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    • Chrisa RybickiMay 2011SociologyProfessor Mead Afghanistan and Their Need for Healthcare
    • Rybicki page 3 The country of Afghanistan has gone through many changes over time. Therehave been multiple invasions by many countries dating back to Alexander the Great.Afghanistan continues to have foreign countries occupying their land presently teachingthe Afghan people nothing but violence and suffering. Because of the high volume oftravelers in their country, Afghanistan has many different dialects of language mainlyderiving from Pashtu and Dari. In order for Afghanistan to become a full functioningdemocratic nation, the Afghanistan government must continue to seek aid from NATOfor economic relief, political structure, a fair and just legal system, better educationalfacilities and teachers, and especially an actual healthcare system with up to datehospitals that can be found in more locations. Afghanistan has a long, violent history of different groups trying to take over theirland to control the central trading routes or crossroads. The earliest groups of peoplewere Alexander the Great accompanied by the Persian Empire around 328 B.C. After thatit was the Scythians, White Huns, and Turks that all tried to invade the country. “In A.D.642, Arabs invaded the entire region and introduced Islam” (Afghanistan Overview).This is the most significant change to the Afghan culture because it not only changed thelanguage throughout the land, people started to adopt the Islam faith as well. “In 1747, Ahmad Shah Durrani, the founder of what is known today asAfghanistan, established his rule” (Afghanistan overview). Durrani came into power bygetting elected by a tribal council and was considered to really started to expand histerritories. He wanted to make Afghanistan a solid nation and did so by combining the
    • Rybicki page 4counties sub-provinces into greater, more concrete areas. This is a big deal for the peopleof Afghanistan because they are finally trying to get a nation of their own without beingoccupied by some other nation or group. Unfortunately, this time of self preservationliving in a nation they can call their own does not last for long. The first European influence in Afghanistan was in the nineteenth century when theU.K. became concerned with Russia’s movement along Central Asia which resulted intwo Anglo-Afghan wars in 1839 and 1878. A man by the name of Amir Abdur Rahmanwas considered to be responsible ending the British and Russian conflict and finallyestablishing actual boundaries between the two countries. Unfortunately, Rahman wasassassinated in 1919 and then his third son regained control of the country after attackingIndia, this was considered to be the third Anglo-Afghan war. It comes as no surprisetoday that the Afghan culture is perceived to be very violent because they have beenfighting for their country for centuries. Most people from younger generations remember the Soviet Invasion the mostbecause it is still fairly recent and it is the first time the US came to the Afghan people’said. The Soviet Union saw an opportunity after Afghanistan just finished fighting anawful civil war in 1978. The Soviet Union knew the Afghan army was diminished sothey lied to Afghan officials and pretended to come to their aid and by 1979 tensionsgrew thick between Afghans and the Soviet Union. Most of the Afghan people did notagree nor accept the communist regime and they started to rebel, but it was too late. Bythis time the Soviet Union had over 100,000 troops on ground and a very impressive air
    • Rybicki page 5support. Like most countries that are being controlled by an unwanted entity, freedomfighters or patriots are going to defend his or her land at all costs. In Afghanistan,freedom fighters are known as “mujahideen”. The mujahideen were not foolish andknew that they were out-numbered and had a much smaller and inferior army, so theyneeded aid. “Poorly armed at first, in 1984 the mujahideen began receiving substantialassistance in the form of weapons and training from the U.S. and other outside powers”(Afghanistan overview). The greed of Russia caused many people to die before their time. The Soviet’ssigned the Geneva accords promising to be completely withdrawn from Afghanistan nolater than February 15, 1989. However, the damage was already done. “About 14,500Soviet and an estimated 1 million Afghan lives were lost between 1979 and the Sovietwithdrawal in 1989” (Afghanistan overview). How can a country ever become a part of anormal functioning society if all they are always getting invaded by foreign countries?The Afghan society knows nothing but war and violence and they continue to teachviolence to future generations because war has become a way of life for them. After the Soviet Union was completely withdrawn from Afghanistan, theUS soon followed and stopped giving military aid to the Afghan Army. “Internalfactions, who had aligned with each other against the Soviets, quickly splintered andfought for control of the country” (Brennan et al 217). Also, due to the lack of educationin Afghanistan, it was easy to manipulate the minds of the youth by Islamic Radicals
    • Rybicki page 6make believing that the US did more harm than good. “Many Afghans whom the UnitedStates had trained, supported, and armed during the proxy war against the Soviets joinedthe extreme Taliban” (Brennan et al 217). This is what made the “Taliban” strongerduring the mid- 1990’s because they had plenty of young Afghans to recruit after beinglied to by radicals. What would you do if a country of greater power was helping you,giving you faith and hope about your country, suddenly packed up and left? The Talibanhad most of the country under control by 1996. After the horrific events that took place on September 11, 2001, the U.S. and itsallies decided to start an antiterrorist campaign against the Taliban in Afghanistan andaround the world. “Because of its extreme political views, plus need for financial support,the Taliban sheltered and supported the al-Queda, an international terrorist group led bythe now-infamous Osama bin Laden” (Brennan et al 218). What people need tounderstand about the citizens of Afghanistan is that not all Afghans are supporters ormembers of the Taliban and a lot of the people want a better way of life. “Afghanfactions opposed to the Taliban met at a United Nations-sponsored conference in Bonn,Germany in December 2001 and agreed to restore stability and governance toAfghanistan”(Afghanistan Overview). This is a historic event because it marks thebeginning of an ongoing ten year war with the U.S. and allies against the Taliban knownas the War on Terror.
    • Rybicki page 8 Afghanistan is located in Southern Asia. It is about 652,000 square kilometerswhich is slightly smaller than the state of Texas. According to the CIA World Fact Book,Afghanistan has a population of 29,835,392, with the average median age of men andwomen of 45. The fertility rate is 5.39 children per woman. Also, it is very difficult to geta precise count of the population because of the many visitors that are always occupyingtheir territories. Afghanistan land is mostly rugged mountainous terrain with few plains in theNorth and Southwest. Only about twelve percent of the land is suitable for growing cropsand only half of that land is cultivated. Some of the valuable land cannot be cultivateddue to land mines that are still active. According to the studies conducted by WorldBank, N. Anderson, C. Palha da Sousa, and S. Paredes, “Afghanistan has more landmines and unexploded ordinance than any other country in the world” ( qtd. in Brennan etal 217). This affects not only where farmers can plant their crops, but their lives as well.Also, Afghans have a difficult time with growing crops due to the extreme climatesincluding dry hot summers, cold winters, droughts, limited or damaged irrigationsystems, and very little use of fertilizer and pesticides. “Overall agricultural productiondramatically declined following severe drought as well as sustained fighting, instability inrural areas, and deteriorated infrastructure” (Afghanistan Overview). “Most of the population (85%) is highly dependent on farming or herding”(Brennan et al 216). The main source of formal agriculture is cereal crops, wheat, fruitsand nuts; and informal agriculture is opium, which is then refined into heroin. “The
    • Rybicki page 9noticeable characteristic of Afghanistan’s economic structure is the dominance of theinformal sector, not only in agriculture and in the illegal drug industry, but also in mostother sectors” (Riphenberg 508). Due to Afghanistan’s location connecting Central Asiawith Southern and Southeastern Asia, it has led to centuries of trading and migrationpaths throughout the country known as “crossroads”. Because of their location, it is easyto smuggle opium and other illegal goods both in and out of the country. As per reportsdone by the United Nations development program and J. Goodhand, it is stated that,“Partly as a result of the dire economic state, some Afghans have turned to trade innarcotics and precious stones, such as lapis, and the smuggling of weapons” (qtd. inBrennan et al 217). In fact, “Afghanistan is thought to account for the production of 87%of heroin and opium consumed worldwide” (Riphenberg 508). Research obtained by the Central Intelligence Agency and United NationsDevelopment Program indicate that, Afghanistan’s “per capita yearly income is estimatedto be between US$200 and $800, making Afghanistan one of the poorest and leastdeveloped countries in the world” (qtd in Brennan 216). The country does have manyuntouched natural resources, including natural gas, coal, copper, lead, zinc, iron ore, salt,and precious stones. “Unfortunately, ongoing instability in certain areas of the country,remote rugged terrain, and inadequate infrastructure and transportation network havemade mining these resources difficult, and there have been few serious attempts to furtherexplore or exploit them” (Afghanistan Overview). In the 1980s, natural gas sales were$300 million a year for export. However, they were capped from fear that the mujahideenwould damage them after the Soviet troops withdrew in 1989. “Restoration of gas
    • Rybicki page 10production has been hampered by internal strife and the disruption of traditional tradingrelationships following the collapse of the Soviet Union” (Afghanistan Overview). Access to technology is very limited in Afghanistan because for a long period oftime it was controlled by the Taliban and also because it is still a very poor nation, one ofthe poorest and underdeveloped countries in the world. Everything from the internet,television, radio stations, and even newspapers are controlled by corrupt politicians andrebels that still remain. “Many Middle Eastern states fear two consequences of theinternet in particular: diffusion of Western political thought and the spread ofpornography” (Riphenberg 512). Most of the population lives in the rural areas that haveno electricity which prevents Afghans from communicating with the outside world. ForAfghans who live near or in the larger cities such as Kabul, have limited or no access totelephone, television, internet, or radios. “Afghanistan faces severe challenges after itsyears of upheaval, from devastated roads to electricity supply that reaches less than 6% ofthe population and then for only a few hours every other day” (Riphenberg 518). Notonly does most of the population having no electricity, they also have no access to cleanrunning water. The water wells that were existing were damaged or have been dried up.“As a result of the present drought, the worst in years, many regular aquifers that supplyground wells have dried up, forcing the use of irrigation canals as the only source ofwater” (Brennan et al 216).
    • Rybicki page 11 With all the turmoil that has been ongoing in this country throughout many years,Afghanistan needs serious rebuilding in every aspect from criminal justice, social class,infrastructure, and healthcare. Their poor economic structure and political order has to beimproved in order for the country to be self sufficient. Education and healthcare needs tobe available to Afghans in the small rural villages. Because of all the internal conflict,there were many healthcare professionals that were either killed or forced to leave thecountry. As indicated by author Gebreel AO in the article titled, “Afghanistan: a nationbeset by war”, “The Taliban attempted to purge all civil servants, including physicians,who had any link with the former government or who did not support their “Holy War”,thus further depleting the already decimated medical and professional classes” (qtd. inBrennan et al). One of the many health issues that Afghanistan’s internal conflict has affected isthat there are too many unnecessary maternal and infant mortality deaths. “The infant andunder 5 mortality rates are 165 and 257 per live 1000 live births" (Ahmad 1301). For thematernal mortality rate according author Abir Ahmad in the article “Health and Money inAfghanistan” it is said that The maternal mortality in Afghanistan (1600 per 100 000 live births) is one of the highest in the world; every 20-30 minutes a women dies because of pregnancy related complications. Badakshan, in the northeast of the country, has the worst rate ever reported: 6500 maternal deaths per 100 000 births.
    • Rybicki page 12 Badakshan has “more maternal health facilities than many of the less peacefulprovinces such as Helmand. For its population of 351,000, Badakshan has 106 midwives,10 female obstetric experts and 73 health centers” (Bainbridge 447). Many of the ruralvillages have limited or no essential obstetric care services to be sure the mother andbaby are doing well. “Health facilities had been damaged or destroyed during the yearsof fighting and, in many rural areas, neither facilities nor trained health workers wereavailable” (Ameli and Newbrander 920). Not only were the health facilities damaged or destroyed, but so were the fewpaved roads that the country has, making it even more difficult for pregnant women to getmedical treatment. “The country only has about 2000 miles (3218 km) of paved roads”(Riphenburg 519). For most of the rural area, the only ways of travel is by donkey orhorse. With the limited number of clinics, lack of transportation and impassable roadsmakes it almost impossible to get the necessary medical treatment that is needed formother and baby in a reasonable amount of time. “Only 8% of women receive prenatalcare, and only 8% of births are attended by trained personnel” (Brennan et al 218).Afghanistan is divided into 330 districts, “only 35 % of the 330 districts have maternaland child health clinics” (Brennan et al 218). Another issue with the health care system in Afghanistan is children not havingthe needed immunizations for preventable deadly viruses. Even if infants survivedelivery, there still have been thousands of preventable deaths of children under the ageof five years old due to lack immunizations. “After the fall of the Taliban government in
    • Rybicki page 13December 2001, there were concerns about a widespread measles outbreak against a backdrop of low routine measles coverage, poor access to health care and crowding amongdisplaced persons” (Salama et al 257). Measles is a very contagious virus that can lead todeath, especially with undernourished and unimmunized children. Since measles is a verycontagious, it can spread rapidly through these small overcrowded rural villagesdevastating many lives. Author Peter Salama et al, indicates according to statisticsobtained by the CDC and WHO: From 1998-2001, only 40-47 per cent of infants aged less than one year in Afghanistan reportedly received one dose of the measles vaccine (CDC, 2003); coverage was low because of the collapse of the public health infrastructure, insufficient material and human resources and logistical difficulties connected with the terrain. During this time, measles accounted for an estimated 35,000 deaths per annum in Afghanistan, nearly all preventable by immunization (WHO, 2001). A 2001 survey in Kohistan District revealed that 15.7 per cent of all deaths in children less than five years in the preceding six months were due to measles (Assefa et al., 2001) These deaths, as well as deaths caused by acute respiratory infections, diarrhealdiseases, malaria, and malnutrition could have been prevented if more or improvedhealthcare facilities were made available to these poverty stricken villages. According tostudies by the World Health Organization in 2000, the healthcare system in Afghanistan
    • Rybicki page 14“ranked 173 out of 191 nations” (qtd in Brennan et al 218). Afghanistan had 823 medicalfacilities, hospitals, or clinics for their large population, some that were not evenfunctioning because of all the damage that was done during all the conflicts. “In 1996, 8of the 14 hospitals in Kabul were not functioning because of damaged infrastructure andlack of critical supplies and staff” (Brennan et al 218). Unfortunately, damage to thefacilities and lack of staff is still a major concern for their poor healthcares system.
    • Rybicki page 16 In order for any improvements to be made to the health care system inAfghanistan, its economy and political order needs to be stabilized. There have beenefforts to help women, infants, and children that are in the most need of medicaltreatments. As stated by Omid Ameli and William Newbrander: To improve the health care rapidly, the Ministry of Public Health (MOPH) of Afghanistan developed the Basic Package of Health Services (BPHS) to deal with those areas in which the country faced its most pressing health related problems: maternal and neonatal health, child health immunization, nutrition, communicable diseases, mental health, disabilities and the regular supply of regular medicines. This campaign was implemented after the fall of the Taliban in 2001 to see whatit would cost per person to get the much needed healthcare for an individual. Manyagencies volunteered to be donors to this cause including United States Agency forInternational Development, the European Commission, and the World Bank. ResearcherKahbir Ahmad, indicates Afghanistan received $67 per person from foreign aid in theyears 2002 and 2003, which is considerably less than other countries that were in need offoreign aid. Another organization in 2001, The Ministry of Health (MoH) of the TransitionalIslamic State of Afghanistan, implemented a campaign to help children by giving thevaccination for prevention of the measles virus. Volunteers had traveled throughout
    • Rybicki page 17Afghanistan and vaccinated an estimated 11.5 million children ages 6 months to 12 years.This organization also did a follow up campaign as well in the year 2003. Foreign Aid from “hundreds of other groups have been providing emergencyassistance and development program in health, food relief and education” (Brennan et al220). According to World Health Organization, 70% of Afghanistan’s health care isreceived from an outside agency. It is unfortunate that as “a consequence of the fall of theTaliban there is less security” (Brennan et al 221). These humanitarians put their ownlives at risk daily to help and “armed gunmen have hijacked cars, trucks, andambulances” (Brennan et al 221).
    • Rybicki page 19 In conclusion, even with all the efforts from foreign aid that is provided toAfghanistan, this country still needs assistance to help rebuild the health care system.When their economy and political conflicts can be stabilized, the start of rebuilding ofdamaged healthcare facilities and building of new facilities can be implemented. Beforethis can be done, the whole country needs to start out with the basic essentials to improvetheir quality of life. They need to have electricity and sanitary running water needs to bemaintained throughout the country in order to begin this long process. Also, everyoneshould have access to a good educational system for both men and women. I feel if thiscan be provided, Afghans should be able to function as a whole and boost not only theirself esteem, but economy as well. There are many things that I would suggest to help to implement a functioninghealth care system. The first thing that would have to be done is to have all the existingfacilities repaired and staffed, especially with more women since that is a big concern forAfghan women. Secondly, have all the roads that were damaged repaired so the Afghanswould be able to travel to the facilities. Thirdly, there would have to be both more roadsand facilities built to reach all the Afghans in the rural areas. Finally, it is impeccable toeducate Afghans on basic sanitation to prevent future disease and illness. This country has been in turmoil for centuries and even though the need for healthcare improvements is very important for the survival of the people, there are many muchneeded steps that need to be taken beforehand. As far as where to start can be debated,
    • Rybicki page 20but something needs to be done. Unfortunately, it is going to be a long process and manymore years before Afghanistan will ever be considered a full functioning nation. Theproper health care facilities are desperately needed for the survival of Afghans. Theongoing internal conflict between all the people that call Afghanistan their home has beenthe biggest obstacle going on for centuries and still continues to this day.