Afghanistan.
All international aid organizations in Afghanistan, which is about the size of Texas, have already shut down or are operating with a skeleton staff of Afghani residents. Foreign-born workers were evacuated in fear of local reprisals should the US attack. Michalski, 32, spoke to CMAJ from Turkmenistan, where he arrived just 2 days after the terrorist attacks in the US.
MSF had 70 expatriates and over 400 local staff running or helping out at 32 clinics and 6 hospitals, as well as mobile clinics, vitamin outreach programs and more. The programs will continue to be run by local staff.
But food aid programs, which 3 million of Afghanistan's 25 million citizens were depending on, have stopped.
The UN now estimates that a fifth of the population — 5 million Afghanis — face famine this winter. MSF was already coping with epidemics of scurvy in 5 provinces, and widespread malnutrition.
“They are barely surviving,” said Michalski, a Toronto resident who began working in Afghanistan in March. The country has been at war for 22 years, initially with the former Soviet Union and now in a civil war. There has also been a drought for the past 3 years, and since 85% of Afghanis depend on agriculture for their livelihood, the results have been devastating. It is estimated that there are now about 750 000 internally displaced Afghanis. The life expectancy for men is 45 years, for women, 47.
Michalski, who worked at a refugee camp for 150 000 displaced people near Mazar-e-Sharif (population 131 000) in Northeast Afghanistan, says there was a surge of cholera cases this year with up to 100 new cases daily, though “not too many deaths.”
If the US and its allies attack, Michalski says there will be massive movements internally and across the border. “There will be a huge, huge problem in a short time,” he said.
The majority of refugees will likely try to get into Pakistan or Iran, the most geographically accessible countries. MSF estimates there are already 1.5 million Afghani refugees in Iran and some 2 million in Pakistan.
Aid officials in Pakistan were preparing for the deluge of refugees, moving tents, food supplies and staff to border areas. The US recently gave $2 million to the United Nations High Commissioner for Refugees to help Pakistan cope.
“I'm very fearful for the ordinary Afghani,” said Michalski. “The newspapers make it look like Afghanistan has declared war. Nothing could be further from the truth. The average person is just trying to provide for their family.”
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Barbara Sibbald
CMAJ
Figure. Already underserviced refugee camps, such as this one near Peshawar, Pakistan, are faced with a new influx of fleeing Afghanis. Photo by: Canapress